Sir, – Jim Lawless (March 10th) drew attention to deficiencies he perceives in our national approach to the medical catastrophe of subarachnoid haemorrhage (SAH). Because interventional radiological and neurosurgical services cannot be provided at local hospital levels, it is incumbent upon providers to ensure timely access to these services at specialist centres.
Appropriate urgent care will predictably improve survival and reduce disability in this clinical scenario.
We, the Council of the Intensive Care Society of Ireland (ICSI), wish to commend Mr Lawless on his motivation to address this matter and indeed on how constructively he has directed his grief following his wife’s tragic death toward better outcomes for others.
Definitive resolution of the problems relating to SAH will require a coordinated and multidisciplinary approach. However, we would emphasise that neurosurgical emergencies are among many acute medical and surgical scenarios which require immediate intensive-care admission. In such circumstances, rapid access to intensive care and its ancillary services is crucial.
The report Toward Excellence in Critical Care , by management consultants Prospectus, commissioned by the HSE in 2008, outlined Ireland's need for intensive-care unit resources. The standards at the time of publication fell far short of those required.
While some of its broad-reaching findings and recommendations are being addressed, the overarching requirement was for a doubling of intensive-care unit bed capacity by 2020.
Halfway through this timeframe, bed capacity has actually been actively reduced.
We in the ICSI feel obliged to highlight the necessity for an expansion of critical care capacity.
For any patient faced with an acute life-threatening illness, delay in accessing intensive care units demonstrably reduces the prospect of survival.
As regards subarachnoid haemorrhage, whilst more research on outcomes is welcome and essential, the immediate emphasis should be on ensuring timely access to adequate critical care resources for all patients who need them. The case for this can be predicated on existing data. – Yours, etc,
Dr PATRICK SEIGNE,
Dr BRIAN O’BRIEN,
Dr IVAN HAYES,
Dr ROBERT PLANT,
Dr DOROTHY BREEN,
Consultants in
Intensive Care Medicine,
Cork University Hospital;
Dr RORY DWYER,
Consultant in Intensive Care
Medicine,
Beaumont Hospital;
Dr CATHERINE
MOTHERWAY,
Consultant in Intensive
Care Medicine,
Mid-Western Regional
Hospital, Limerick;
Dr EILIS CONDON,
Consultant in Intensive
Care Medicine, James
Connolly Hospital, Dublin;
Dr IAN CONRICK-MARTIN,
Specialist Registrar in
Intensive Care Medicine,
The Mater Misericordiae
University Hospital, Dublin;
Dr MARIA DONNELLY,
Dr ARABELLA FAHY,
Consultants in
Intensive Care Medicine,
Tallaght Hospital;
Dr VIDA HAMILTON,
Consultant in Intensive
Care Medicine,
Waterford Regional
Hospital;
Dr BRIAN MARSH,
Consultant in Intensive Care
Medicine, The Mater,
Dublin.
Dr PATRICK NELIGAN,
Consultant in Intensive
Care Medicine,
University College
Hospital, Galway.
Dr RUTH-AOIBHEANN
O’LEARY,
Specialist Registrar in
Intensive Care Medicine,
The Mater, Dublin;
Dr ELLEN O’SULLIVAN,
Consultant Anaesthetist,
St James’s Hospital, Dublin;
Dr DERMOT PHELAN,
Consultant in Intensive
Care Medicine, The Mater,
Dublin;
Dr DONAL RYAN,
Consultant in Intensive Care
Medicine, St. Vincent’s
University Hospital;
Dr MICHAEL SCULLY,
Consultant in Intensive
Care Medicine, University
College Hospital, Galway ;
Dr ANDREW
WESTBROOK, Consultant
in Intensive Care Medicine,
St Vincent’s University
Hospital;
The Intensive Care
Medicine Society of Ireland,
22 Merrion Square North,
Dublin 2.