Major trauma care in Ireland lags behind a lot of its western contemporaries (think UK, Aus/NZ and the US). We have 28 hospitals receiving major trauma (for a population of 4.5 million). We do not have a trauma system. We compare fairly poorly to our contemporaries who do have trauma systems. Not wanting to make hysterical and headline grabbing claims here but it seems a perfectly reasonable thing to say that people are dying in Ireland due to a lack of a trauma system, never mind the increased long term disability that comes from poor trauma care.
Trauma in Ireland is finally beginning to get a little bit of attention. We have joined TARN and the major overhaul in trauma care across the water in the UK has got us shifting rather nervously in our seats as to what might happen here.
The Irish Association for Emergency Medicine (for whom I have no formal position, apart from being a member) has just published its position paper on trauma care in Ireland and it’s well worth a read. It says a lot of very sensible things about the political hot potato of reconfiguration and the steps needed to produce a significant trauma system. There is of course a phenomenal amount of work ahead of us and this is only a started, if we want to develop advanced trauma care in Ireland. From an EM point of view there seems to be lots of interest (especially amongst the trainees and the recent consultants) but of course we have about 1/3 of the EM consultants here than they do say in Victoria, Australia so we can be as interested and as enthusiastic as we want we can’t fix it alone. There appears to be (though please correct me if I’m wrong) little interest in the surgical community. I recently met one of the advanced surgical trainees whose passion is trauma surgery. He couldn’t identify a single colleague in training who shared his interest.
Have a read at the paper and see what you think, discussion is always welcome.
[featured image – wikipedia, CC]
Very sensible position paper.
A few points spring to mind:
1. The number of whole time equivalent ED consultants in Ireland is, frankly, a joke. I’m genuinely horrified – haven’t seen the figures presented before. A maximum of 5 WTE’s in any hospital at the moment? Shocking.
2. There needs to be a physician/paramedic team on HEMS
3. Big work to be done reconfiguring services, particularly in Dublin
4. ICU trauma care must remained “closed”, rather than straying into the American system of having the referring surgeon retaining ownership
It’s a strong piece of work from the IAEM – let’s hope there is the political and medical will to follow up on it and deliver
-John
I agree with every single one of those. IAEM (just like the UK college) has had a big focus on increasing numbers of fully trained EPs. The HSE is perhaps a little bit more focused on simple service provision as opposed to providing a consultant delivered, physically present EM service.
I think if you’re gonna have a helicopter then it’s not just transport, it’s delivering the right interventions when needed. It’s also a job I would like so I’m biased…
We could close 2 or 3 of the big dublin hospitals (given the right plan of course)
Agree with the comments on closed ICU too. I don’t think it’s realistic to see that changing in Ireland anyhow…