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Irish Journal of Medical Science (1971 -)

, Volume 184, Issue 3, pp 659–666 | Cite as

Saving lives, limbs and livelihoods: considerations in restructuring a national trauma service

  • H. M. Mohan
  • D. Mullan
  • F. McDermott
  • R. J. Whelan
  • C. O’Donnell
  • D. C. Winter
Original Article

Abstract

Study hypothesis

Level 1 trauma centers reduce mortality and improve functional outcomes in major trauma. Despite this, many countries, including Ireland, do not have officially designated major trauma centers (MTC). This study aimed to examine international trauma systems, and determine how to “best fit” trauma care in a small country (Ireland) to international models.

Methods

The literature was reviewed to examine international models of trauma systems. An estimate of Irish trauma burden and distribution was made using data from the Road Safety Authority (RSA) on serious or fatal RTAs. Models of a restructured trauma service were constructed and compared with international best practice.

Results

Internationally, a major trauma center surrounded by a regional trauma network has emerged as the gold standard in trauma care. In Ireland, there are no nationally coordinated trauma networks and care is provided by 26 acute hospitals with a mean distance to hospital from RTAs of 20.6 km ± 15.6. Based on our population, Ireland needs two Level 1 MTCs (in the two areas of major population density in the east and south), with robust surrounding trauma networks including Level 2 or 3 trauma centers. With this model, the estimated mean number of cases per Level 1 MTC per year would be 628, with a mean distance to MTC of 80.5 ± 59.2 km, (maximum distance 263.5 km).

Conclusion

Clearly designated and adequately resourced MTCs with trauma networks are needed to improve trauma outcomes, with concomitant investment in pre-hospital infrastructure.

Keywords

Trauma network Emergency medicine Road traffic accident (RTA) Major trauma center Ireland 

Notes

Acknowledgements

The authors acknowledge the assistance of Prof. Brendan Whelan with the statistical elements of this study.

Conflict of interest

None.

Supplementary material

11845_2014_1234_MOESM1_ESM.doc (41 kb)
Supplementary material 1 (DOC 41 kb)

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Copyright information

© Royal Academy of Medicine in Ireland 2014

Authors and Affiliations

  • H. M. Mohan
    • 1
  • D. Mullan
    • 1
  • F. McDermott
    • 1
  • R. J. Whelan
    • 1
  • C. O’Donnell
    • 2
  • D. C. Winter
    • 1
  1. 1.Department of SurgerySt Vincent’s University HospitalDublinIreland
  2. 2.National Ambulance ServiceHSE, Regional Ambulance Communications CentreLimerickIreland

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