Lack of Coronary Care in the Mid West

phog

I've just heard that if you require coronary care over the weekend in the midwest region you will not be admitted to the regional hospital. You will, instead be brought to Galway by ambulance, probably a coronary care ambulance, do we have many to cover the region while one or more are enroute to Galway?.

I'd love to know who's daft idea that was and what savings are they really making while putting lives at risk.

Jofspring

It's not just the weekend either, I'm pretty sure it's any day after 9pm.

phog

Jofspring wrote: »

It's not just the weekend either, I'm pretty sure it's any day after 9pm.

That may be true but it's daft policy.

Miike

Jofspring wrote: »

It's not just the weekend either, I'm pretty sure it's any day after 9pm.

It's after 5PM, If you have a coronary episode you'll be sent to Galway.

Furthermore, there is a cardiac trauma team setup in the MWRH but they're awaiting certification from an inspector which will be a wait time of about 5 or 6 weeks as an approximate estimation from the inspectors office. I find this the most ridiculous thing that's happened since they tried to close MWRH A&E down. Totally unreal out of our official bodies altogether

Brennans Row

Two very lucky people give an account of their recent experiences with our Regional Hospital.

Heart attack by appointment only (Letter in Irish Times)

Limerick heart attack patients express concern (Limerick Leader)

cul-2008

This country baffles me. Plenty of money for resurfacing roads and erecting new signposts to roads that go nowhere, yet when it comes to something actually life threatening, it's ignored. Simple as.

A neighbour of mine was unlucky enough to experience this excuse for a health service on Saturday last. Cleaning her windows at home, she became suddenly ill, and collapsed due to a blocked artery in her heart. Instead of being treated in LMWRH only 20 minutes in the road, she had to be driven to Galway for lifesaving treatment to insert a stent in her heart. According to doctors, if it had been 90 minutes more, the woman would be dead.

So instead of employing the additional staff necessary, we'll go off and build an enormous extension to the hospital that will probably lie empty or we won't be able to adequately staff due to 'budget constraints'.

Shame on the HSE. And shame on those high up in that organisation who sit back and watch while it crumbles to pieces. Disgusting.

phog

I sent a few emails to our TDs about this and he're a few of the replies (3 but the last 2 from the same TD).

I've left out the political football ones as they dont add any value to the current situation.

Following recent media reports in relation to this matter, I raised my concerns with the Health Service Executive. I understand that these reports do not relate to all Coronary Care in the Mid West Region. I understand that it refers to a specific type of heart attack (ST elevation MI) which is currently provided at the MWRH in Limerick from Monday to Friday 8 to 5. The number of patients requiring this service out of hours in the Mid West Region each year is approximately 58. I have been assured that Limerick will become a 24 hour centre for these patients within the next few weeks as the programme is rolled out throughout the country following an inspection by the National Clinical ACS Programme lead. The ACS Programme is a national clinical programmed aimed at improving cardiac care throughout the Country by providing patients with prompt access to higher level investigations and treatment such as cardiac cauterisation (angiography), advanced radiology and critical care.

Preparatory work has been going on for several months in accordance with the National guidelines. The two centres for STEMI patients in the Mid-West Region are Galway University Hospital which went live on the 1st October and the Mid Western Regional Hospital in Limerick which I understand will be going live in the next few weeks. As I understand it STEMI (ST elevation myocardial infarction) is not a case of cardia arrest. Anyone suffering a cardia arrest will continue to be treated at the Mid Western Regional Hospital in Limerick on a 24/7 basis, 365 days per year.

I understand that a STEMI is a heart attack caused by a blockage in the arteries. I also understand that it is diagnosed by using a 12 lead ECG machines and it is treated by clot busting drugs or by the insertion of wire into the artery to open it by using a balloon to allow the blood to flow to the heart muscle again. This is known as PPCI (Primary percutaneous coronary intervention) which can only be done in a hospital equipped with an emergency catheter laboratory.

All ambulances are equipped and paramedics trained to recognise a major heart attack and to transport these patients to a primary PCI centre hospital. International evidence shows that PPCI is the most effective treatment for major heart attacks and that his why I understand that Limerick is expanding its services to include this model of treatment.

I bolded the quantity of patients that require the specific treatment

Thank you for taking the time to contact me and raising your concerns. I have raised this issue with the Department of Health and I understand that patients who suffer cardiac arrest are still being treated in Limerick on a 24 hour basis. However if a patient suffers a specific type of heart attack (ST elevation MI of which an estimated 58 people a year) then they will be taken to the STEMI centre in Galway University Hospital. I have also been informed that the new state of the art critical care block will be fully operational, in the Regional Hospital, in the coming weeks as the programme is rolled out throughout the country following an inspection by the national clinical ACS Programme Lead.

