It is well known that our public hospital system is struggling to cope with increasing patient numbers and needs. The pressure on acute care is most evident in our Emergency Departments (EDs) with long waits to see a doctor and unacceptably long waits (for the 25% of our attendances needing hospital admission) on an ED trolley waiting for a hospital bed now being the norm.
Half a million people are due to travel to the Phoenix Park this Sunday for the Papal Mass. The medical literature on mass gatherings describes the numbers likely to require medical care on site and the numbers that will need transport to hospital. From the literature it is clear that Papal Masses carry additional specific risks such as a significant number of older attendees, many with pre-existing illnesses; a mobile unseated crowd; a prolonged length of time on site and exposure to the elements. One large review includes figures from 9 Papal Masses and showed an average of 40 patients needing medical assistance per 10,000 attendances with 5 per 10,000 attendances needing transport to a hospital. For the expected 500,000 people in the Phoenix Park this equates to 1,000 - 3,000 requiring medical assistance (mostly first aid on site) but between 250 and 750 needing transport to one of the 6 Dublin EDs.
Some planning has occurred but it has been too late starting and the necessary extra funding to hospitals is as yet unconfirmed. The assumptions about workload also appear to have been unduly conservative. While the volunteer first aid services and the Ambulance services will be on site to provide care, these services will not have medical support. An on-site medical facility is planned with the aim of resuscitating and stabilising the most critically ill before transport to an ED but it is not yet adequately staffed. Because of ongoing staff shortages, Dublin EDs are struggling to bring in the extra medical and nursing staff that will be needed to cope with the extra arrivals to the receiving hospitals.
Last Monday morning (13th August) there were 47 admitted patients without hospital beds in the Dublin hospitals, 41 of them on ED trolleys. By Tuesday morning that number had increased to 87 including 5 children. We expect that scheduled care will be cancelled to provide some extra bed capacity but this is unlikely to be sufficient. Some people may defer attending for care until the Monday or Tuesday after the Papal Mass. This will bring its own risks to individuals and is likely to cause a continuing surge in ED attendances. These days will also need to be staffed and resourced appropriately.
Our advice to those attending is:
- prepare for a long day;
- prepare for significant walking;
- take your medications as normal;
- bring any medications you might need during the day;
- bring identification and details of your next of kin with you;
- stay hydrated and ensure you have access to food.
Importantly, do not attend if you are unwell.
There is a justified nervousness among those staffing Dublin’s EDs (which at this stage are overstretched all the time) about the lack of contingency planning. While, no doubt, heroics will be performed by those staff working on the day, the perennial lack of capacity and the lack of timely and comprehensive enough planning is a serious concern. Hopefully, the numbers needing medical assistance will be at the lower end of estimates and hospital beds will appear for those who need them………