Nearest Hospital ‘Not Always the Best’

Instead of being rushed to the nearest hospital, an ambulance may, in future, take an accident victim to one that is better equipped and staffed to deal with the injury. 

This means patients will be directed to accident and emergency departments or trauma centres on the extent of their injuries, as well as the capabilities of the hospital.

This is one of the models that a working committee, tasked with improving the trauma management system here, is exploring as it prepares to put its recommendations by the middle of the year to the Ministry of Health.

Dr Chiu Ming Terk, chairman of the National Trauma Committee, said Singapore has relied on the current system of sending a victim to the nearest hospital for years. “And we realised that may not be the best system for the country,” he added.

The trauma surgeon was speaking to The Sunday Times ahead of the 7th Singapore Trauma Conference that started yesterday. He said concentrating severe trauma cases, such as pelvic fractures and spinal cord injuries, to a few hospitals can help staff there build valuable experience and expertise.

The United States, for example, has a five-tier system, where critically wounded patients are sent to a Level 1 trauma centre, which provides the highest level of surgical care. Level 5 centres, the lowest on the scale, may only be able to help stabilise a patient.

Dr Chiu said that the committee is taking a cue from developed places such as the US and Hong Kong, where the tiered system is well-established and shown to have increased the survival rate of severely injured patients.

Experts like Professor Andrew Peitzman, the University of Pittsburg Medical Centre’s vice-president for trauma and surgical services, say studies show it “probably doesn’t matter” which trauma centre a patient with minor injuries is sent to. “But when you have a bad head injury, that’s when (survival) depends on going to the hospital that does a lot of (severe trauma)... You want one hospital that can take care of everything,” he said. 

The tiered system also consolidates the most crucial resources at a few locations, making the system more efficient, Prof Peitzman said.

All public hospitals here generally meet standards equivalent to that of a US Level 3 trauma centre. But some can improve in areas such as training and rehabilitative service, said the Ministry of Health’s director of medical services, Professor K. Satku, at the conference at Tan Tock Seng Hospital yesterday.

“Probably 80 to 90 per cent of trauma cases can be managed by hospitals meeting minimum standards, but we feel there is at least 10per cent of trauma that will require hospitals with greater capabilities and that is what we are trying to work towards,” added Dr Chiu.

Debate over this issue swirled last May when some argued that the victims of a Ferrari crash on Rochor Road should have been taken to the nearby Raffles Hospital instead of the Singapore General Hospital and Tan Tock Seng Hospital.

A group of top experts, including Dr Chiu, later came out to say paramedics did the right thing, as those were the nearest fully equipped hospitals. Dr Chiu added: “With a tiered system, any criticism of that can easily be explained.”