Centralisation of services will not increase risk, says surgeon
A report commissioned by the HSE proposes that all major accident and medical cases be sent immediately to Limerick rather than Ennis and Nenagh general hospitals. However, the plan also envisages limited A&E services would remain at Ennis and Nenagh.
The HSE has already commenced implementation of the report’s proposals. Dr Paul Burke said new arrangements would improve on-the-scene medical treatment to very sick or injured patients who do not live within the “golden hour” of Limerick’s Mid-Western Regional Hospital.
New highly-equipped mobile paramedical units based in Nenagh and Ennis will ensure people in remote areas get all important initial treatment much quicker than before, he said.
Dr Burke said: “The bottom line is that anybody living in a remote area in any part of the country is, by definition, more in danger if something happens.”
Under present arrangements, he said by the time these patients are brought to Ennis or Nenagh hospitals, the delivery of the care they need may not be available and they then have to be moved to Limerick.
He said: “Firstly we are going to ensure that the advanced paramedics get to that person, say in Loop Head, much quicker.
“Secondly, we will stratify the patient immediately and decide where the best place to bring the patient. By and large it will always be the mid-western regional hospitals.”
Over the next two years while a critical care block is being built at the Mid-Western, heart attack patients will still be brought to Ennis and Nenagh, where additional facilities will be provided
Dr Burke said: “The critical thing about the ‘golden hour’ is that at the end point there is delivery of service.”
He said there is a lot of data that states that stopping at an intermediary hospital along the way can actually be harmful..
“The other most important period is at the scene of the accident. Clearly now what we have put in place are six advanced paramedics in Nenagh and Ennis who will go to the scene of an accident, usually getting there before an ambulance and institute the resuscitation and stabilisation of the patient. That has a huge impact on the outcome. Once that’s done the patient is then taken as quickly as possible to the Mid-Western Regional Hospital.”
Dr Burke said the new A&E strategy will not lead to morepatients being brought to the Mid-Western.
He said: “The capacity issue is not going to be one in the short term, because all these very sick patients are brought to the Mid-Western Regional anyway. Often they come in a staged way, but ultimately they come into that hospital.”
He said it is hoped to introduce the new centralised A&E system by April. When a new emergency theatre is commissioned at the Mid-Western Regional next summer, he said all acute emergency surgical work will be carried out there.
Dr Burke said there would be no reduction in the numbers being treated at St John’s, but there may be a greater streamlining of medical cases going there.