My bolding again but it looks like they're singing from the same hymnsheet.

I have been in touch with the Minister for Health and he has informed me that the inspection which is needed for the centre to become fully operational will be carried out on Thursday. I hope this clarifies the situation.

So no one seems too concerend about the 58 people or so that may require this treatment. The 58 is over one person a week, if we had a dangerous road in the midwest that was resulting in possible death or serious injuries of 58 people a year they'd be an outcry but someone in the HSE can decide to close a clinic at the stroke of a pen. :mad:

I've asked for more info on when the clinic is expected to open once the inspection is completed on Thursday.

Kess73

The minister for health was in Limerick this week rambing on about how there would be no more cuts in healthcare in Limerick. I wonder how long it will take for that line to be proven utter rubbish.

Tango Alpha 51

First of all there's no such thing as a coronary care ambulance. Even the old training that you look for a cardiac ambulance is a thing of an by gone era (this only existed in the early 90's when very few ambulance personnel were trained to use a defib). Nowadays all emergency ambulances provided by the National Ambulance Service are staffed by highly trained Paramedics & Advanced Paramedics. The only time a cardiac patient will be directly transported to a PCI centre in Cork or Galway is when the paras/AP's diagnose the Stemi. All other cardiac problems are still being dealt with in the hospital. For the STEMI to be treated properly you really need the PCI centre where you will be treated accordingly resulting in a better prognosis, otherwise you would be in the hospital in Limerick & might not get definitive care. In relation to the question is there enough ambulances to cover the city & county, I would pose the question to anyone here do ye actually know how many ambulances are on duty at any one time?

phog

Tango Alpha 51 wrote: »

First of all there's no such thing as a coronary care ambulance. Even the old training that you look for a cardiac ambulance is a thing of an by gone era (this only existed in the early 90's when very few ambulance personnel were trained to use a defib). Nowadays all emergency ambulances provided by the National Ambulance Service are staffed by highly trained Paramedics & Advanced Paramedics. The only time a cardiac patient will be directly transported to a PCI centre in Cork or Galway is when the paras/AP's diagnose the Stemi. All other cardiac problems are still being dealt with in the hospital. For the STEMI to be treated properly you really need the PCI centre where you will be treated accordingly resulting in a better prognosis, otherwise you would be in the hospital in Limerick & might not get definitive care. In relation to the question is there enough ambulances to cover the city & county, I would pose the question to anyone here do ye actually know how many ambulances are on duty at any one time?

Forgive me here as I'm not a medic and dont really understand the situation but are you saying that anyone that suffered an STEMI in bygone times they weren't treated properly in the regional, if that's incorrect then why are we waiting for the new unit?

I really couldnt give a fiddlers how many ambulances there are once there's enough to cover the norm requirements for a region the size of the mid-west and one to cover or be called in when one has to head to Galway.

Can Galway cover the overflow from the Mid-West region for those that required the STEMI treatment.

How come the unit still isn't open in the regional, surely once the new unit was planned a project manager would have timed the H&S checks that we're waiting for could have been scheduled to begin once the unit was completed. My understanding is that the unit has been inspected.

From the Office of the Minister of Health

The provision of Primary Percutaneous Coronary Intervention (PPCI) is governed under the Acute Coronary Syndrome (ACS) Clinical Programme. A number of sites, including Limerick, are proposed for the provision of PPCI and each proposed site must be inspected by the national clinical ACS Programme Lead. It is understood that such an inspection was to take place but it should be noted that it would not be standard practice to inform the SDU of the scheduling of such an inspection or, indeed, of the results of the inspection: this is a matter for the Clinical Programmes in the HSE".

The SDU are following up with the RDO in HSE West to request information on this matter. As soon as I have this I will get back to you

Tango Alpha 51

Phog, this is the HSE we're talking about. Nothing is done normal. The point I'm making is the Cath lab is only open 9 to 5 in the hospital & there is only one or two consultants that can perform the procedure. Up to 3 yrs ago pre hospital thrombylisis didn't exist, now ambulance staff can do that so in essence your chances have vastly improved. The skill level has increased enormously in the last 5-10years as opposed to days of old.

No there is not enough ambulances to cover the region on a normal basis (only 4 vehicles to cover limerick city & county) let alone if one had to go to cork or Galway.

his_dudeness

There are 4 consultant cardiologists in the Regional,(albeit 2 working over two sites, namely one to Nenagh and one to Ennis) all providing cardiac catheterisation during the day.

