Serious trauma cases to be directed away from Navan

Vorsprung

The Irish Times, 10/1/10 wrote:

Concern over end of trauma services at Navan hospital

THE IRISH Nurses and Midwives Organisation (INMO) has expressed its “serious concerns” about the end of major trauma services at Navan hospital from this weekend.

Its members will not co-operate with the move until its concerns are met, it says.

The HSE yesterday announced that from Friday at midnight, complex trauma patients in the Meath area requiring surgical intervention would be taken by ambulance directly to Our Lady of Lourdes Hospital, Drogheda, Co Louth, or the nearest appropriate hospital, not first to Navan, Co Meath.

There will continue to be a 24-hour AE department at Our Lady’s Hospital, Navan, and ambulances will continue to bring less complex and non-surgical cases there.

Until now major traumas in the area were being brought first to Our Lady’s Hospital, Navan, to be stabilised before being moved on, usually to Our Lady of Lourdes or to Connolly Hospital in Blanchardstown, Dublin. No complex surgery has been performed at Navan since 2006.

The direction to take patients directly to these hospitals “is in the interest of patient safety and to ensure the best possible outcome for patients,” the HSE statement noted.

The move has been in the pipeline since 2007 when a draft report concluded that the Navan hospital did not have sufficient infrastructure to care safely for major emergencies.

In September last year, staff at Our Lady’s hospital and at Louth County Hospital in Drogheda were briefed about plans to eventually centralise acute medical care and critical care services at Drogheda. The INMO says there are not enough beds at Drogheda.

“This often results in admitted patients spending excessive time in the emergency department on trolleys, sometimes up to three or four days.”

The organisation said there were 24 patients on trolleys in Drogheda yesterday and five in Navan hospital. “Our members will not co-operate with the transfer to the new emergency department until the significant problems that have afflicted the current department are addressed.”

Local Fine Gael TDs Damien English and Shane McEntee criticised the move as a “terrible blow to Meath and all its residents. “The HSE has clearly deliberately downgraded Navan Hospital to pave the way for this decision,” they said.

Link

So the way I understand it, instead of 1st going to Navan for stabilistation, trauma patients are going straight to the nearest big centre, be it Drogheda or Blanchardstown.

The INO's issues are (according to their site)

According to Tony Fitzpatrick, INMO Industrial Relations Officer: “The HSE’s announcement earlier today will exacerbate the overcrowding problem in Our Lady of Lourdes Hospital. The HSE’s lack of consultation with staff, who will be adversely affected by this decision, is deplorable. Also, the implementation of this plan ahead of the opening of the new emergency department is idiotic and demonstrates a reckless disregard for the well being and comfort of patients and the workload of staff. The HSE’s contention that the new emergency department will be opened by March 3rd is also completely unrealistic.”

Maybe I'm slow tonight, but is this actually going to cause an increase in the number of trauma patients going to Drogheda? Surely they're just getting the same number, except now they're just going straight there when they're going to be a bit sicker, so it's not in itself going to cause more overcrowding. And I would've thought that going straight to the big centre would have been best thing.

Opinions?

Carsinian Thau

Vorsprung wrote: »

Opinions?

Would it not be better to stabilise the patient and then transfer them? In which case I would be in favour of keeping Navan as a site.

MrCreosote

I suspect (could be wrong) that most of the transfers out of Navan would have formerly gone towards Dublin, like head traumas and that sort of thing. Now it'll be pick up and head to the nearest A&E. So to take a random example- someone in north meath whacks their head, before might have gone Accident-Navan-Beaumont, now would go Accident-Drogheda-Beaumont? Not sure it would massively increase the numbers in Drogheda though.

Personally I think it's a good thing to be centralising services for major trauma, cancer treatment etc. There are a good few local hospitals around the country that don't need to be trauma centres. As long as the "centres of excellence (tm)" are ready to take the increased load, and TDs can put their poxy local interests to one side and think of the country as a whole for a change it should work. For trauma as well getting the ambulance crews upskilled for roadside stabilisation might be no bad thing...

Carsinian Thau

Vorsprung wrote: »

The INO's issues are (according to their site)

Maybe I'm slow tonight, but is this actually going to cause an increase in the number of trauma patients going to Drogheda? Surely they're just getting the same number, except now they're just going straight there when they're going to be a bit sicker, so it's not in itself going to cause more overcrowding. And I would've thought that going straight to the big centre would have been best thing.

Could be wrong on this but: if a patient arrives unstabilised, they'd surely necessitate more attention to get them stabilised than a patient who had arrived stable. The extra demand on staff involved in the stabilisation would remove staff from dealing with the background patients and hence, would mean it would take longer to process them through and therefore contribute to the overcrowding problem?

So while the number wouldn't be the same, the dynamic could shift enough to impact on patient waiting times.

Personally, I'd rather bring Navan up to standard so that it could deal with these problems better. But, I willingly admit that my attitude to hospitals is very unrealistic when it comes to stuff like money.

charlieroot

Carsinian Thau wrote: »

Would it not be better to stabilise the patient and then transfer them? In which case I would be in favour of keeping Navan as a site.

I was at a talk recently in relation to paediatric emergency medicine. The research showed that for major trauma results were better if the patient was brought asap to a major trauma central with the necessary staff/equipment to deal with the issues rather than first stabilising the patient (beyond basic ABC done by paramedics on route). Anyone know of similar results in adult / general medicine? Sorry can't put my hand on the study at the minute. But it was done in Oz, around Melbourne/Victoria I think?

