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Groote Schuur doctors and the Western Cape health department are to square off on...

Groote Schuur doctors and the Western Cape health department are to square off on Tuesday over the future of the province's only dedicated trauma unit.

The hospital's trauma unit, which serves nearly 12 000 people every year, is threatened with closure if Health MEC Theuns Botha and his department get their way to amalgamate it with the hospital's casualty unit.

But doctors at the hospital are fighting the plan. Severe head injuries, stab wounds, gunshot wounds and motor vehicle accidents account for most of the cases which test doctors' abilities on a nightly basis.

"A dedicated trauma centre in the city is essential to provide optimum care in dealing with the carnage," said Trauma head Professor Andrew Nicol.

In July the Health Department proposed restructuring plans which included the amalgamation of the casualty and trauma units that make up the emergency service unit of the hospital.

Groote Schuur doctors were told at the beginning of July that the department had issued a directive to merge those sections. They were also told the decision had been made in 2006.

Nicol said yesterday that negotiations between the Health Department and the hospital were under way. "We are having a big meeting on Tuesday to discuss how emergency services will be affected. "I'm not sure what the plans are for the future," said Nicol.

Botha confirmed that the department was "assessing ways in which to modernise the treatment of emergency care and trauma patients". He said no final decisions had been made and that it had not been determined whether the same staff would be used.

Botha said the trauma units would continue to function. "The interface and the reception of trauma patients are not working well, that's why we want to improve the area. "This is not a cost-cutting exercise. It's an exercise to improve efficiency," Botha said.

The trauma unit provides specialised treatment and emergency operations to nearly 1 000 patients each month - or almost 12 000 cases every year. On Saturday night the Cape Argus witnessed at first hand what a night in Groote Schuur's trauma unit, located in ward C14, is like.

At 6pm the unit's dedicated trauma team conducted routine ward rounds. Four bloodstained patients were laid out on stretchers in the resuscitation room, which forms part of the trauma unit.

By the end of the round, two more patients had been admitted to the resuscitation room. The first was a young man who appeared to be in his 30s. He was the victim of a hit-and-run accident and, according to doctors, had severe head injuries.

The second patient was a 25-year-old man, his body riddled with multiple gunshot wounds. The unit smelled of blood and urine mingled with antiseptic fluid. Between 9pm and 2am, scores more patients were admitted to the unit.

At 2.45am, the unit's front doors swung open. Wheels squeaked urgently across the floor and doctors rushed to treat the critically wounded young man lying on the gurney. He had been stabbed in the chest and abdomen and had been sent to Groote Schuur from GF Jooste. Wrapped in a foil blanket, the man was in shock, trembling because of the extent of his injuries.

His small intestine protruded through one of the stab wounds. According to a paramedic, the young man had spent three hours at GF Jooste before being transferred to the trauma unit.

The team at Groote Schuur managed to stabilise him. "When your trauma patient does better, it's always rewarding," Dr Michelle Maartens said. "Trauma patients' needs are often on a very short term basis. They need care very rapidly.

"That's why it's important to have a dedicated trauma unit," Maartens stressed. Fifteen doctors work each shift and there are two operating theatres available at night - which is when more serious cases tend to arrive at the hospital.

"The unit deals with the end stage of trauma management, with more severe cases," Nicol said. "That's why we function so well - patients are dealt with immediately."

About 60 percent of the patients who require specialised treatment at the trauma unit are referred from hospitals across the province. Most referrals come from Somerset and Victoria hospitals. But day hospitals, like GF Jooste, Gugulethu Community Health Clinic (CHC), Khayelitsha CHC, Mitchells Plain CHC and Vanguard CHC, also send many patients.

"There is so much trauma; problems dealing with the numbers are huge," Nicol explained.