Brennans Row

Tango Alpha 51 wrote: »

. . . Up to 3 yrs ago pre hospital thrombylisis didn't exist, now ambulance staff can do that so in essence your chances have vastly improved. The skill level has increased enormously in the last 5-10years as opposed to days of old. . .

According to live95fm, an elderly man had to be airlifted to Galway by army helicopter from his County Limerick home after suffering a heart attack last weekend.

The paramedic who responded to the call judged that the patient required an air ambulance and the Army Air Corps helicopter was mobilised.

Obviously the paramedic made the right call here to get him as quickly as possible from County Limerick to Galway. :cool:

I wonder is our system of just sending paramedics out on emergency calls adequate enough to deal with all life and death situations, after all they only have a ten month training.

I'd imagine it still took a few hours for this elderly man before he got his treatment.

A big responsibility for a paramedic during that period of time?

In some European countries, emergency doctors are part of the emergency medical service and are dispatched together with paramedics in cases of potentially life-threatening situations for patients (heart attacks, serious accidents, resuscitations or unconsciousness, strokes, drugoverdoses, etc).

crackcrack30

Brennans Row wrote: »

.

Obviously the paramedic made the right call here to get him as quickly as possible from County Limerick to Galway. :cool:
Correct...
I wonder is our system of just sending paramedics out on emergency calls adequate enough to deal with all life and death situations, after all they only have a ten month training.
Wrong...
I'd imagine it still took a few hours for this elderly man before he got his treatment.
Wrong...
A big responsibility for a paramedic during that period of time?
Correct...
In some European countries, emergency doctors are part of the emergency medical service and are dispatched together with paramedics in cases of potentially life-threatening situations for patients (heart attacks, serious accidents, resuscitations or unconsciousness, strokes, drugoverdoses, etc).

All 999 emergencies are potentially life-Threatening.... :rolleyes:

Hope this helps....

Tango Alpha 51

First of all it was an Advanced Para that made the call. It's takes 2 years to train as a paramedic here, then you have to be 3 yrs post qualified before you can be considered for the AP programme which takes nearly another year to complete. Plenty of countries around the world have shorter training programmes which work just as well. The patient in question would have gone straight to the Cath lab in GUH where the necessary procedure would have been performed straight away resulting in a better outcome for the patient. 99.9% of emergency calls are handled extremely well by the ambulance service here.

Brennans Row

Tango Alpha 51 wrote: »

First of all it was an Advanced Para that made the call. It's takes 2 years to train as a paramedic here, then you have to be 3 yrs post qualified before you can be considered for the AP programme which takes nearly another year to complete. Plenty of countries around the world have shorter training programmes which work just as well. The patient in question would have gone straight to the Cath lab in GUH where the necessary procedure would have been performed straight away resulting in a better outcome for the patient. 99.9% of emergency calls are handled extremely well by the ambulance service here.

I was going on the basis from what I read from the live95fm report (i.e. a paramedic) and the HSE's information where they state that the paramedic programme consists of a ten month training period (o.k. plus a one year operational internship).

I'm not disputing the fact that they do a great job as paramedics, but I'm not convinced that even an advanced paramedic would have the same medical competences as an emergency services doctor?

I don't know how long they had to wait for the helicopter to arrive or how long it took them eventually get to Galway, but in my opinion the normal ambulance transport time for this patient to be treated by a paramedic was exceeded in this case and he should have been accompanied by a medical doctor instead.

flutered

my 2 cents, a while back the hse tried to move the oncology center from the regional to galway, they forgot one thing, the center is funded by a certain jp mcmanus who said if the center moves so does my funding, he also funds the 2 dialisis centers.for years limerick has been shunted aside to upgrade other hospitals, after barringtons was closed with the blessings of our local tds, a while later the regional was downgraded so as uch cork could be upgraded, now limerick is downgraded again so as galway can upgrade, have we heard a whimper from our elected repesentives.

Tango Alpha 51

& what is the normal ambulance time your referring too?

phog

According to the Limerick Leader the unit opens today.

HEART attack victims will no longer be taken by ambulance to Galway for treatment following confirmation that the cath lab at the Mid Western Regional Hospital will operate on a 24-7 basis from today.

What's the betting that I'll get a rush of emails now from the long list or previously silent public representatives telling me what I already know. :mad:

Brennans Row

Tango Alpha 51 wrote: »

& what is the normal ambulance time your referring too?

