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May 1, 2019

WADEM Congress on Disaster and Emergency Medicine 2019

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

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Trauma system

Rural Hospitals

Trauma Bypass

HEMS

EMS

Trauma Audit

Prehospital transport times

EMS response times

Trauma Centre

Trauma Unit

Abstract

Abstract

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Keywords

Trauma system

Rural Hospitals

Trauma Bypass

HEMS

EMS

Trauma Audit

Prehospital transport times

EMS response times

Trauma Centre

Trauma Unit

Abstract

Introduction Trauma bypass has been introduced successfully worldwide with sustained reductions in mortality/morbidity. Analysing 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. Mortality rate for the year 2016 was only 4%. AIM To determine ability of road based EMS system to bring patients from areas of Wexford country to proposed receiving centres within 60/90 minutes. METHOD Taking population centres in Wexford county, using Googlemaps to estimate travel times at 3pm on a weekday to proposed new trauma units and centres in Dublin, Cork and Waterford RESULTS In Wexford county urban centres >95% of patients will not reach a Trauma Unit in less than 60 minutes with current pre-hospital emergency medical service capabilities even leaving out 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.

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© Copyright 2019 Morressier GmbH.
All rights reserved.