Mon | Jun 17, 2019

Editors' Forum | Crash trauma cripples hospitals - One in three emergency cases is crash victim

Published:Sunday | May 19, 2019 | 12:23 AMErica Virtue - Senior Gleaner Writer
Dr Nicole Dawkins-Wright, emergency physician.

Road crashes have forced the Government to spend billions of dollars on treatment annually, but attendant costs such as diagnostic services, hospital occupancy, physiotherapy and emotional trauma are taking a heavy toll on the country’s healthcare personnel.

Despite professional training and experience, healthcare personnel who are among first responders are traumatised by the severity of injuries from crashes, road-safety officials told a Gleaner Editors’ Forum on Thursday. Crashes have taken more than 160 lives up to May 16 and have scores of others with injuries requiring emergency surgery and long periods of recovery.

Dr Nicole Dawkins-Wright, emergency physician and representative of the Ministry of Health and Wellness at the forum, said crash victims and related injuries represented 30 per cent of the emergency cases in Jamaica’s hospitals.

“From my perspective as a care-giver, I am an emergency physician, and as such, I am on the floor. This is a subject matter that really comes home to me, because it’s not on command that we sit and wait for crash victims to come,” said Dawkins-Wright.

“This is a very high number, when compared not just to Sweden and the other First-World countries, but to other countries in the world of similar socio-demographic characteristics, our numbers tend to be on the high side.”

Injuries occurring from road crashes are among those called “non-intentional”, requiring significant surgical and emergency management time in treatment.

“Even though, for greater than a decade, we have recognised that injuries are a significant part of what we manage in the emergency department and our surgical services and intensive care units (ICU), as significant as it was then, it is likely to become more so, because … the numbers are coming in, and with more critical injuries, so they can’t be treated, in the other settings that we are not capturing on our data base,” the physician explained.

While she did not present a definitive monetary costs, she insisted that they were “very high”, indicating that even she had doubts that official estimates captured the on-the-ground realities.

“… I know that local studies, commissioned outside of the MOH, point to a figure, which we probably anticipate is an underestimation of the real cost of care … . The data coming out of the six hospitals show the estimate of $2 billion to $3 billion per annum,” she told the forum.

$1.4 billion to treat victims

Paula Fletcher, National Road Safety Council (NRSC) executive director, said a Cost of Care study done in 2015, but published 2017, showed that the estimated direct medical cost for road traffic crashes was $1.4 billion in 2015, with knock-on indirect productivity cost of $1.8 billion.

The study was conducted by the Violence Prevention Alliance at The University of the West Indies.

The only definitive study to date, Fletcher said, showed the average cost of treating a motorcycle victim of $260,000 then, although some cases reach stratospheric highs of $2m.

“It all depends on the severity of the injuries, because you have a lot of head and spinal cord injuries, and those are among the costlier aspects of hospital care, neurosurgeons. For pedestrians, the average costs is $170,000; pedal cyclists, $120,000; and passengers in motor vehicles, $94,000,” Fletcher stated.

Dawkins-Wright said the personnel required for treatment were highly specialised and came with a high cost at all phases of care. Emergency care was among the most expensive points of hospitals intervention, often requiring CT scans with a price tag of up to $30,000. Two scans are often required, and multiple injuries involve multiple imaging, she said.

“… When one comes in, everything else is at a standstill. The whole staff must participate in that level of management in those couple of hours, then move that patient on because it now becomes a surgical condition, which now impacts the operating theatres.

“These are the cases that bump off everything from your elective and schedule list, and emergency surgery numbers are now packing up,” she stated, illustrating the direct impact on wait times and cancellation of scheduled surgeries.

Beyond those costs, however, are psychological and mental health costs, said Dawkins-Wright.

“It tends to be a predominant male population who are breadwinners, households in the family, children in schools are affected, and what then happens there are mental-health complications for the whole household,” she stated.’

Last Sunday, Nurses Association of Jamaica President Carmen Johnson lamented that trauma overload was contributing to burnout of the island’s nursing staff.

erica.virtue@gleanerjm.com