REGIONALISED EMERGENCY MEDICINE - the Belfast Experience

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REGIONALISED EMERGENCY MEDICINE - the
Belfast Experience

• Laurence Rocke FRCS, FFAEM
• Consultant in Emergency Medicine
• Royal Victoria Hospital
• laurence.rocke_at_royalhospitals.n-i.nhs.uk

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16 EDs, 4MIUs for 1.7 million people
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GB v N I

• 300,000 population per hospital
• About 30 attend at EDs per annum
• Average distance to ED 30 miles

• 100,000 population per hospital
• About 45 attend at EDs per annum
• Average distance to ED lt10 miles

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CHANGES

• Increasing trauma transfers to RVH
• Head injury protocol
• Thoracic trauma protocol
• Opt-out - Mater
• Fracture centralisation - BCH to RVH
• Whiteabbey closes
• DGHs close to long bone trauma

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HEAD INJURIES

• Patients with any evidence of serious head injury
  -
• GSW
• Obvious fracture
• Reduced LOC
• Discretion of ambulance crews

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THORACIC INJURY

• Penetrating injury - gun, knife, etc
• Flail chest
• Other obvious serious injury
• Discretion of ambulance crews

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FRACTURE PROTOCOLS

• Any evidence of spinal injury
• Inability to weightbear or other evidence of
  lower limb fracture
• Complex upper limb injury - compound, angulated,
  major deformity, amputation.
• Discretion of ambulance crews

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EFFECTIVE?
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Where does trauma happen?
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Transfers to RVH
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Trauma Work in RGHMay - Sept 2002

• 56 patients admitted to RVH AE directly
• 5 patients admitted to RBHSC AE directly
• 57 patients transferred to RVH
• 5 patients transferred to RBHSC

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Resources required

• The length of time during which Accident and
  Emergency staff took responsibility for patient
  care i.e. in the AE Dept, X-ray and CT scanner
  varied from lt1 hour to gt6hours
• average time (excluding those patients DOA)
• 3 hours 10mins.

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EFFECT ON HOSPITALS BYPASSED?

• Little so far
• BCH - one SpR post removed
• BCH - difficulty recruiting staff
• But - is this due to bypass protocols?
• Recent talk of clinical networks
• Effect of EWTD and New Deal for JDs

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