Carsinian Thau

charlieroot wrote: »

I was at a talk recently in relation to paediatric emergency medicine. The research showed that for major trauma results were better if the patient was brought asap to a major trauma central with the necessary staff/equipment to deal with the issues rather than first stabilising the patient (beyond basic ABC done by paramedics on route). Anyone know of similar results in adult / general medicine? Sorry can't put my hand on the study at the minute. But it was done in Oz, around Melbourne/Victoria I think?

I'd like to take a look at this if you manage to find it.

Can you remember if it mentioned anything about the time before treatment vs. outcome?

Vorsprung

charlieroot wrote: »

I was at a talk recently in relation to paediatric emergency medicine. The research showed that for major trauma results were better if the patient was brought asap to a major trauma central with the necessary staff/equipment to deal with the issues rather than first stabilising the patient (beyond basic ABC done by paramedics on route).

This was my understanding as well. I don't have a link to a paper.

This isn't the first time this has been done in Ireland - I know that in the last 10 years or so (probably less), a decision was made to have traumas on the N11 in Wicklow bypass Loughlinstown in favour of going straight to Vincent's.

I'm sure DrZ or Traumadoc will have more to add.

Vorsprung

MrCreosote wrote: »

For trauma as well getting the ambulance crews upskilled for roadside stabilisation might be no bad thing...

I think this is going to be key in the future as Emergency Departments are closed and services centralised in the future.

charlieroot

Carsinian Thau wrote: »

I'd like to take a look at this if you manage to find it.

Can you remember if it mentioned anything about the time before treatment vs. outcome?

Sorry spent about 20mins there rooting around google scholar without any luck.
Pretty sure it mentioned that by reducing the time before (definitive) treatment resulted in better outcomes. This interestingly included reducing time spent say at the roadside by paramedics as well as leap frogging the secondary care or "rural" hospitals.

I have an exam tomorrow so I'll see if I can find it next week.

DubMedic

I doubt the docs and nurses will take this lightly..

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Olduvai

Does it not make sense that if we are really talking about developing services that a designated air ambulance service needs to figured into that equation so at least we are capable of quickly responding to incidents and cutting down in the time it takes to transfer casualties be it to Navan or Beaumont.

DubMedic

Olduvai wrote: »

Does it not make sense that if we are really talking about developing services that a designated air ambulance service needs to figured into that equation so at least we are capable of quickly responding to incidents and cutting down in the time it takes to transfer casualties be it to Navan or Beaumont.

What's needed essentially first of all, is for Paramedics and Advanced Paramedics to be given the additional skills needed to stabilize patients in a pre-hospital setting.

We need to build on the basics first.. then get about the technical parts.

Walk before you run as they say.

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Dr Galen

i'd give Navan to the end of the year, then I think it'll go the way of the Louth County or Monaghan.

I do worry though about the potential issues with shifting everything to Drogheda though. I'm pretty sure its running to full capacity at present, andhow much more it can take i dunno.

locum-motion

Mystik Monkey wrote: »

...I do worry though about the potential issues with shifting everything to Drogheda though. I'm pretty sure its running to full capacity at present, andhow much more it can take i dunno.

Not to mention their apparent infection control issues...

DrIndy

Pre-Hospital Trauma Life Support guidelines state that paramedics should bypass a small centre and head for a tertiary centre because a smaller centre may need to transport on anyway to a larger centre which delays the beginning of definitive or operative treatment.

But - once again - its a case of half assed implementation of this guideline. Selecting this information out, then closing navan is good.

However, paramedics are limited in the drugs and treatment they can give. Only AMTs can go the extra step and canulate and give IV fluids to help stabilise the patient.

There is no HELO service for the critically ill which allows the magical golden hour to be achieved.

Without all being implemented closing navan is just that. Its stupid.

DubMedic

DrIndy wrote: »

Pre-Hospital Trauma Life Support guidelines state that paramedics should bypass a small centre and head for a tertiary centre because a smaller centre may need to transport on anyway to a larger centre which delays the beginning of definitive or operative treatment.

But - once again - its a case of half assed implementation of this guideline. Selecting this information out, then closing navan is good.

However, paramedics are limited in the drugs and treatment they can give. Only AMTs can go the extra step and canulate and give IV fluids to help stabilise the patient.

There is no HELO service for the critically ill which allows the magical golden hour to be achieved.

Without all being implemented closing navan is just that. Its stupid.

I'll bite my tongue on this one.. I'd love to give it a good lashing and say how ridiculous it is but for what it's worth, no-one in the governing organizations seems to care.

.

Traumadoc

charlieroot wrote: »

I was at a talk recently in relation to paediatric emergency medicine. The research showed that for major trauma results were better if the patient was brought asap to a major trauma central with the necessary staff/equipment to deal with the issues rather than first stabilising the patient (beyond basic ABC done by paramedics on route). Anyone know of similar results in adult / general medicine? Sorry can't put my hand on the study at the minute. But it was done in Oz, around Melbourne/Victoria I think?

Is far as I recall trauma cases do better at level one trauma centers, so I suppose all my cases should go to Cork.

"Bigger" as far as I can see means more overcrowded.

RobFowl

Speaking from personal experience I was in Navan after a serious accident and as I have to say it was a terrible experience.
No senior supervision that I could see (3 days there) and Doctors who couldn't read X rays (waited 6 hours on a spinal boards for a surgical reg to come down to look at my C Spine ones.
It really had no place as a major trauma cente.
The problem is of course Drogheda does not have the physical capacity to take on the work load.
The whole North East "reconfiguration" is a textbook lesson in how not to change service provision.
Well done Drumm.......