Rahij Anwar and Nitish Gogi: Fractures in snow: Are we better equipped this time?

Nitish GogiRahij AnwarEarlier this year, I (RA) slipped on ice on my rather steep drive. The result was an electric shock like sensation from head to toe and a sore neck. I conducted a quick “self examination” and couldn’t come to a diagnosis that could qualify me to be “off sick.” I therefore, disappointingly proceeded to work with a sore neck.

However, not every individual who slips on ice is “medically capable” of making that judgment in such a situation. Therefore, quite rightly an A&E visit is mandatory, which causes a huge surge in A&E cases during snow periods.

In recent years, the United Kingdom has witnessed rather harsh winters with prolonged and frequent periods of snowfall,which has resulted in a sharp rise in injuries related to snow. Most of these injuries occur due to mechanical falls on slippery ice and may be in the form of sprains and fractures, mainly involving the wrists, ankles, and hips. However, road traffic accidents following icy weather may cause much more serious injuries, which can sometimes be life-threatening.

A&E and orthopaedic services are worse hit after heavy snowfalls and the sudden increase in patient numbers in the absence of proper planning may lead to disastrous consequences in terms of service provision, patient satisfaction, and resources. Waiting times in the A&E soar and this combined with staff shortages can make matters worse. Fractures that require operative intervention get referred to orthopaedic surgeons who struggle to cope due to limited theatre time. In a hospital in Yorkshire, last year after a period of heavy snowfall there were 35 patients with fractures waiting to be operated on the trauma list compared with an average of 5 on a normal day.

As NHS hospitals are not geared up for such an unexpected increase in trauma cases, they face acute shortages of resources including equipment in the A&E, wards, and theatres. For example, Chorley Hospital in Lancashire made news headlines in January this year, after a shortage of walking frames owing to a massive increase in requirement because of the snow. Bed managers also came under huge pressures because of this massive unexpected influx of patients on top of the usual winter overload. Complaints from patients and their relatives increase due to repeated cancellations of operations.

Staff shortages due to impossible road situations, train cancellations, and unexpected school closures put an enormous strain on the health service. This affects not only new patients but also other inpatients who have already been receiving treatment in hospitals.

Although some hospitals have started looking into the matter closely, steps taken to manage this “snow crisis” effectively are far from satisfactory. However, there are some simple measures that can be adopted to improve the situation. Fractures that may require only manipulation under anaesthetic, such as simple wrist fractures, can perhaps be managed in the treatment rooms of the A&E, with assistance from orthopaedic and anaesthetic staff if necessary. This would save theatre time, which could be used for other major trauma cases.

“Elective lists” in hospitals should be cancelled even if this risks the wrath of the target oriented managers. This will improve the bed situation and free up more surgeons to deal with the outstanding trauma patients. Also, the usual half day trauma lists should be converted into “ongoing emergency lists” until all pending trauma operations are done.

Short-term hire of extra equipment such as splints, frames, implants, and operating instruments at a reduced cost from regular NHS suppliers is another option that may be considered in order to cope with extra requirements. Ensuring adequate staffing levels is also paramount. Planned leave should be sanctioned judiciously if it is likely to fall during the “snow period.” Extra fracture clinics and A&E staff, including nurses and plaster technicians, should be available in this time of crisis. Providing free food and overnight hospital accommodation to a few staff members who would want to avoid an “uncertain and unpleasant” commute may help to ensure their continuous presence in the hospital. The more the merrier!

Rahij Anwar is a specialist registrar in trauma & orthopedics in Medway Maritime Hospital, Kent.

Nitish Gogi is a speciality doctor in trauma & orthopaedics in Calderdale & Huddersfield NHS Foundation Trust, West Yorkshire.