Closing Regional Hospital's A&E

donaghs

Forgive my ignorance in this area, but the news of the woman dying in ambulance near Roscommon town has got me thinking about A&E closures again.

Firstly, what is point of having regional hospitals without A&E? Surely, by their nature, emergency facilities should be nearby.

Would it not make sense to relocate or close any other part of the hospital before A&E?

seamus

Non-critical in-patient care accounts for the vast majority of patients in the health system I would think. Critical A&E cases are the very minority of cases admitted to hospitals.

So that means that just because an area doesn't have the population to support acute emergency services, they may still have a population which requires a proper hospital.

donaghs

So... ?

seamus

So....does that not address your question?

You're asking why not close the rest of the hospital before A&E - because the rest of the hospital may be required, whereas A&E may not.

2Scoops

A&E, to an extent, is an admission system that redirects patients to the appropriate centre (excluding minor cases and non-emergencies). In the Roscommon example, there would be little point in having an open A&E if there wasn't also the equipment and personnel to deal with a severe trauma case.

donaghs

OK, I get you know. If the treatment is non-critical though still seems like a target for cutting/relocation

opinion guy

People are looking at this the wrong way.

The problem isn't that there wasn't an A&E in Roscommon, the problem is that there wasn't a helicopter bringing her to a major trauma in a fraction of the time it took to drive there

Vorsprung

And an ED isn't going to save this woman's life, she needed an operation and a surgeon to save her and as I understand it, there are no after hours surgical services in Roscommon.

lonestargirl

opinion guy wrote: »

People are looking at this the wrong way.

The problem isn't that there wasn't an A&E in Roscommon, the problem is that there wasn't a helicopter bringing her to a major trauma in a fraction of the time it took to drive there

Exactly, although we do now have a national air ambulance service run jointly by the HSE and the Air Corps. It's based at the Curragh, and did its first callout in May.

As others have said providing an A+E also means providing all the services needed to cope with emergencies and trauma including 24 surgery services and ICU beds.

donaghs

2Scoops wrote: »

A&E, to an extent, is an admission system that redirects patients to the appropriate centre (excluding minor cases and non-emergencies). In the Roscommon example, there would be little point in having an open A&E if there wasn't also the equipment and personnel to deal with a severe trauma case.

I understand that in the Roscommon example, its former A&E, and Ballinasloe's current one would probablyt have been deemed unsuitable for the treatment required. However, it did get me thinking that people will die in future in that area if they can't treated locally quickly.

I grew up in Dublin, so I'm used to the idea that say if one of the many school accidents that occurred (e.g. broken leg on a football field, someone punching a windows and shredding their fist, etc), people could just be dropped off at an A&E like Beaumont or Vincents. Do all such instance in Roscommon now go to Ballinasloe, then Galway or Sligo? Is there any sort of emergency care left in Roscommon?

MrCreosote

donaghs wrote: »

I understand that in the Roscommon example, its former A&E, and Ballinasloe's current one would probablyt have been deemed unsuitable for the treatment required. However, it did get me thinking that people will die in future in that area if they can't treated locally quickly.

More likely that people will die getting treatment at the local cottage hospital and delaying transfer to the major centre.

Better to allow the paramedics to do proper prehospital care and get serious cases to a major centre as fast as possible.

First Aid Ireland

MrCreosote wrote: »

More likely that people will die getting treatment at the local cottage hospital and delaying transfer to the major centre.

Better to allow the paramedics to do proper prehospital care and get serious cases to a major centre as fast as possible.

A problem, to my mind, is that paramedics in Ireland can't put lines into patients. Is there AP coverage available quickly in Roscommon? If no AP available, there becomes an interesting balance between fluid resucitation etc at local hospital and putting the foot on the floor to get to the regional centre.

Dr Galen

First Aid Ireland wrote: »

A problem, to my mind, is that paramedics in Ireland can't put lines into patients. Is there AP coverage available quickly in Roscommon? If no AP available, there becomes an interesting balance between fluid resucitation etc at local hospital and putting the foot on the floor to get to the regional centre.

I think this cuts to the crux of the natter tbh. Mobile, fast moving trauma teams, that can get somewhere quickly and deliver a high standard of pre-hospital care are what is needed in this country, not rakes of cottage hospitals with pseudo services.

Delancey

lonestargirl wrote: »

Exactly, although we do now have a national air ambulance service run jointly by the HSE and the Air Corps. It's based at the Curragh, and did its first callout in May.

..... and within 3 weeks suffered what the Air Corps called a' Hard Landing ' which was actually a crash landing which resulted in the almost certain write-off of the helicopter at a cost of several million Euro.

Doubtless single-issue politicians like Luke 'Ming' Flanagan will make much of the closure of Roscommon A+E but it simply is not possible to give every county its own A+E.

Every time an effort is made to centralise services the ' NIMBY ' brigade are up in arms and local political concerns seem to win out ( the Cancer care Centres of Excellence strategy being an exception ).

Marcusm

lonestargirl wrote: »

Exactly, although we do now have a national air ambulance service run jointly by the HSE and the Air Corps. It's based at the Curragh, and did its first callout in May.

As others have said providing an A+E also means providing all the services needed to cope with emergencies and trauma including 24 surgery services and ICU beds.