That would be the minimum time that’s required for an ambulance to get a patient to a emergency department doctor.


I'd imagine a normal time span could unfold as follows . . .

• Paramedic diagnoses patient - 10 minutes?
• Paramedic informs hospital and prepares patient for transport - 10 minutes?
• Paramedic accompanies patient from Castlemahon to Regional Hospital 40 minutes?

So in this case the emergency department doctor takes over from paramedic after 60 minutes.

But I would not be surprised if the airlift option to Galway took altogether at least two hours.

I'm just making the point that an emergency services doctor would have seen that particular patient in his home two hours earlier, if he had been living in Denmark for example.

his_dudeness

Brennans Row wrote: »

That would be the minimum time that’s required for an ambulance to get a patient to a emergency department doctor.


I'd imagine a normal time span could unfold as follows . . .

• Paramedic diagnoses patient - 10 minutes?
• Paramedic informs hospital and prepares patient for transport - 10 minutes?
• Paramedic accompanies patient from Castlemahon to Regional Hospital 40 minutes?

So in this case the emergency department doctor takes over from paramedic after 60 minutes.

But I would not be surprised if the airlift option to Galway took altogether at least two hours.

I'm just making the point that an emergency services doctor would have seen that particular patient in his home two hours earlier, if he had been living in Denmark for example.

What do you suppose this "Emergency Services Doctor" would have done had he arrived on scene an hour earlier? This patient ultimately needed an invasive procedure requiring, at a minimum, a trained interventional cardiologist, a radiographer and nursing support staff, not to mention the facilities that would not be in every patients home. Paramedics and APs can and do ECGs, which give the early indication of definitive treatment, and can prescribe and give the initial treatment. The addition of an emergency doc in this setting would not have added to this patients treatment and would just mean another potential victim if the ambulance was invovlved in the crash!

Docs are sent out to scenes of major accidents and multiple casualities, where on-site triageing of patients is needed to ensure that those that are sickest are the first on to amublances and brought to hospital. Major Emergency Plans exist for all hospitals. The docs that attend the scenes can be either Emergency Medicine Consultants and in some cases GPs.

While I'm on a bit of a rant...there are no emergency doctors available to stick in the back of ambulances. There is trouble enough to keep doctors on the island working in our hospitals; sending them out to do jobs that APs and paramedics are more than capable of doing is redundant. The only benefit of sending a doctor along in an ambulance would be to potentially see the patient, and decide that they don't need to go to hospital! Which is exactly why groups like ShannonDoc have some of their GPs in jeeps going around the region!

crackcrack30

'But I would not be surprised if the airlift option to Galway took altogether at least two hours.'


Chopper - Galway to castle mahon 16minutes. (on site that day)
On scene/ground - 15 minutes
Castlemahon to Galway- 16minutes

Brennans Row

his_dudeness wrote: »

What do you suppose this "Emergency Services Doctor" would have done had he arrived on scene an hour earlier?

Firstly, a part from once doing a basic first-aid course many years ago I know absolutely nothing about medicine.

I'm not belittling our emergency services in any way.

I'm just trying compare two systems, where ours seems to based on the Anglo-American paramedic ambulance service as compared to the European ambulance model that includes an emergency services doctor.

The latter emphasises on giving the best qualified diagnosis and treatment first, before moving the patient to hospital.

There was some discussion a few years ago about introducing emergency services doctors in Ireland but I could not find anything online, but I did find this article from the Irish Examiner.

Emergency doctors ‘could cut A&E admittance by 31%’

By Stephen Rogers Wednesday,April 16, 2008

A STUDY by researchers in the Cork University Hospital has shown the attendance of emergency medicine doctors could reduce by as much as a third the need to admit patients to overcrowded A&E units.

A rapid response team, consisting of a specialist emergency medicine registrar and a paramedic was introduced on allotted days to respond to
999 calls in a rapid response vehicle to see if that would improvepre-hospital care and reduce unnecessary emergency department (ED) visits. According to the report on the operation in the Irish Medical Journal, 263 patients were seen on designated days between January 2004 and March 2006. Among the presentations were road traffic accident (23%), collapse (12%), fall (10%) and seizure (8%).

The majority of calls were to houses (36%). In 62% of cases, the team arrived in advance of the ambulance and the research found it was possible to safely discharge 31% of patients on scene.

"Patients discharged at the scene had their GP notified or a scheduled ED review appointment made. GPs were given the option to arrange ED review if they felt it warranted having seen the patient — this option was not availed of in any case," said the authors.

