Liver injury to boy proves new hospital deals with major trauma, Health Committee told

Published: 28 Sep 2012 08:50

DESPITE its rural setting, South West Acute Hospital (SWAH) and its staff are equipped and prepared to deal with all major trauma cases as and when they occur.

Members of the Northern Ireland Health Committee pictured along with Western Trust staff including Dr Jim Kelly (right) during a visit to the South West Acute

That was the message Northern Ireland Health Committee members left with following a visit to the £276 million facility last Wednesday.

The visit provided an opportunity for the Trust to showcase the new hospital and highlight some of the advances and innovations in service delivery now in place.

The committee was treated to a tour of the new hospital where they spent some time meeting a range of staff from a number of hospital departments. The visit also included a presentation from Dr Ian Crawford and Dr Campbell Brown, Consultants in Emergency Care.

Dr Crawford outlined to members a recent major trauma case which presented at SWAH to illustrate the use of ultrasound in the hospital.

"If they were living in a more densely populated environment patients suffering from major trauma would probably bypass a hospital of this size and go to a major trauma centre where all the specialities would be available. But we don't have that luxury here, so we have to be prepared to deal with all major trauma cases."

Dr Crawford described how at the end of July the hospital had received a call from the Northern Ireland Ambulance Service warning staff of an impending arrival, a seven-year-old male patient who had fallen off a horse and had been trampled on.

The patient had initially been taken to the Urgent Care Centre at the Tyrone County Hospital in Omagh.

But as he was considered a major trauma case, an ambulance transferred him to Enniskillen.

Dr Crawford told the members that ahead of the patient's arrival, a consultant anaesthetist, a consultant surgeon, two consultant paediatricians and a consultant radiologist were on stand-by.

They noted bruising around his stomach and that his heart rate was fast and his blood pressure low.

The Committee Members were told the senior team found the patient to be too ill to be moved safely for a CT scan.

However an X-ray and an ultrasound were conducted.

While the X-ray showed that his chest looked normal, the ultrasound showed fluid around his liver, indicating active bleeding.

He was immediately transported to theatre.

Dr Crawford said this was all done within 30 minutes from the patient's arrival at SWAH.

He explained that during the operation, surgeons found the boy's liver had been split in two.

The operation was successful and the patient was stabilised.

He was subsequently sent to the Royal Victoria Hospital's Paediatric Intensive Care Unit and was able to go home after eight days of hospital care.

Dr Brown told Health Committee members that this was an exciting time for emergency medicine.

"When I started in medicine, none of the emergency departments had ultrasound and you had to get a radiologist to do it for you."

He said though, that since the 1980s, ultrasound has gradually become the norm in emergency departments and now larger volumes of staff were opting to get more extensive training in its use.

Dr Brown said one of ultrasound's particular benefits is that it is non-invasive and as such is safe to use on most patients. In emergency departments this particular scan is now used daily for assessing trauma patients, abdominal aortic anurisms and vascular and heart problems.

"There is certainly no doubt it saves money and provides a more efficient and safer service to the patient," he said, "In the example of the boy, straight away we knew there was blood around the liver and we were able to treat it quickly."

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