Government questioned on Nepean Hospital trauma protocol

Calling for change: Liu Bianchi and Grant Jannison with Greens NSW Upper House MP Dawn Walker (centre).
Calling for change: Liu Bianchi and Grant Jannison with Greens NSW Upper House MP Dawn Walker (centre).

The state government has been asked in Parliament if it intends to classify Nepean Hospital as a major trauma centre.

Greens NSW Health Spokesperson Dawn Walker asked government MP Niall Blair, representing Health Minister Brad Hazzard, during questions in the NSW Upper House on Wednesday whether the government was planning change the hospital’s status following concerns raised by local paramedics and doctors.

“In 2008 the status of Nepean Hospital was downgraded to a regional trauma centre, despite having the medical expertise and equipment of a major trauma centre,” she stated. “Under NSW trauma transfers protocols this is now effectively diverting patients to Westmead Hospital, resulting in further patient travel and paramedic fatigue in western Sydney.

“Will the government restore Nepean Hospital's classification as a major trauma centre to ensure that the people of the Nepean are not without their paramedics?”

Mr Blair responded saying the issue was complex and he would take the question on notice.

“It is a question that involves some history, detail and a response around what the government may be proposing to do,” he said. “So it is best that I take the question on notice, refer to the health minister for a detailed answer, and come back to the member in due course.”

Paramedics and doctors are campaigning to change Nepean Hospital’s trauma designation in what they say would help save lives currently being put at risk by red tape.

Dr Alan Garner and Australian Paramedics Association delegates Liu Bianchi and Grant Jannison met with Greens NSW Health Spokesperson Dawn Walker on October 9, saying the hospital’s current regional trauma designation forced paramedics to bypass it in favour of major services like Westmead and Liverpool in emergencies.

“There have been cases where patients have deteriorated in transit,” Dr Garner said.  “The ridiculous thing is that we have all the facilities here [at Nepean] already. We’re not asking for more resources or money. All the services required to run a trauma service are already here.

“All we need is the designation to change from a regional trauma service to a major trauma service so that ambulances no longer have to bypass us and they can bring severe trauma patients directly here rather than taking them to Westmead or Liverpool.”

Nepean had previously been able to accept major trauma cases until its designation was changed in 2009, he said.

Ms Walker said she was “quite stunned” by the revelations.

“It seems a ludicrous situation we have at Nepean Hospital,” she said.

As the Gazette revealed in August, the T1 Protocol dictates that when transporting major trauma cases in the local area, ambulances should bypass Nepean Hospital – a regional trauma hospital – and instead take patients to a major trauma service – Westmead, Westmead Children’s and Liverpool Hospitals.

Nepean Hospital intensive care specialist and trauma director Dr Marek Nalos said the situation was leading to many patients injured just minutes from Nepean Hospital tying up ambulances being driven to Westmead.

Ms Bianchi and Mr Jannison said paramedics could then be out of their own areas for hours, as once an ambulance goes to Westmead it could be sent anywhere across Sydney as the first available ambulance.

“We play a game sometimes and see how far we can get from our own station [at Richmond],” Mr Jannison said. 

That meant on-call crews – who may have just completed 12-hour shifts – were left to cover the area, he said.

The state government-affiliated NSW Agency for Clinical Innovation (ACI) released a statement saying the T1 Protocol ensured “any major trauma patient meeting the set criteria for (or potential) major trauma must be transferred from the scene to the highest level trauma service within one hour travel time”.

Because Nepean was a regional trauma hospital rather than a major trauma service, it is effectively out-ranked by Westmead - which the ACI considers relatively close by.

“This ensures that critically injured patients are brought as quickly as possible to the highest level of care, for the greatest chance of early survival and recovery,” the ACI stated. “As Nepean is relatively close to Westmead … a number of patients bypass Nepean as per the protocol."

APA (NSW) secretary Steve Pearce said the situation “would be comical if it wasn’t dangerously risking patients’ lives.”

“It is outrageous that the few intensive care paramedics in the Nepean, Blue Mountains and Hawkesbury areas… are being sent on extended transports to Westmead instead of transporting their patients to nearby Nepean Hospital.”

Mr Jannison said the solution was simple.

“This is a drag and drop situation; you drag the T1 trauma designation and drop it on Nepean Hospital.”