"Paramedics or advanced paramedics are not currently permitted to discharge patients at the scene — all patients encountered must be transported to hospital.

"This practice has significant cost and human resource impact on both the ambulance service and the ED. It is also recognised that patients arriving at the ED by ambulance use significantly more resources than their walk-in counterparts.

"In our experience, skilled emergency medicine doctors attending at scene could provide advanced care and reduce ambulance transportation and patient attendance," said the authors.

They said opportunities for hospital-based emergency physicians to gain exposure to pre-hospital care are limited. "The project provided an opportunity for ambulance personnel to work with physicians and served as a method of improving liaison between the ED and the ambulance
service. The need for improved liaison between GPs and paramedics in Ireland has been identified; during this project GPs were communicated with directly by the ED registrar.

"We conclude pre-hospital utilisation of an emergency medicine doctor facilitates reduction in patient presentation to the emergency department
and facilitates a heightened level of medical care for patients."

crackcrack30

In an ideal world a prision officer would be chasing criminals and bringing them straight to jail.........A midwife would attend every emergency delivery.....only firemen would be allowed to use matches...... and Ronald McDonald would be wearing a butchers apron

Your points are begining to meander......

Brennans Row

crackcrack30 wrote: »

. . . . Chopper - Galway to castle mahon 16minutes. (on site that day) . . . .

In what capacity where you there on site that day?

phog

crackcrack30 wrote: »

'But I would not be surprised if the airlift option to Galway took altogether at least two hours.'


Chopper - Galway to castle mahon 16minutes. (on site that day)
On scene/ground - 15 minutes
Castlemahon to Galway- 16minutes

Am I reading this correctly? Just 16 minutes elapsed from time of initial request for helicopter to it being on the ground in Castlemahon. If that's the case then fair dues to all concerned, however, I still cant see why it should ever have come to this.

phog

crackcrack30 wrote: »

In an ideal world a prision officer would be chasing criminals and bringing them straight to jail.........A midwife would attend every emergency delivery.....only firemen would be allowed to use matches...... and Ronald McDonald would be wearing a butchers apron

Your points are begining to meander......

No one is looking for the ideal world but surely the Mid West Regional Hospital should be capable of dealing with the heart attacks mentioned above. We're not talking about a back street hospital here we're talking about the main hospital for most of Clare, Tipperary, Kerry and Limerick.

crackcrack30

That reply was to b-row @ post 15.30 yesterday.......

The Chopper was on site at galway dropping off a pt at uch galway on the day in question.

Brennans Row

crackcrack30 wrote: »

'But I would not be surprised if the airlift option to Galway took altogether at least two hours.'

Chopper - Galway to castle mahon 16minutes. (on site that day)
On scene/ground - 15 minutes
Castlemahon to Galway- 16minutes

crackcrack30 wrote: »

That reply was to b-row @ post 15.30 yesterday.......

The Chopper was on site at galway dropping off a pt at uch galway on the day in question.

I honestly understood that you were on site that day in Castlemahon.

When you say the Chopper was on site at Galway dropping off a pt at UCH Galway on the day in question.

Does this mean that helicopter happened to be in Galway when it received the call to fly to Castlemahon?

phog wrote: »

Am I reading this correctly? Just 16 minutes elapsed from time of initial request for helicopter to it being on the ground in Castlemahon. If that's the case then fair dues to all concerned . . . .

I see that the Air Corps Emergency Aeromedical Service is based at the Custume Barracks in Athlone.

A helicopter round-trip (Athlone-Castlemahon-Galway) must be around 250 Km?

A helicopter round-trip (Galway-Castlemahon-Galway) must be around 200 Km?

A EC135 helicopter has a cruising speed of around 250 Km/h?

crackcrack30

There very well may still have been a chopper requested for the call in castlemahon, and I'm sure this would definitly been considered even if a PPCI centre was available in limerick Regional on the date in question.

We cannot decide where people decide to live or have their heart problems, & the fact that castlemahon is at least 30-40 minutes away by road would not go unnoticed.....(BTW don't think it was the ec135) .

Tango Alpha 51

It's an AW139 with a top speed of 300knots but that's semantics. There is a window of 90mins from when a STEMI is diagnosed to being treated in a PCI centre. The chopper was in GUH & was on scene in Castlemahon within 20mins. It was on the ground less than 10mins & the patient was in the PCI centre again within 20mins flight time, well within the 90min window. The reason i know is I was one of the ambulance staff on duty that day. Now the PCI centre in Limerick is open so it doesn't really matter anymore.