I think the Helis are based in Athlone some of which is in Rscommon but of course as one of them had a "hard landing" in the second week, the service is not quite operating to expected levels!

Rasheed

Vorsprung wrote: »

And an ED isn't going to save this woman's life, she needed an operation and a surgeon to save her and as I understand it, there are no after hours surgical services in Roscommon.

The surgical services were gotten rid of when the A+E was gotten rid of as a 24hr anaesthetist is needed for a 24hr A+E. Perhaps this would have been enough to recognise the problem, stabilise as much as possible and blue light her to Galway with bags of blood, we'll never know.

opinion guy

First Aid Ireland wrote: »

A problem, to my mind, is that paramedics in Ireland can't put lines into patients. Is there AP coverage available quickly in Roscommon? If no AP available, there becomes an interesting balance between fluid resucitation etc at local hospital and putting the foot on the floor to get to the regional centre.

I'm pretty sure they can put lines in.

First Aid Ireland

opinion guy wrote: »

I'm pretty sure they can put lines in.

Paramedics in Ireland can't cannulate.

sam34

First Aid Ireland wrote: »

Paramedics in Ireland can't cannulate.

I stopped at an RTA a while back and the paramedics had all the equipment to cannulate but hadn't done it, as soon as I arrived and announced I was a doc they gave the line etc to me to insert.

that was a sight for sore eyes I tell ya, a psychiatrist putting in a line for the first time in 7 or 8 years, at the roadside in an emergency situation :pac:

I got it in on the second attempt...!

sillymoo

First Aid Ireland wrote: »

opinion guy wrote: »

I'm pretty sure they can put lines in.

Paramedics in Ireland can't cannulate.

We had paramedics in theatre at one stage in a busy Dublin teaching hospital, last march/April if memory serves me right. They were learning to cannulate an insert LMA's with the anaesthetist. It was part of their training scheme. So they are trained - will they just not put in cannulas for insurance or trade union issues?

Traumadoc

I read that this poor girl died from a ruptured thorasic aorta.
Does Galway have 24 hour cardiothorasic surgeons?

Should trauma be bought to Galway, or any other hospital that is not a level 1 trauma center?

First Aid Ireland

sillymoo wrote: »

We had paramedics in theatre at one stage in a busy Dublin teaching hospital, last march/April if memory serves me right. They were learning to cannulate an insert LMA's with the anaesthetist. It was part of their training scheme. So they are trained - will they just not put in cannulas for insurance or trade union issues?

They were probably advanced paramedics. Normal paramedics don't do cannulas. I'm not sure why. But as far as I'm aware, they're not trained to put them in. Only APs are.

First Aid Ireland

sam34 wrote: »

I stopped at an RTA a while back and the paramedics had all the equipment to cannulate but hadn't done it, as soon as I arrived and announced I was a doc they gave the line etc to me to insert.

that was a sight for sore eyes I tell ya, a psychiatrist putting in a line for the first time in 7 or 8 years, at the roadside in an emergency situation :pac:

I got it in on the second attempt...!

I hope it was a grey

Piste

Why can't paramedics put in lines?

First Aid Ireland

Piste wrote: »

Why can't paramedics put in lines?

Beats me. I think it's crazy.

I asked about it here: http://www.boards.ie/vbulletin/showpost.php?p=78888338&postcount=50

And the response given is here: http://www.boards.ie/vbulletin/showpost.php?p=78889562&postcount=51

"This is true.......but i cant see much demand for this from the paramedics without some recognition in pay, the new entrants at the moment are on a very basic wage.... what may happen down the road is an accross the board paramedic upskilling and then gradual disolvement of the AP programme but that could take years....."

I don't know if that's the real reason or just somebody's opinion, though.

his_dudeness

Traumadoc wrote: »

I read that this poor girl died from a ruptured thorasic aorta.
Does Galway have 24 hour cardiothorasic surgeons?

Should trauma be bought to Galway, or any other hospital that is not a level 1 trauma center?

The Republic of Ireland has one level one trauma centre, Cork University Hospital. Only hospital in Ireland that has onsite Neurosurgery, cardiothoracics, paediatrics, ICU, plastics, obstetrics.

All other university hospitals have some but not all of those features i.e there is no neurosurgery in Galway.

That said, even CUH falls short of what would be classed a Level 1 trauma centre in the US.

First Aid Ireland wrote: »

A problem, to my mind, is that paramedics in Ireland can't put lines into patients. Is there AP coverage available quickly in Roscommon? If no AP available, there becomes an interesting balance between fluid resucitation etc at local hospital and putting the foot on the floor to get to the regional centre.

I worked in Ros before the A+E was closed down and there were specific efforts made to have extra APs there. There were something like 5 or 6 on the roster when I was leaving

his_dudeness

donaghs wrote: »

Forgive my ignorance in this area, but the news of the woman dying in ambulance near Roscommon town has got me thinking about A&E closures again.

Firstly, what is point of having regional hospitals without A&E? Surely, by their nature, emergency facilities should be nearby.

Would it not make sense to relocate or close any other part of the hospital before A&E?

Out of pedantics, Roscommon is a "county" hospital. The next nearest, Portiunlca, is a "general" hospital. Only Galway is a "regional" hospital.