There is an urgent need to review the overall national preparedness strategy for total defence, said a Mr Francis Lee in his letter (Forum: Ensuring preparedness for total defence, even at private hospitals, 2 Jan) published on the Straits Times (ST) forum.
Mr Lee pointed out, “When an incident involving serious injuries occurs, especially one with multiple casualties, the time taken for medical help to be administered could mean the difference between life and death.”
Noting that Orchard Road is a prime target for terror-related activities as well road accidents like the one which happened at Lucky Plaza on Sunday (29 Dec 2019), it is crucial that victims be taken to the nearest hospital for immediate attention.
Mr Lee was responding to a statement by the Ministry of Health (MOH) about how Mount Elizabeth Hospital is not equipped to deal with multiple trauma patients.
MOH had said in a joint statement (1 Jan) with the Singapore Civil Defence Force (SCDF) that most private hospitals “are not able to provide proper resuscitation and emergency treatment for severe and multiple trauma patients”.
The authorities were, in turn, responding to queries about why the six Filipino victims of the fatal car accident were not taken to Mt Elizabeth which was only 200m away but to Tan Tock Seng Hospital (TTSH) instead.
The Ministry said that while Mt Elizabeth has a 24-hour walk-in emergency department, it is not equipped or even staffed to be able to handle all forms of emergency cases. TTSH was the closest hospital that could handle such an emergency.
Of the six Filipino victims, two died in hospital from their injuries. Of the remaining four, two are still warded while two have been discharged.
Speaking to Straits Times, an MOH spokesman said that all public hospitals, except for Alexandra Hospital have an emergency department that “can resuscitate and provide initial treatment of acute emergencies in both adults and children”.
Mt Elizabeth, however, is a private hospital which does not meet those standards. The only private hospital that does meet the MOH’s “minimum standards for trauma care” is Raffles Hospital, said MOH.
But even then, Raffles is unable to handle “mass casualty accidents”. So even though patients without life-threatening conditions have been ferried there by ambulances since 2015, the hospital is not designated for serious trauma cases.
And so far, we’ve just been talking about hospitals that can handle adults. As for public hospitals that can treat paediatric trauma cases, only KK Women’s and Children’s Hospital and the National University Hospital are fully equipped to treat children.
MOH and SCDF explain in their statement that patients with severe trauma are taken to the nearest accident and emergency (A&E) department that has the necessary resources, equipment, and medical support to deal with complex cases.
In the case of Sunday’s accident, TTSH met those needs, not Mt Elizabeth.
“In addition, as part of pre-hospital medical care management, all SCDF emergency ambulances are equipped with the necessary medical equipment and manned by well-trained paramedics and crew that are capable of performing resuscitation on patients,” the authorities said.
However, as Mr Lee raised in his letter, there is a concern that all hospitals in Singapore should be equipped to handle multiple trauma emergencies.
Mr Lee wrote, “I do believe Singapore has the financial means to equip every hospital, whether private or public, with the necessary means of handling such emergencies.”
“When it comes to such life and death matters, money should not be a consideration.”
Are some hospitals really better prepared?
On the topic of some hospitals being better prepared than others to handle trauma cases, one person who commented on TOC’s article shared a story about their experience with NUH.
Following a motorcycle accident at Jurong, Ms Lih Loo’s brother was taken to the nearest hospital for medical care, which happened to be the National University Hospital (NUH). When he arrived, they were told by doctors there that his leg needed to be amputated.
Hearing that, the family immediately arranged for his transfer to Mt Elizabeth instead because “the best specialist is there”. However, NUH held her brother for a few more hours before releasing him. In that time, they did not clean the wound or otherwise treat it, instead only giving him morphine.
Ms Lih Loo and her family continued to push for her brother’s release, fearing that the still untreated leg could not be saved if they waited any longer.
Once at Mt Elizabeth, Ms Lih Loo said the staff immediately took her brother into surgery without waiting for the paperwork, focused instead on saving his leg.
“At NUH, all forms had to be filled before they released my brother,” she wrote.
She said, “Mount E may not have the traumatic standards, but I witnessed their high standard of ER & medical [ethics] as compared with NUH”.