Five lives a year could be lost

Five more people will die a year - and the same number will be severely brain-damaged and need permanent care - if the South loses neurosurgery, a former Dunedin Hospital intensive-care director predicts.

Dr Mace Ramsay, now a locum anaesthetist in Kalgoorlie, Western Australia, said the "millions" of dollars it took to care for someone with permanent brain injury needed to be taken into account if Dunedin lost neurosurgery to Christchurch.

The Southern and Canterbury District Health Boards cannot agree on the configuration of the South Island's neurosurgery service.

The former Director-general of health, Stephen McKernan, has appointed an advisory panel, which is yet to meet or release terms of interest.

A public outcry has erupted in the South over a suggestion all six neurosurgeons be based in Christchurch.

Dr Ramsay left Dunedin Hospital in 2006, warning publicly that Dunedin Hospital risked being downgraded over time and losing specialties such as neurosurgery to Christchurch.

It was crucial to keep neurosurgery at Dunedin Hospital because permanent injuries and deaths would result if it was moved.

When an internal bleed put pressure on the brain's blood supply, surgeons had up to two hours to relieve the pressure.

After two hours, brain cells "start to say goodnight", Dr Ramsay said.

If weather conditions were good, the transfer from Dunedin to Christchurch took three hours, not including the trip to Dunedin Hospital or the time taken to make a decision.

The best possible time if every condition was optimal was just under three hours, but that was unusual.

Dunedin's was a "novel population", with a large student body, and a hinterland which included busy tourism and recreation areas in Queenstown Lakes and Central Otago.

The Southern District Health Board serves a population of more than 286,000, according to its website.

Dunedin city has about 120,000.

"Twenty thousand [of Dunedin's population] are young stupid people who go round doing stupid things. They're called students," Dr Ramsay said.

In Dr Ramsay's time in Dunedin, one person a month received a major head injury during the ski season.

The South had a decent population base and should not have the same emergency style medical care as developed for isolated centres in Australia.

Dr Ramsay said the emergency neurosurgery used to stabilise patients before transfer from isolated Australian towns increased the risk of death and was only used because of the country's huge size.

Adelaide neurosurgeon and panel member Glenn McCulloch would be accustomed to the "wastage" of life because Adelaide provided neurosurgery for isolated parts of Australia, including Darwin.

Having worked in isolated centres, such as Alice Springs and Mount Isa, Dr Ramsay had "seen the wastage [of lives] that occurs because the distance is so great".

If Australian expertise was required, New Zealand ought to look to Melbourne because distances in Victoria were more comparable to the South Island.

Working in intensive care in isolated centres was "scary", and Dr Ramsay said that was why he had opted to work as an anaesthetist in Australia.

Dr Ramsay was involved in setting up Otago's first dedicated air ambulance service in 1997.

He worked in Dunedin Hospital's intensive care unit for more than 18 years, and was director between 1993 and 2006.

eileen.goodwin@odt.co.nz

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