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Emergency Departments

INMO calls for return of mandatory mask-wearing in crowded settings amid record trolley numbers

Over 931 patients are without beds in Irish hospitals today – the highest number since records began in 2006.

LAST UPDATE | 3 Jan 2023

THE IRISH NURSES and Midwives Organisation (INMO) has called on the Government to “make difficult decisions” including the return of mandatory mask-wearing in crowded settings as hospitals struggle to deal with a record number of patients on trolleys.

Over 931 patients are without beds in Irish hospitals today, according to the INMO.

This is the highest number of patients that have been without a hospital bed since the trade union began counting trolleys in 2006.

Thr INMO said that 767 patients are on trolleys in emergency departments and 164 are on trolleys elsewhere in hospitals. Twenty-six children have been admitted to hospital without a bed, the organisation added.

Commenting on the trolley figures, Phil Ní Sheaghdha, General Secretary of the INMO, said: “Today’s numbers require immediate and serious intervention from the government.

“We do not need those at the top to describe how we got here; we need to know what exactly the plan is from today until the end of February.

Just telling people to avoid hospitals is not a plan or indeed safe. The public need to know exactly what type of care they can expect over the next six weeks.

Ní Sheaghdha called on the Government to “make difficult decisions including the return of mandated mask-wearing in congregated settings”.

“We know that one of the main pressure points in our health service is the rise of respiratory infections. Asking people to return to mask-wearing in busy congregated settings is a simple measure.

“Over the coming days we need to see real tangible plans and decisions at a national level about the ensured safety in our acute public hospitals,” she said.

Ní Sheaghdha added that the INMO’s members “are extremely disillusioned by the current set of circumstances they are working in”.

“We are not seeing unsustainable overcrowding confined to a handful of hospitals, each hospital is facing significant overcrowding challenges, a trend which has continued to escalate since late summer. Our members are treating patients in inhumane and often unsafe conditions.”

Jump in Covid and flu cases

The Health Service Executive (HSE) has appealed to members of the public to “consider all care options before going to a hospital Emergency Department (ED) during what is going to be “one of the busiest ever periods experienced by the health service”.

It comes as Covid-19 and influenza cases continue to increase rapidly, while notifications of RSV – which had been declining for several weeks – are also increasing.

Nearly 1,500 people are in hospitals with these viruses today. As of 11.30am, there were 686 patients in hospital with Covid-19, 28 of whom were in intensive care.

Services at several hospitals around the country are under extreme pressure. A consultant at University Hospital Limerick (UHL) earlier today said that conditions in many instances are “inhumane”.

In a statement, the HSE said that some patients will “regrettably” experience long wait times in EDs, but urgent patients will be prioritised for treatment and care.

“Unfortunately, we expect this incline to remain sharply upwards for a number of weeks to come and to continue to seriously impact our hospitals and Emergency Departments,” the statement read.

“While this surge of winter virus infections was predicted and planned for, the trends being seen are following the more pessimistic of predicted models, and also appear to be increasing earlier than had been hoped.”

Damien McCallion, the HSE’s chief operations officer, said in a statement: “As expected, Emergency Departments are becoming extremely busy due to the unprecedented combination of very high levels of flu, Covid-19 and other respiratory illnesses in the community.

“Those who believe they may be seriously ill and require emergency care should of course come to hospital, but we would urge others to consider seeking support from pharmacists, GPs, GP out-of-hours services and Minor Injury Units.

“These services have emergency responses in place for patients presenting with respiratory and other urgent health issues.”

The health service is encouraging people to consider attending a community pharmacy if they feel unwell, or a minor injury unit, which treat injuries that are not life-threatening. A list of these units can be found on the HSE’s website.

The HSE is also encouraging the public to attend their GP or a GP out of hours service. It was announced last week that the Irish Medical Organisation (IMO) has agreed to provide temporary support to GPs to run additional clinics this month amidst rising demand for services due to a surge in winter virus infections.

‘Perfect storm’ of viruses

Speaking on Morning Ireland today, McCallion acknowledged that the situation in EDs across the country is “far from ideal” but that protocols are in place to make sure that the patients in most need get the care they require.

McCallion said that EDs have been experiencing growth in attendances year-on-year but, beyond that, there is currently an “unprecedented spike in relation to the three viruses which has put us into the pressure points that we are in at the moment”.

“So that’s one of the key issues for us as we face into the next number of weeks in terms of trying to manage that in overall terms while we grow capacity in terms of our beds, diagnostics and community staff.

“We are still seeing, I suppose, increased demand year-on-year with growth in population, and also in relation to the increase in aging in our population as well.”

McCallion said there has been investment in the health service in recent years in a bid to deal with these issues, but added there is “no question” that further investment is needed.

