It was with great sadness that I read about the death of Carol Romero.
Carol was involved in a fatal car accident after crossing the road not more than 100 feet from the Hurley’s roundabout. It was supper time and I believe she was on her way home after working all day at the Blockbuster Video store
I never had the pleasure of knowing this young lady but was able to attend to her at the roadside prior to the arrival of the ambulance. She was unconscious with a head injury and had signs suggestive of a fractured skull and intracranial bleeding.
I was somewhat relieved when the ambulance sped away to the HSA hospital at George Town, thinking that she would be getting the best of care. Little did I know that her case would be complicated by insurance and medical issues.
Carol apparently had the Government Standard Plan issued by British Caymanian. In my opinion, the latter is actually one of the better insurance companies on the Island. The problem is that the so called Standard Plan is substandard and is in need of radical reform. The coverage is limited and inadequate for a life threatening situation like this. However, that said, I see many patients with no insurance whatsoever; so in some ways it’s better than nothing!
Following admission to hospital the patient was found to have raised intracranial pressure resulting from intracranial bleeding. The skull is an enclosed box and any raised pressure is transmitted to the brain resulting in compression and lack of oxygen. This is a medical emergency and if left untreated results in brain injury or death. The treatment is to relieve the pressure by drilling one or two holes into the skull (burr holes). This is a fairly simple procedure that can be done under local anaesthesia or even with no anaesthetic in an unconscious patient. With CT scanning there is little guess work. The scan will tell you exactly were the bleeding is located.
Apparently the patient was booked in the operating room for this procedure the following morning. The procedure was for some unknown reason subsequently cancelled. The patient was transferred to Honduras some 16 hours later were the procedure was eventually performed.
I have been involved with air ambulance transfers and it is not uncommon for them to take from six to 24 hours. The delay therefore does not surprise me. I suspect by the time Carol Romero arrived in Honduras it was a case of being too little too late. Probably there would have been irreparable brain damage considering that it was now simply more than 30 hours since the accident
Normally burr holes would be performed by a neurosurgeon. There are private general surgeons that operate at the HSA that have performed this procedure in the past and would have willingly helped. In a life threatening situation you have to do what you have to do.
Most of us who live here know that hardly a week or two goes by without hearing of a fatal car accident or some other cause of head injury. It concerns me that surgeons at the HAS are not trained to perform this relatively simple life-saving procedure. In an island community such as this, where tertiary centres are hours away, it is an absolute necessity. There are many talented surgeons in both the government and private sector that are quite capable and could easily be trained. One should be available 24 hours a day.
These issues should concern us all. Anyone of us, or our children, could easily end up in the HSA Emergency Department with a serious life threatening head injury. I would like to see policies introduced to handle these situations.
None of this will bring back this poor helpless girl that I cared for at the roadside. She was an unfortunate victim of a system that failed her. This should never happen again to anyone here in the Cayman Islands; regardless of nationality. This is not a third world country. We all need to know that we are going to get the best of care and not be booked on tomorrow’s flight to Honduras.