Trauma care reform ‘urgently needed’

Trauma care in Ireland must be reformed to meet evidence-based standards of best practice and to care for the changing profile of trauma patients .

The National Office of Clinical Audit (Noca) report captures the clinical journey of more than 4,000 patients who sustained life-changing or life-threatening trauma in 2016, auditing every step of their journey in all 26 Irish hospitals currently receiving severely injured patients.

The report shows patients are being brought to hospitals that are not set up to deal with their care needs and are being put at risk as a result; 28 per cent of patients were transferred from their initial hospital to another hospital to receive care.

If you fall down a flight of stairs and sustain head, chest, abdominal and bone injuries, a lot of medical procedures need to happen quickly in parallel

A fundamental requirement in the management of severely injured patients is the delivery of the right care, by the right people with the right skills in a timely manner.

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If you fall down a flight of stairs and sustain head, chest, abdominal and bone injuries, a lot of medical procedures need to happen quickly in parallel. You may need to be placed in a medically-induced coma to protect your brain and your lungs from being further injured. You may need chest drains inserted, or a blood transfusion.

Delivering this complex care safely and quickly requires a team that is trained, skilled and practised. This report shows only 8 per cent of major trauma patients were received by a trauma team or had consultant input within the initial 30 minutes in the emergency department. Only one-third of patients received their scan within one hour.

Low falls

Even the busiest trauma hospitals in Ireland do not receive the threshold number of severely injured patients required to maintain staff skills and meet standards for accreditation as a “major trauma centre”.

Today, falls of less than 2m are the most common major trauma. These low falls particularly affect our older population

In our system, only 11 per cent of patients sustaining severe head injury were brought directly to a neurosurgical centre and 45 per cent of patients with severe brain injury did not receive care at a neurosurgical centre at any time.

In the 1990s 40 per cent of major trauma was sustained in people aged 24 years and younger; today, 40 per cent is sustained in patients over the age of 65 years. Road traffic collisions account for 18 per cent of cases, down from 60 per cent in the 1990s.

Today, falls of less than 2m are the most common major trauma. These low falls particularly affect our older population.

When an inclusive trauma system was implemented in England in 2012, a 30 per cent improvement in survival was seen.

Conor Deasy is clinical lead for major trauma audit at the National Office for Clinical Audit, a consultant in emergency medicine at Cork University Hospital and deputy medical director of the National Ambulance Service