Accident and emergency departments at smaller hospitals across the State will be downgraded if the recommendations of a draft report from the Medical Manpower Taskforce are implemented.
The report says there is a tendency to provide a large range of emergency services in many hospitals, including smaller ones, throughout the State. "The result is often very unsatisfactory, with staff and facilities unable to cope with the heavy demands placed upon them and insufficient support services available on-site to cope with emergency situations," it says.
"In addition, medical and nursing staff may find themselves having to deal with medical emergencies for which they have insufficient training and experience.
"The current situation is not sustainable, either from the viewpoint of patient safety or staffing."
The report recommends emergency care be concentrated in what it terms "regional centres" with minor injuries only being treated at smaller hospitals.
It acknowledges the proposal may raise concerns about the access of patients to treatment in life-threatening situations. "The experience is, however, that many of the main immediate life-saving measures in emergencies are not affected by the immediate proximity of a hospital".
Explaining this further, the report notes that two-thirds of deaths from heart attacks happen before the patient reaches any hospital. "This is usually because the death is sudden and there is no opportunity to call for medical help; no bystander has initiated resuscitation measures or there has been a delay in seeking medical help," it says.
"The extra time required to transport a patient to a site a number of miles away would not be significant in mortality terms by comparison with the common delay time in calling for medical help at the outset" and administering other interventions such as an electric shock to the heart or mouth-to-mouth resuscitation.
Furthermore, it says, survival after serious accidents is improved by two factors not dependent on the location of a hospital. These are the maintenance of the injured person's airway at the site of the accident and early action to stop or reduce bleeding. Both of these measures can be performed by ambulance personnel, it says.
The taskforce also believes that in most regions a network of "associated hospitals and one regional centre" should form "the basic organisational unit" in the delivery of acute hospital care.
Each "associated" or local hospital would do elective surgery five days a week and its outpatient department would open from 8 a.m. to 8 p.m.