Elaine Hanly’s life changed in the blink of an eye, as it does for so many victims of major trauma.
While a passenger in a car, Hanly was involved in a crash that broke her back, sternum and nine of her ribs. The spinal cord was also severed, leaving her paralysed below the arms.
“In five hours I went from being a nurse to a patient. That was hard – it was quite a head spin,” she recalls of the incident, a decade on.
She is from Roscommon, and was brought initially to a local hospital, which didn’t have the expertise to deal with her multiple injuries, so she was transferred to Dublin.
About one in three victims of major trauma end up requiring hospital transfer, leading to delays in treatment and poorer outcomes. This is one of the reasons why the new major trauma centres, in the Mater hospital in Dublin and Cork University Hospital, are being created in an effort to centralise and streamline the treatment of patients with serious injuries.
The Government's decision to award the major trauma centre to the Mater was long delayed, in part due to Covid-19. It also flew under the radar, again due to the focus on the pandemic. And then it became the subject of criticism by neurosurgeons at nearby Beaumont Hospital, which had also been in the running for the project.
Arguably, the major trauma centre is the most important health project since the national children’s hospital. About 100 lives could be saved each year through the creation of major trauma centres and the re-organisation of services, according to Keith Synnott, a spine surgeon and HSE national clinical lead for trauma.
Another 200 people may be saved from serious disability through quick medical intervention, he says, with a trickle-down effect from better organisation also benefiting the treatment of minor trauma.
Major trauma includes falls, burns, road traffic collisions, industrial accidents and suicide attempts. But half of all major trauma involves low falls, Dr Synnott points out, “such as when a frail person trips over the cat”.
Time is of the essence in treating people who have suffered this kind of injury. Someone whose airways are blocked will die within six minute unless treated. The survival time for collapsed lungs is up to 15 minutes, and for severe bleeding is 25-30 minutes.
Under the plan, patients who are within 45 minutes of the two major trauma centres will be brought there for treatment; otherwise they will go to one of a network of trauma units for stabilisation and possibly onwards to Cork or the Mater.
Dr Synnott describes the lack of a major trauma network up to now as embarrassing. Inter-hospital communication results in vital time being wasted. At its most extreme, a patient with multiple injuries might have to be brought to different hospitals for treatment – Tallaght for the pelvis, the Mater for the spine, Beaumont for the brain. A rock climber from Dublin who falls off a cliff in Mayo, is treated locally and then transferred to the capital, might end up being "repatriated" back to the Mayo hospital because of a bureaucratic requirement.
Trauma networks in other countries have achieved a 20 per cent increase in survival, an outcome the Irish system is hoping to replicate.
Under the new system, the Mater and CUH will be able to treat all injuries “in the one place”, Dr Synnott says, and patients won’t be “bounced from Billy to Jack”. Rehabilitation services, and support in the community, are also being beefed up.
Hanly spent seven weeks in the Mater after her crash, followed by four months in the National Rehabilitation Hospital in Dún Laoghaire. She says the process was "fabulous" but adds: "Nobody can tell what you are feeling. Even with all their expertise, they have no idea what you're going through."
“The loss of identity is massive. People are always comparing you to the old you. They think everyone in a wheelchair is the same.”
She now works three days a week in a home care agency and lives independently in a house built on a family site near home.
Dr Synnott acknowledges “there is never enough rehab” but believes there is scope to use current resources more efficiently. With long waiting lists to get into the Dún Laoghaire facility, he is hoping some patients could receive rehabilitation in other centres.
Big hospitals can specialise more. This writer has been treated in a major trauma centre in Germany with a catchment area of more than 12 million people, yet Ireland is setting up two such centres for our much smaller population.
A further problem was that, in deciding where in Dublin to site the centre, “no hospital had everything and no hospital was big enough to have everything”, says Dr Synnott.
With the decision being made in favour of the Mater, home to the national spinal centre, this means that, as things stand, a stroke patient requiring a live-saving thrombectomy will have to be transferred to the national neurosurgery centre in Beaumont for the procedure.
The Beaumont neurosurgeons have argued that colocation of neurosurgery and major trauma services is the norm internationally and have even suggested they should all move to the Mater if the project goes ahead as planned.
Dr Synnott says it “doesn’t make sense to move everything to the Mater ... Neurosurgical capability needs to be of an appropriate standard and not detract from capability elsewhere. Trauma is a team game, involving different specialties, and neurosurgery is an important part of the team. We need all the best players working together.”
The Mater centre is due to open next March, and will eventually treat 1,600 major trauma patients a year.