Hospital ? Or Health Centre ?

Every big country town in Australia has what is termed a " District Hospital " which dispenses basic medical services - and delivers emergency care. There is growing concern that the hospital at Pambula on the New South Wales south coast will have it's emergency department staffed by nurses and there will be no doctor available.   To get the services of a qualified doctor, patients will need to be taken to Bega hospital and that delay will add a critical time risk.

Of course this is simply at outcome that arises from an over stretched health dollar. There is a growing tendency to rename these smaller country facilities as a " Health Centre " rather than use the term " Hospital ".   In many areas a local doctor in private practice is also the on-call doctor at the local hospital who delivers emergency aid, but we are seeing many country towns that now lack any sort of resident local doctor.   In such circumstances, it is hard to see how a sign that declares that the hospital accepts emergency patients can be justified.

This seems to be part of the general contraction of medical services to a central focal point. There is logic in concentrating all the very expensive equipment needed to treat patients rather than scattering it widely and that can be partly justified by the use of air ambulances.  Those life saving medical helicopters whisk patients to fully equipped hospitals rather than leave them in the hands of the basic facilities available in a small country hospital more used to minor surgery.

It all seems to be a matter of balance, and unfortunately there is a downside.  We consistently hear of events such as " trolley block " when ambulances are queued up outside a central emergency room because the number of patients presenting is beyond the scope of the facilities to deliver immediate attention.   Perhaps the emergency situation in the city of Wollongong serves to illustrate that point.

Decades ago this city was served by three major hospitals - Wollongong central,  Port Kembla and Bulli and all three had functioning emergency departments.   Port Kembla served the southern industrial area and Bulli the northern suburbs, and one by one those emergency departments were closed and all patients treated at the hospital in central Wollongong.

The choke point that is now a problem is caused by the necessity of ambulance crews to deliver their charges to a central point, rather than distributing them on the basis of degree of emergency.  Trained paramedics are quite capable of using the triage system used at emergency reception and with a dispersal to emergency rooms on the basis of need that central emergency room would function as the treatment for severe cases with less pressure.    It would also prevent those with minor needs waiting interminably on gurneys and ambulance block preventing our ambulance fleet from delivering needed services.

What is being eroded - is flexibility !    It is the " one size fits all " approach and it is quite clear that this crumbles under peak load.   In the case of Wollongong, this city now has a number of very good private hospitals capable of treating this overload if a suitable Medicare reimbursement can be negotiated.   It is simply the imposition of inflexibility in herding the masses through a single emergency room that is creating this choke point !