Also speaking on Morning Ireland, medical virologist Cillian de Gascun said the current situation is partially due to a “perfect storm” related to viruses post-pandemic.

“Notwithstanding the pressure on the service is that in an ordinary [year], if we look at, say, influenza and RSV, the two sort of big ones that aren’t Cvoid.

Typically, in an average season, we reckon that influenza affects about 15% of the population in any given season. So that’s 15% that wasn’t infected in 2020, 15% that wasn’t affected in 2021, and now 15% [is affected] for 2022. So there’s a far greater susceptible population for influenza.

De Gascun said there are also high levels of two different types of influenza – namely A-H1 (which disproportionately affects younger people) and A-H3 (which predominantly affects older people).

In a typical season, de Gascun said one strain would be more prevalent than the other but, at present, it’s about 50/50.

“The problem is now we’re seeing pretty much a mix of almost sort of 50/50 between those two at the moment, so everybody’s getting infected,” he stated. 

UHL, Mercy and Mater

In a statement issued last night, a spokesperson for the University Limerick Hospitals Group confirmed that the ULHG had “activated HSE operational contingency plans with the National Ambulance Service (NAS) to divert some patients from UHL to other acute hospitals to support extreme levels of demand at UHL”.

The six hospitals in the ULHG are University Hospital Limerick; University Maternity Hospital Limerick; Nenagh Hospital; Ennis Hospital; Croom Orthopaedic Hospital and St John’s Hospital.

The spokesperson said the group “requested that NAS activate those arrangements for a number of hours to support University Hospital Limerick’s response to an internal major incident”.

“Where these procedures are activated, non-critical patients are diverted to the closest alternative appropriate hospital. The most critically ill patients, for example those with suspected heart attack, stroke and those that were medically unstable continue to be conveyed to UHL during this time.”

Screenshot 2023-01-03 07.18.18 University Hospital Limerick (file photo) Google Maps Google Maps

Speaking on Morning Ireland, Professor Declan Lyons, a consultant at UHL, said:

“We’re seeing an accentuation of what we’ve been seeing for the last few years which is chronic and persistent overcrowding in the emergency department.

It’s very difficult, particularly for patients. The conditions in many instances are inhumane, they are not really appropriate for the evaluation of patients who are sick.

“The big worry we have at the moment is that patients who are coming in sick into that environment are not being helped by the environment that we have to assess them in.”

Lyons said that one of his concerns is that it “simply isn’t possible to carry out an optimal clinical evaluation on patients given the extent to the overcrowding” in the ED.

So it’s a very serious situation in terms of patient comfort, but also in terms of patient safety… We’ve been advising our junior doctors to just, as best you can, practice the best type of medicine that you can under the circumstances.

“And I have to say I’m full of admiration for the junior doctors, nurses, attendants, everybody working in the A&E department at the moment in the circumstances that they’re having to deal with,” Lyons added.

The Mercy University Hospital (MUH) in Cork has also renewed an appeal to people needing less urgent treatment to ”avail, where possible, of other care services” as its ED “continues to experience high demand for its services”.

A spokesperson for MUH today said that visiting restrictions are continuing at the hospital “due to a spike in the number of patients presenting at the hospital with flu, Covid and winter vomiting”.

“Visiting will be allowed on compassionate grounds under prior arrangement with the hospital,” they said.

The spokesperson added that while the ED remains open 24/7, it is “regrettable that patients are experiencing significant delays and this situation is being treated as a priority by hospital management”.

“All patients are triaged and treated based on clinical need when they present at the Emergency Department.”

The spokesperson said that patients with less urgent complaints should contact their GP or South Doc, or avail of services at the Mercy Local Injury Unit, St Mary’s Health Campus in Gurranabraher (which is open from 8am to 6pm); the Local Injury Unit at Bantry General Hospital (open between 8am and 7.30pm) or the Local Injury Unit in Mallow General Hospital (which operates from 8am to 8pm).

Yesterday, the Mater Hospital in Dublin city issued a similar appeal for people to avoid its ED if possible, with a spokesperson saying services are “under extreme pressure”.

The HSE previously expressed concern that it expects to see over 900 patients in hospitals with flu in the first week in January, while a higher number of hospitalisations have occurred than had been anticipated in its “more pessimistic projections”.

Last week, the HSE’s National Crisis Management Team (NCMT) said it was “meeting regularly to oversee the health service response to these pressures”, which includes “significant surges of respiratory illness”.

In the last week of reporting, up to 24 December, flu cases increased by 100% from 1174 to 2,329. There was an even greater increase in hospitalisations from flu, increasing 113% from 299 to 637.

With reporting by Jane Moore

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