A REVIEW of emergency hospital services in Cork and Kerry published by the Health Service Executive South has recommended the creation of a single trauma centre at the emergency department at Cork University Hospital (CUH) to provide care for all complex and acute trauma cases.
The review proposals will mean the end of 24-hour emergency services as they are now constituted at the Mercy University Hospital, the South Infirmary Victoria University Hospital, Mallow General Hospital and Bantry General Hospital.
It proposes to create Medical Admission Assessment Units (MAAU) at all four hospitals which will continue to operate on a 24/7 basis along with the establishment of Urgent Care Centres which will operate on a 12-hour basis.
CUH has 60,000 emergency department attendances per annum while the Mercy and South have between them a further 50,000. Mallow has 12,000 attendances, and 6,000 attend the emergency department at Bantry.
Director of reconfiguration for Cork and Kerry Prof John Higgins explained the MAAU, which has proven hugely successful at St Luke’s in Kilkenny, would cater for patients with medical emergencies such as serious pneumonia needing urgent admission.
“An MAAU is specifically intended for patients who show symptoms of acute medical illness and need immediate assessment and treatment, or for patients about which there is a level of clinical uncertainty but who require further assessment and treatment.
“Examples would be symptoms such as abdominal pain, chest pain, rash or headache or somebody suffering a seizure or a fit. MAAUs must be supported by good diagnostics up to and including X-rays and CT scanning,” he said.
Prof Higgins rejected suggestions the establishment of 24-hour MAAUs and 12-hour Urgent Care Centres would mean a downgrading of emergency services at Cork hospitals outside of CUH, and pointed out complex trauma cases are already going to CUH.
He instanced the case of a car accident where the casualty would be assessed by an advanced paramedic at the roadside who would decide if they needed complex treatment, in which case they would be brought to the emergency department at CUH.
The advanced paramedic system, already operational on a pilot basis in west Cork, would see the advanced paramedic performing advanced life support procedures such as intubation, defibrillation and administration of drugs under a doctor’s direction.
Prof Higgins said Kerry General Hospital, which has 34,000 emergency attendances a year, will continue to operate its own 24/7 emergency department. Construction of a new emergency department at the Tralee hospital should be a priority capital project.
In addition to the development of advanced paramedic teams to service west Cork, north Cork, Cork city and Kerry, the review proposes a full 24/7 ambulance service in which the on-call service is replaced by an on-duty service.
Prof Higgins said the two-year plan would have to be achieved through redistribution of the HSE South’s €1.4 billion budget as no extra resources would be available.