'Trauma services need more staff'


Orthopaedic surgeon at Tallaght hospital, Prof John McElwain, is retiring after 28 years

‘ALL YOU hear about Tallaght are the bad things, you never hear the good things,” says Prof John McElwain.

As head of trauma at Tallaght hospital and an orthopaedic surgeon there since it opened 14 years ago, he thinks the place gets a bad rap. “It’s a very credible place I can tell you, despite all the bad publicity we get.”

The hospital’s problems in recent years have been legion – in 2010 it was subject to investigation after thousands of X-rays had gone unreported to consultants while many referral letters from GPs had not been processed.

In May this year, a report by the Health Information Quality Authority cited “a history of longstanding challenges in leadership, governance, performance and management at board and executive level of the hospital”.

McElwain says the bad publicity is unfair. “The quality of work here is outstanding, it’s just that we’ve always been the subject of bad publicity. The work that’s done in Tallaght is of the highest order.” He describes his own patch – the trauma service – as “the best in the country”.

The Galway native trained as an orthopaedic surgeon in Dublin and subsequently in Toronto. Specialising in the treatment of pelvic and acetabular or hip joint socket fractures, many of the patients on his operating table will have had a close brush with death.

“I’m not talking about granny fracturing her hip. I’m talking about high-velocity major trauma, multiple injury patients,” he says of those he treats.

“The vast majority of them have been in a high velocity road traffic accident. Quite a few of them are equestrian accidents as well where people can be crushed by a horse.”

He describes operating on the socket part of the hip joint, the acetabulum, as “one of the most difficult operations you can do”.

“There aren’t that many of us in the world who are doing them, it’s kind of an elite organisation if you want to put it that way.”

McElwain has treated 1,600 trauma cases in his 28 years of practice. Stepping down from his post in Tallaght next year, he says just three of those patients died.

But he believes there is room for improvement in how Irish hospitals treat such injuries, with faster treatment critical to survival or avoiding complications such as pulmonary embolism, damage to blood vessels, arteries and veins, rectal problems, urinary tract infection and pressure sores.

“Ideally, pelvic fractures should be treated within the first hour, but that’s not possible within this country, and acetabular fractures should be treated within a week,” he says.

Instead, he says the average transfer time to Tallaght is 10.5 days, which though it compares well with some UK hospitals, he says pre-referral treatment principles are not applied equally in all regional hospitals here.

“They come to us from various parts of the country and the standard of care is questionable,” he says. “One has to be quite blunt about it, it’s pretty poor.

“They don’t treat them in those areas because they don’t know how to treat them. Plus there is kind of an attitude of that’s your problem; it’s not our problem. Wait for the bed in Tallaght.”

McElwain says Ireland lacks “a system of care for the management of the multiple injured patient”.

“Take, for example, my catchment area of Naas. You have patients with multiple injuries being brought to Naas and they should never be brought there, they should be brought straight to Tallaght . . . you hear this rubbish that small hospitals save lives – small hospitals don’t, they are responsible for more problems than the big ones.”

He says in addition to improving the referral process, trauma services need more staff.

“Unfortunately one of the problems in this country is that we are not training enough people in trauma – there are much more ‘attractive’ shall I say subspecialisations and they go for that rather than trauma.”

But what of the number of consultant staff who have defected from Tallaght’s own orthopaedic unit of late?

“There certainly is that problem . . . they are leaving because they want a better quality of life,” says McElwain.

But isn’t that a problem for services there? “Yes. But at the moment, we have appointed two people and they will take up their posts between now and Christmas and another will take up this post when I retire next year.”

Looking back on his career in treating trauma, has dealing with such catastrophic injuries day-in day-out ever got under his skin?

“Oh no, you have a job to do,” he says.

“We have to provide the best care and people might think we are a bit brash and arrogant maybe, but if it means it gets the job done and the patient survives and gets out of hospital mobile, that’s all you need to do.”