Distance to A&E linked to risk of dying

Tue, Aug 28, 2007, 01:00

The further a seriously ill patient has to travel by ambulance to reach a hospital's emergency department the more likely they are to die, new research has found.

The study, carried out among more than 10,000 patients in the UK, established that the risk of death for people who are unconscious, not breathing or have chest pain rose by 1 per cent for every 10km (6.2 miles) travelled.

The findings, just published in the Journal of Emergency Medicine, come as no surprise to those fighting to save A&E units in smaller hospitals across the State.

Researchers from the University of Sheffield looked at 10,315 seriously ill patients taken to hospital between 1997 and 2001.

They found that while 6 per cent of patients died overall, the numbers rose with the distance to hospital.

Just 5.8 per cent of those who travelled up to 10km died, while 7.7 per cent of those who were taken between 11km (6.8 miles) and 20km (12.4 miles) did not survive. Among patients who travelled 21km (13 miles) or more, the mortality figure rose to 8.8 per cent.

Consultant cardiologist at Portiuncula Hospital, Ballinasloe, Dr John Barton, is a former chairman of the Hospital Services Action Group (HSAG) set up in the wake of the publication of the Hanly report which recommended A&E units at smaller hospitals be replaced with nurse-led minor injury units. He said the new study confirms earlier research which the HSAG highlighted to the Department of Health.

"The findings of the UK study do not surprise me one little bit. I get very deeply concerned about people at the very top in the Health Service Executive (HSE) and Department of Health who believe they need to centralise all acute emergency care services, for example, in the northeast.

They are apparently totally unaware of the research that shows the dangers for patients in that sort of scenario and this worries me intensely," he said.

Dr Barton said it was ludicrous to try and equate the level of management and care that a heart attack patient would get in the back of an ambulance with the care they would get in Portiuncula Hospital or any other hospital.

"I myself have seen many patients over the years who would have died if the ambulance they were travelling in had passed the front door of Portiuncula and taken them straight to University College Hospital Galway," he added.

Marie O'Connor, author of the recently published Emergency - Irish Hospitals in Chaos and public relations officer for the HSAG, said: "The whole issue of closing A&E units is a serious issue for everybody, not just people living in non-urban areas. For example, people living in Dublin go down the country for work, on holidays and to visit family. There are 20 crashes on the country's roads every day. If the Government proceeds with its plans to close down A&E units, we will all be at risk."

Meanwhile, former senator Kathleen O'Meara of the Nenagh Hospital Action Group said she was aware of a number of cases where people would have died if Nenagh Hospital's A&E unit was not there.

"Without the availability of the trauma unit and the range of services at Nenagh Hospital, these people would have died, as has happened in Monaghan. It's common sense that the further away a person is from hospital, the higher their chances of dying, but it's good to have it backed up by proper statistical analysis like this new UK report," she said.

Hospitals threatened with closure of their A&E facilities include Monaghan, Dundalk and Our Lady's Hospital, Navan, in the northeast as well as hospitals in Ennis, Nenagh and St John's voluntary hospital in Limerick. Meanwhile, the HSE West is reviewing services at Portiuncula Hospital and Roscommon County Hospital.