Mount Snowdon & the NHS BillThe financial cost of treating casualties from the highest mountain in Wales

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Laura-Beth Pilkington Medical Student, Cardiff University

Lydia Bregman Medical Student, Cardiff University

Dr Linda Dykes Consultant in EMYsbyty Gwynedd,

BangorNorth Wales

UK

Methods• Casualties from Snowdon brought to Bangor ED between January

2004-August 2011 following contact with Mountain Rescue +/- RAF SAR helicopter were identified from our Mountain Medicine database.

• Costs of hospital treatment at YG were calculated (using 2010/11 costs) from the sum of ED visits, nights in hospital, trauma theatre usage, and thrombolysis if applicable.

• Details of reimbursement from Out of Area patients was available for the last three financial years.

Results• 278 casualties from Snowdon were identified on the database

during the study period. 72% were trauma cases and 28% medical. 10% were fatalities.

• Mean age was 40.5 years (range 3-85, median 39); 91% resided outside North Wales & 32% were admitted.

• The cost to YG was £211,000. Over half of this - £123k – was from inpatient care. ED visits cost only £24k. A further £61k was spent on trauma theatre.

• Reimbursement from Out of Area patients admitted to hospital in 2008/9, 2009/10 & 2010/11 (n=42) generated a small surplus of £9k.

Mount Snowdon is the crowning glory of Snowdonia National Park in North Wales. Over half a million people each year ascend Snowdon on foot or by the mountain railway.

The local hospital, Ysbyty Gwynedd (YG, Bangor) provides healthcare for 676,000 residents & millions of tourists: rescue services bring all casualties from Snowdon requiring hospital care to our Emergency Department.

We wished to ascertain the cost to our local NHS health economy of treating Snowdon casualties.

www.mountainmedicine.co.uk

Conclusion

• The cost of treating Snowdon casualties (£211,000) is minimal set against the annual Bangor Emergency Department budget of £4.5m, and the organisation budget for the NHS in North Wales of £1.2 billion.

• Total NHS costs will be higher: most casualties used an ambulance (77% from hospital helipad to the ED, the rest from scene/nearest road-head). Many patients will also have required ongoing treatment at their local hospital.

• Total cost to UK taxpayer is at least £1m more: the RAF Sea King costs £3000/hr on crew & fuel alone (several times this if all related costs are included). 214 cases arrived by Sea King & a typical Snowdon job takes about 90 minutes.

• Our project only includes casualties who required MRT/SAR assistance: self-presenters are excluded. Young children (who can be carried by their parents) and upper limb injuries (who often self-evacuate) are likely to be under-represented, but we are confident that our database inclusion criteria captures the vast majority of significantly ill/injured mountain casualties.