HSA controls A&E care for trauma patients
(CNS): The Health Services Authority (HSA) has said it is responsible for providing emergency care across the three Cayman Islands and coordinates with Health City Cayman Islands in emergencies to transfer patients when necessary. But it seems that in the first instance, no matter where an emergency occurs, unless it is cardiac related, patients carried in HSA ambulances will almost always be taken to the ER in George Town before being transferred to HCCI, even when an accident occurs in the Eastern Districts.
The question of which emergency room people are transported to if they suddenly become critically ill or are involved in an accident has been dominating local social media platforms and talk radio this week following the death of motorcycle rider Kashwayne McKenzie. After a major crash at Parker’s Raceway in Breakers, where he was criticality injured at the weekend, McKenzie reportedly died in the ambulance during the ride to the hospital in George Town.
While there is no indication that taking McKenzie to the closest emergency room at Health City would have saved his life, the HSA has still not fully explained the protocols regarding the use of the HCCI in the case of emergencies.
There have been numerous occasions where an ambulance dispatched from the government hospital to a crash in East End passes the Emergency Room at HCCI on the way back to George Town, only to take the patient back to East End following triage at the HSA facility.
Speaking at a press briefing on Wednesday, Health Minister Sabrina Turner, Chief Officer Nellie Pouchie and the HSA CEO Lizzette Yearwood all said the emergency protocols were being reviewed. However, they all agreed that it is not as simple as sending a patient in need of emergency care to the closest emergency room.
However, HCCI has had a fully functioning and approved Emergency Room and Urgent Care Centre for more than four years, so it is unclear why protocols to include the East End A&E have not already been adopted.
Yearwood said the HSA is continuing to review the situation, but she reassured the public that the government hospital has a fully operational emergency room that meets international standards and can deal with all and any emergencies.
The HSA A&E is a Level 1 Trauma Centre, comparable to any major medical facility in the UK, US or Canada. It has the capacity to deal with mass casualty and disaster situations, multi-trauma, domestic violence and sexual assault. It also has the capacity to deal with patients with mental health issues or infectious diseases or who are immuno-compromised.
“Historically, the HSA has been the only national provider of life-threatening multi-trauma emergency care in the Cayman Islands,” HSA Medical Director Dr Delroy Jefferson said in a statement responding to the public concerns about how ambulances are directed.
“HSA has always welcomed efforts by other healthcare providers capable and willing to play a role in filling any identified gaps in emergency care. For many years there has been, and still is, a collaborative approach between HSA and Health City Cayman Islands (HCCI) to coordinate emergency medical patient transfers based on the patient’s medical condition,” he added.
HSA officials have explained that the EMS service is dispatched by 911 and the team of pre-hospital care professionals provides assessment and treatment, and transports the patient to A&E. Throughout the event, the EMS team communicates with the medical control team at the A&E in George Town. Based on the clinical assessment, patients can be diverted to Health City Cayman Islands (HCCI) in consultation with physicians. This transport protocol requires communication with HCCI to advise them of the patient’s clinical needs.
But Health City’s Emergency Room is approved by the Health Practice Commission to provide emergency and intensive care services. It has six beds and is open 24 hours a day, seven days a week and is fully staffed around the clock by ER physicians.
“Our ER physicians are qualified with Masters in Emergency Medicine and capable of managing various medical emergencies, including where there is trauma, involving multiple organs,” the HCCI said this week in response to CNS inquiries. “Our ER physicians are supported by a team of nurses who have experience working in advanced trauma centres prior to joining Health City.”
Clinical Director Dr Binoy Chattuparambil explained that most patients who are being transported by the government ambulance by protocol do not arrive at Health City. “We continue to have dialogue with the relevant authorities to ensure during circumstances where there is threat to life or limb. Health City can be an option when in the Eastern Districts. We look forward to our partnership with government and the HSA to make this a reality,” he said.
All emergency patients are treated at HCCI at the point of need, regardless of their insurance status, just as they are at HSA.
“Individuals in life-threatening scenarios who reach our facility by private vehicle are treated. We accept all of the private insurance on island and there is no issue with individuals with private insurance availing themselves of our services. The process is simple: if the individual has threat to life or limb, we accept and treat. As with any other hospital, we deal with the insurance circumstance in due course,” Dr Chattuparambil added.
However, the issue however is more complicated for those covered by CINICO and Caymanians who are under-insured or without insurance whose medical tab at the HSA will be by the government. But there does not appear to be an agreement in place between the government and HCCI regarding payment for these groups of people if they are treated at Health City in an emergency.
Describing this as a “grey area”, Dr Chattuparambil said the complications arise with CINICO patients who arrive at HCCI ER without a formal HSA referral. “The after-the-fact payment may be declined, as the protocol indicates a referral is needed,” he explained. “This once again is an area that we thank the chief medical officer and HSA for the ongoing discussion towards the best outcomes for Caymanians and other residents.”
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Category: Health, Medical Health
Anyone else waiting on a PSA from the RCIPS telling residents of the Cayman Islands to avoid getting into accidents past Breakers since an ambulance will likely need to drive from town and back?
It’s 2022 FFS why is this island perpetually stuck in the 70s/80s? (Rhetorical question)
BLVCKLISTED _ “Avoid accidents” ? Right! The fact that an accident occurred proves it was unavoidable – for whatever reason. Also, in many ways these islands would be good to be stuck in the 70s/80s.
