Trauma Consultation – Frequently Asked Questions¹

Definitions and Technical Terms

1. What is the definition of major trauma?

  • Major trauma involves high severity injuries which have the potential to cause prolonged disability or death
  • This includes injuries such as knife and gunshot wounds, injuries to the head and spine, falls, road traffic collisions and severe burns.

2. What is the Trauma Review Implementation Group?

  • The Trauma Review Implementation Group (TRIG) is the group set up within the HSE to drive the implementation of the recommendations of the report of the Trauma Steering Group prior to the establishment of the National Office for Trauma Services, due to be in place in early 2019.
  • The TRIG developed the document detailing the proposals at the centre of this consultation process.

3. What are the Service Specifications outlined in the document?

  • The Service Specifications outline in detail what trauma-related services will be delivered in Major Trauma Centres and Trauma Units
  • All Major Trauma Centres and Trauma Units will be required to attain and maintain the level of service outlined in their respective Service Specifications. The proposed draft Service Specifications were developed to reflect and summarise the detail set out in the report of the Trauma Steering Group.

The Future of Trauma Services:

4. What was recommended in the report of the Trauma Steering Group, A Trauma System for Ireland?

  • The report recommends the establishment of an inclusive trauma system, and sets out key recommendations for the organisation of trauma care and the provision of patient-centred trauma services
  • A key step to deliver this trauma system is the designation of two Major Trauma Centres. These will work with Trauma Units located across the country as part of two hub-and-spoke networks. The report of the Trauma Steering Group outlined that one Major Trauma Centre should be based in Dublin servicing the Central Trauma Network, with another based in Cork University Hospital servicing the South Trauma Network
  • The designation of hospitals as Major Trauma Centres or Trauma Units is contingent on meeting the respective Service Specifications.

5. What is a trauma system?

  • Trauma systems allow for the coordinated, integrated and standardised delivery of care to trauma patients. There is strong evidence that trauma systems lead to: better patient outcomes in terms of reduced death and disability; access to quality services, and; cost effectiveness
  • ‘Inclusive’ trauma systems, similar to the proposed model, integrate the trauma care pathway in a structured and organised way (Trauma Networks) that optimises resources, care and outcomes for patients.

6. What is a Major Trauma Centre and a Trauma Unit and how do they fit into a Trauma Network?

  • A Trauma Network is a coordinated integrated system within a defined geographical region delivering care to injured patients from injury through to recovery
  • A Major Trauma Centre provides the highest level of specialist care and clinical and organisational leadership within a Trauma Network. It is a multi-specialty hospital on a single site
  • A Trauma Unit provides a high level of trauma care as part of a Trauma Network but does not have the same range of clinical specialities as a Major Trauma Centre.

7. What would change with the introduction of an inclusive trauma system?

  • Currently, 29 Emergency Departments provide care to trauma patients. There is inconsistency in the level of care provided and patients are being brought to hospitals that do not have the range of clinical services appropriate to their needs
  • Under the proposed model of an inclusive trauma system, trauma services will be coordinated via the Trauma Networks and clear protocols and procedures will be in place to support the hospitals and ambulance services in ensuring that patients are brought and / or transferred to the appropriate facility for treatment in line with their care needs.

8. Why have two Trauma Networks as opposed to one?

Given the geographical spread of the population, the availability of only one Major Trauma Centre in Dublin would inevitably lead to access challenges and the subsequent potential for a poorer service and reduced quality of care. As a result, the report of the Trauma Steering Group recommended that a second or South Trauma Network be established, with its Major Trauma Centre based in Cork University Hospital.

9. I live outside Dublin and Cork, how will this impact me?

A key recommendation of the report of the Trauma Steering Group, and a continued aim of the HSE, is that the trauma system delivers standardised care to all trauma patients throughout the country, irrespective of location.

10. What has been the experience in other countries?

Care for trauma patients in the UK is delivered using a network approach comparable to the proposed model for Ireland. Analysis of trauma registries has demonstrated that the introduction of regional Trauma Networks in the UK has been associated with large increases in survival rates for major trauma patients, with the risk-adjusted odds of a major trauma patient surviving being 25% better in 2015 than in 2012.

11. Which hospitals are to be considered for the Major Trauma Centre and Dublin Trauma Unit(s) for the Central Trauma Network?

Six options have been identified, under the proposed approach and process, for the Major Trauma Centre. They are, in alphabetical order:

  • Beaumont Hospital
  • Connolly Hospital Blanchardstown
  • Mater Misericordiae University Hospital
  • St. James’s Hospital
  • St. Vincent's University Hospital
  • Tallaght University Hospital (Adelaide and Meath Hospital, Dublin)

It should be noted that all of the identified options provide a level of core trauma services. However, no hospital currently has the full range of specialist services as set out in the proposed draft Major Trauma Centre Service Specification

Hospitals that are unsuccessful in being designated as the Major Trauma Centre for the Central Trauma Network will be considered for designation as a Trauma Unit.

12. When will a hospital be designated as the Major Trauma Centre for the Central Trauma Network?

  • Following the public consultation process, the Service Specifications and assessment criteria will be finalised
  • These will then be used by an Independent Assessment Panel to advise which hospital will be designated the Major Trauma Centre for the Central Trauma Network
  • Following consideration of the advice of the panel the HSE will make a recommendation to the Department of Health.

The Public Consultation Process

13. Why is the HSE holding a public consultation process?

Before a decision is made regarding the hospital to be designated as the Major Trauma Centre for the Central Trauma Network, and the other hospital(s) to be designated as Trauma Unit(s) for Dublin, the HSE wishes to ensure there is an opportunity for key stakeholders and the general public to carefully consider and provide feedback on the proposed approach.

14. How do I submit feedback as part of the public consultation process?

  • Feedback can be submitted through an online survey available here
  • A separate feedback process is open for ‘key stakeholders’ in the Health Sector. This feedback process uses the same questions as found in the online survey but the feedback is gathered through a different mechanism.

15. Who are the ‘key stakeholders’ for the public consultation process?

The key stakeholders are the Hospital Groups, hospitals, colleges, clinical programmes and other groups within the Health Sector

The HSE is conducting this consultation process in line with best practice and the Department of Public Expenditure and Reform’s Consultation Principles & Guidance. These guidelines describe how:

  • Targeted consultations may be considered where for example an expert advisory group or people with a substantial interest is required to assist in developing a policy matter – The HSE will therefore be seeking targeted feedback from stakeholder groups in the Health Sector.

16. What happens after the public consultation process concludes?

  • Following the public consultation process, the Service Specifications and assessment criteria will be finalised
  • These will then be used by the Independent Assessment Panel as part of the formal assessment and designation processes
  • Following consideration of the advice of the panel the HSE will make a recommendation to the Department of Health.

Further Information

17. Where can I get more information?

More information can be found in the public consultation document outlining the proposed draft Service Specifications for Major Trauma Centres and Trauma Units, and the proposed approach and process to designate the Major Trauma Centre and Dublin Trauma Unit(s) for the Central Trauma Network. This document can be found here.

[1] Please see the report of the Trauma Steering Group for detailed references to support the FAQs