Trauma centre decision a risk to patients
Sir, – A major trauma centre not co-located with the National Neurosurgical Centre will worsen the outcome of patients with brain injury (“Major reform of trauma services to be announced”, News, April 27th).
More than half of those who die from trauma, die of brain injury. Head-injured patients account for more than half of those who require immediate life-saving surgery. This is why almost all major trauma centres (MTCs) in the world are on major neurosurgical centre sites. In the UK, 25 of 27 MTCs are co-located with major comprehensive neurosurgical centres. On the island of Ireland also, Cork and Belfast MTCs are on the same site as their neurosurgical centres.
As Ireland’s specialists in treating patients with severe head injury, we welcome the news of reform of trauma services in Ireland. International experience clearly demonstrates the benefits of a trauma system of care. We are, however, dismayed at the announcement by the Minister for Health that the Central Network Major Trauma Centre is to be located at the Mater hospital, where there is no neurosurgical service.
Major trauma centres (MTCs) are a very important component of trauma systems. Patients with severe injuries are taken directly to MTCs, bypassing local hospitals, to ensure access to rapid life-saving treatments by a team of doctors, nurses and allied health professionals. To ensure best outcomes for patients with multiple injuries, MTCs must have all specialist disciplines involved in trauma care.
In Dublin, the situation is complex because none of the Dublin hospitals have all of the necessary specialties.
The international standard is to co-locate the MTC with a major neurosurgical centre. This is to ensure that patients with the most severe injuries requiring the most rapid life-saving operations are cared for efficiently.
International and national data clearly demonstrate that patients with head injury have the highest risk of death among all trauma patients.
The alternative model of locating an MTC on a non-neurosurgical site requires the creation of a new mini-neurosurgical centre to care for head-injured patients. This is the model being proposed for the Mater hospital. Such centres can never provide the full spectrum of care that a major comprehensive neurosurgical centre provides and therefore head injured patients suffer as a result. We must learn from such centres. International experience shows that patients with head injury are more likely to die in this model of care. We must ensure this mistake is not repeated in Ireland.
It should be pointed out that the “independent assessment panel”, which was tasked with the MTC site selection, had no one with specialist expertise in the management of patients with severe head injury. In other words, there was no one representing the most severely injured trauma patients on the panel.
In our opinion, the best model of care for trauma patients is co-location of the major trauma centre with the National Neurosurgical Centre. If the major trauma centre is to be sited at the Mater hospital, plans will need to be drawn up to move the entire National Neurosurgical Centre and all of its allied specialties to the Mater hospital as soon as possible. Any in-between solution will result in avoidable loss of patients’ lives. – Yours, etc,