Concerns for Small Hospitals in Rationalising Trauma Services: How Do We Ensure Enhanced Patient Services in Rural Areas?

Abstract

Introduction:Trauma bypass has been introduced successfully worldwide with sustained reductions in mortality/morbidity. Analyzing structure, process, and outcome individually and collectively in systems has been found to focus improvement efforts in the audit cycle. The second Irish report on Major Trauma Audit (MTA) was published in December 2017. The median age of trauma patients in Ireland was 59, indicating an aging trauma population. 28% of patients required secondary transfer to complete their care. The mortality rate for 2016 was only 4%.Aim:To determine the ability of a road-based EMS system to bring patients from areas of Wexford County to proposed receiving centers within 60-90 minutes.Methods:Analysis took population centers in Wexford County, used Google Maps to estimate travel times at 3pm on a weekday, and proposed new trauma units and centers in Dublin, Cork, and Waterford.Results:In Wexford County urban centers, >95% of patients will not reach a trauma unit in less than 60 minutes with current prehospital medical service capabilities. This even excludes response/on-scene time by prehospital practitioners in land-based EMS vehicles.Discussion:The proposed introduction of trauma bypass systems in Ireland should not disenfranchise patients with respect to the standards they are currently receiving. Gap analysis suggests considerable work is required within the ambulance service to increase critical skill levels of paramedics to support critical patients in the golden hour of their transfer. An increase in vehicles/resources will be required to ensure adequate staffing to meet Health Information and Quality Authority (HIQA) targets of 8 and 19 minutes for response acuity, and for longer durations of transport allied to dynamic resource deployment model as used by National Emergency Operations Centre (NEOC). Unintended consequences of system changes will need to be monitored carefully to avoid further adversely impacting recruitment of staff to bypassed Model 3 hospitals.