Not true. There’s an Ambulance in North Side
somebody somewhere surely must put something in place where, when a casualty has life / death injuries which need immediate attention or they may die, they must be something in place to take them to the nearest hospital? regardless or referrals? insurance? money? LIFE OR DEATH HERE. To pass a hospital on your way to another hospital who probably cant even treat that injury which arrives only to be sent to Shetty. is ludicrous.
somebody somewhere hasn’t covered all the angles. World class? I think not.
I would say that if it is not criminal then it is against Human Rights. Maybe the Commission could take this up.
Sad! Protocols and/or outdated policy is hindering care. And so many highly paid managers won’t see past their egos. Think of the amount of time wasted in traffic by EMS to take someone from the eastern districts to GT to then take them back to HCCI!
In an emergency, getting a referral should not be on the to do list.
A referral would not be needed if people paid their medical bills. Unfortunately they don’t and will expect HCCI to absorb costs just like they do with HSA. Also 50% of our residents hail from a country who think we owe them something, always cry poverty but have the latest cellphone, false nails, hair and now eyelashes.
Common sense (or complete lack thereof) strikes again in Cayman, Shocking I tell you ! Cayman is dying by its passion for red tape , unfortunately this time it took a life that needed every second to maybe be saved !
And our ministers are dreaming about developing medical tourism whereas we still have such gaping holes in terms of emergency care ! Good luck advocating Cayman as a medical tourism destination with that form of a track record!
Extreme Sports trauma facilities and quality and density of emergency services are a few of the determining factors used when investors evaluate a destination for a facility , no wonder that many hesitate at the last second when they realize how sparse the coverage actually is and the knowledge that HSA won’t send patients your way in case of an emergency to your E.R because “reasons” is probably the last straw!
No where in the Hippocratic Oath it states insurance first. Clearly there’s a conflict here and someone or our policy makers failed this young man, his children and his family.
Our policy makers are so fixated to increase revenue yet they forget the basic and fundamental aspect of life and that is the human care of your sick and elderly.
Is the A&E at HCCI a Level 1 Trauma Centre? if it isn’t then the social media brouhaha is all for nought.
Nowhere is it being said that HCCI is a TRAUMA Centre.
The answer to your question is clearly stated in the story!
It isn’t and all of these idiots can’t seem to comprehend that.
https://www.healthcitycaymanislands.com/cayman-islands-trauma-team-saves-impaled-car-accident-victim/
Have read guys
Nope, they are not trauma anything.
Don’t care. They might have saved this one guy.
Poor Tony died on his bike few years ago on his way to work. He was a HCCI worker but had to wait for a GT hospital ambulance to arrive and take him back to GT.
So even if you work there they ain’t collecting you in no emergency.
Please have a look into this issue it is really horrible.
R.I.P. to all the ones who could’ve been saved!!!
when civil service incompetence can cost lives…
What a pile of BS!! What in the world would these so called “managers and directors” know about a level 1 trauma center in the US. They’ve never step foot in one.
People I can assure you neither HSA or HCCI is a level one trauma center but besides the point. So much for doing everything they can to save lives. I’m sure when their loved one is in the back of ambulance things will change. Not surprised at the remarks but this is not a game. Stop with the egos and pride man. Smh
another glorious day for the civil service….
and another story that produces more questions than answers….basic questions that will never be answered.
welcome to wonderland.
I lived on East End, and am under the care of a cardiac specialist at Health City. When I had a serious cardiac event at home and called 911, even though I told them my Dr was at Health City, they still took me all the way into town to the HSA. This seriously delayed my care and the access to the emergency medications I needed. I was lucky and made a full recovery, but if I had worsened in the ambulance during that 45 minutes I could have died. Health City was only 5 minutes away and we drove right past.
Next time I might not be so lucky. So we’ve moved closer into town to be nearer the hospital because the ambulances won’t take emergencies to a hospital that was only a few minutes from my house.
EMS literally has no choice nor do the patients the majority of the time. It all depends on whether they get clearance from the doctor in the ER to take anyone to health city. Very unfortunate indeed… playing games with peoples lives but I can guarantee you the same rules implemented by the HSA have been broken for HSA managements family and friends.
I would say that common sense is not common at all anymore. Neither is rationality nor practicality. Most people nowadays think with their emotions more than their heads, which often leads to a bad outcome. The top priority is saving life and health so that proximity can be critical. All trauma alert patients go to the closest trauma facility. Stroke and cardiac alert patients go to the nearest cardiac or stroke facility.
Wow!. Just wow! So basically, Policy, Protocols and “gray areas” have added to a bad situation, thus making it worse, and robbing this young man of any possible chance of the URGENT care needed which may have helped him.
And to add to this, persons with Cinco might have to pay out of pocket if they arrive at HCCI by private car because they weren’t referred. I understand the need for a referral; but in the case of a serious incident and that being the closest health care facility, let common sense prevail and just help.
HSA, Cinico and the minister for health needs to make the necessary amendments. It can be done just as quickly as they vote to increase their pay!!
It is painfully clear that common sense and proactive thinking is lacking throughout CIG and the various Authorities.