Trauma units like war-zones, says SA doctor


‘Trauma cases at epidemic proportions in Western Cape – sometimes you go in there on a Monday and the place looks like a war-zone’

 Cape Hospital trauma units under threat warn doctors With trauma cases ‘reaching epidemic proportions’ in the Western Cape, medical authorities are becoming desperate to find quick-fix solutions, such as wanting to merge the medical-emergency units of its tertiary hospitals with its highly specialised, heavily-overburdened trauma units. Cape Town’s legendary Groote Schuur Hospital – where foreign doctors often are sent to learn how to run trauma units — last year treated 11,000 patients for trauma: 4,092 for serious assaults, 2,200 from traffic accidents, and 580 patients with gunshot wounds…  Countrywide, SA public hospitals treated 127,000 bullet wounds…


Melanie Gosling of the Cape Times, reports  on July 14 2009 that top Western Cape doctors have slammed the provincial government plans to merge the highly-specialised trauma units of their tertiary hospitals with their emergency departments as ‘completely bizarre’. 

The Western Cape’s health department wants to merge the overloaded casualty sections at its top tertiary hospitals with these highly efficient trauma units. However,  these authorities also reject experienced doctors’ warnings that this will  greatly compromise trauma patient care, Gosling writes.

Currently the Groote Schuur Hospital in Cape Town, the Red Cross Childrens’ Hospital in Rondebosch and Tygerberg Hospital in Parow all have dedicated trauma units to deal with complex trauma cases that need highly specialised treatment for serious motor vehicle accidents, assaults, stabbings and gunshot wounds. Emergency departments at these hospitals concentrate on entirely different medical emergency, namely the treatment of heart attacks, pneumonia, asthma, diabetes etc. Groote Schuur’s emergency department treats a monthly 3,000 such patients.

Groote Schuur: 580 patients with gunshot wounds last year:

DrudeClive_ArgusBike_Race_AttackSurvivorFeb62008 A typical trauma unit case in Cape Town: cyclist Clive Drude, who was attacked in a bizarre, very violent assault during the annual Argus Cycling Competition in February 2008. Groote Schuur’s trauma unit treated just under 11,000 such patients that year, of whom 4,092 just like Clive, had been seriously assaulted, 2,200 had been in motor vehicle accidents and 580 came in with gunshot wounds. Having a specialised trauma unit increases such patients’ survival rates by between 20 percent and 30 percent, the hospital records show.


Trauma on a par with HIV as a killer in South Africa:

Gosling writes that ‘trauma cases are increasing in South Africa, where the trauma rate is the second highest in the world after Colombia, and doctors say trauma is on a par with HIV as a killer.”

She quotes Professor Ken Boffard, president of the Trauma Society of South Africa, who has written to the Western Cape Department of Health as stating: "I would strongly advise that the decision to merge the emergency department and the trauma unit at Groote Schuur Hospital be very carefully reconsidered, with much wider consultation."

Boffard said it had been shown nationally and internationally that where a dedicated trauma unit existed, the mortality rate was "substantially lower than even the large general academic hospitals".

‘The trauma load is massive:’ … ‘it looks like a war-zone’.

Gunshot Head Trauma_TraumaSocietyOfSouthAfrica_log A typical gunshot wound in SA is often inflicted from an AK47 bullet. Countrywide, 127,000 bullet-wounds were treated at the country’s trauma units. The vast majority are never reported to the SA Police. Picture: Trauma Society of South Africa.

Professor Del Khan, head of surgery at Groote Schuur, also said while he fully supported the establishment of central emergency medical facilities at secondary and smaller hospitals, this centralised system "has no place in major tertiary hospitals where we have well-established trauma units.

  • “Trauma has reached epidemic proportions in the Western Cape. The trauma load is massive: motor vehicle accidents, violence, assaults, gunshots. Sometimes you go in there on a Monday and it looks like a war zone," Khan said.

The authorities ‘should increase resources to the creaking casualty section…’ instead of their plan to merge casualty and emergency departments:  "The real problem is the medical emergency side which has been overwhelmed with the workload. The only thing needed at Groote Schuur’s emergency unit is to increase resources," Khan said.

The provincial health authorities have insisted that their proposal does not mean a merger of casualty and trauma units, but a "re-organisation of hospital emergency services". They say they plan to develop a "more integrated way of managing emergency services" with one emergency centre at tertiary and secondary hospitals, with specialised units attached. Beth Engelbrecht, deputy director-general of of the Western Cape Health Department, said emergency services were "too fragmented".

“Trained nurses not doing anything in trauma units… but in emergency, nurses are over-strained…’ claims Beth Engelbrecht of the WC health department…

  • "There is no one in charge. I have travelled in ambulances to get some sense of what is going on," Engelbrecht said.  "We’ve got trained nurses not doing anything (in trauma) but in general emergency the nurses are overstrained. In one part they are playing computer games and in the other one are long queues. Patients are waiting hours on end in casualty," Engelbrecht said.

Engelbrecht said the trauma unit would be "positioned alongside" the emergency centre. Patients would be referred from the central emergency centre to the trauma centre. No extra staff would be hired.

Doctors slammed this however as ‘ a return to the inefficient pre-1980 system. The two sections, casualty and trauma, were amalgamated in the old days and it was a disaster," said one doctor, who did not want to be identified.

You need to be geared up for trauma with a team that’s available 24 hours…

  • "They could not cope. They had patients like diabetics and asthma cases and then a gunshot chest. You can’t work like that. That’s why the two split. You need to be geared up for trauma with a team that is fresh and available 24 hours. Now they’re trying to undo the specialised trauma system, when the real problem is that they have slashed the beds in casualty."

Khan said trauma surgeons could train only at institutions accredited by the Health Professions Council of SA. Groote Schuur’s trauma unit was in the process of being given accreditation.

  • "If we go down the route they (provincial authorities) want, we won’t get accreditation and we won’t be able to train trauma surgeons at Groote Schuur," Khan said.

Groote Schuur’s trauma unit is internationally recognised and has a patient survival rate on a par with the most developed countries. Doctors from the UK and Europe came to work at the unit for six moths or a year to learn from South Africa how to manage trauma. "The UK is now going down the road of having trauma units like ours and Professor Andy Nicol, the head of Groote Schuur’s trauma unit, has been asked to go to the UK to tell them how it’s done here," Khan said. This proposed centralisation of emergency services will happen only in the Western Cape, Gosling writes on Page 1 of Cape Times on July 14, 2009 ‘Hospital trauma units under threat’

Groote Schuur Hospital also gets a lot of medical tourists from abroad:

About Adriana Stuijt
Retired South African-Dutch journalist formerly Sunday Times Johannesburg

One Response to Trauma units like war-zones, says SA doctor

  1. Pingback: Asylum seekers from SA: case studies 2011 « Space van Adriana

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