Greater trauma resources at Cork University Hospital (CUH) could save more lives and prevent long-term disability as a result of trauma incidents, an expert has claimed.
The ‘Major Trauma Audit’ (MTA), published by the National Office of Clinical Audit (NOCA), revealed that just 11% of trauma patients in Ireland are met by a trauma team when entering hospital.
Consultant in emergency medicine at CUH and clinical lead on the audit, Dr Conor Deasy, said this is a concern and that it needs to change.
“At the moment, in Ireland, only a small number of traumas are received by a trauma care team,” Dr Deasy said.
“The reason for this is because we do not have a trauma system. No hospital in the country is actually designated as a major trauma centre and resourced to be so.
“There is a resourcing requirement for hospitals in trauma care, but the right care early is cost-saving,” he added.
While CUH is seen as a future trauma centre for the south of Ireland, Dr Deasy said that further investment and resourcing are required.
“The National Trauma System report describes how trauma care will be reconfigured into two trauma networks, each with a major trauma centre at its hub.
“CUH, subject to certain designation criteria, is the proposed major trauma centre for the South Trauma Network; a hospital in Dublin is yet to be designated as the major trauma centre for the central trauma network,” he said.
“These designation criteria include having a trauma team to receive the patient, the availability of a hybrid suite in, or next to, the resuscitation room, where CT and interventional radiology can be performed, increasing ICU and trauma ward capacity, and further developing the multidisciplinary trauma and rehabilitation services.
“Just as CUH has a breast service or a colorectal service, we will need a trauma service that will coordinate the care of a trauma patient, while they undergo operations by different individual specialist surgeons,” said Dr Deasy.
“At the moment, if a patient crashes their car and has multiple injuries — say a broken leg, a head injury and a chest injury, they will be admitted under a specialist surgeon — this results, at times, in patients with brain injuries being treated on orthopaedic wards by orthopaedic surgeons, for example.
“A better system is that these patients are admitted under a ‘Trauma Specialist Service’ staffed by doctors, nurses and allied health professionals, who have been provided extra education and training in trauma management and they coordinate the patients care with the specialist surgeons.
“At a major trauma centre, there is a trauma team that receives the patient when they come into the ED and then there is a trauma service which looks after them, coordinates their treatment, operations and rehabilitation while in the hospital.
“The combination of both greatly improves efficiency and outcomes for patients.
“When they reconfigured trauma care in London, they reduced the mortality rate from trauma by 50%.”
Dr Deasy explained the benefits of locating the hybrid, which offers CT scanning and interventional radiology, next to the resuscitation room.
“If a patient comes in having sustained major trauma and they’re bleeding from their spleen or liver, they can be brought into this suite, which is next to or part of a resuscitation room,” he said.
“The interventional radiologist will stop the bleeding.
“Previously, this required a surgeon to perform an operation, open the abdomen, and stop the bleeding,” he added.
“Nowadays, a specialist interventional radiologist can plug the bleeding artery without need for a big operation.
“If we become a designated major trauma centre, we’re going to be accepting more patients from our surrounding counties, who will benefit from the services at CUH.
“We need to be geared-up to deal with this demand.
“Nationally, if we compare our data to the London example, we can say that if we configure major trauma care in Ireland into two trauma networks, as is proposed, there will be one extra life saved per fortnight and two patients per week saved from lifelong disability.
“I think we need to crack on and implement this, as it will be cost-saving in the long run.
“It will ensure that people are back on their feet earlier, back living independently earlier, and back to work earlier.”