106. It is considered that planning of the dental school should be associated with whatever planning action may be needed as a result of the conclusions reached in paragraph 67 above regarding medical students.
CHAPTER 10
OTHER RELEVANT MATTERS
107. In the time available to the Committee it has not been possible to go deeply into a number of matters which should nevertheless be mentioned in this concluding chapter, so that, as the work of the Com- mittee proceeds by way of annual reviews of this initial report, these matters (some at present in an early stage of development only) will be kept in view and reported upon. They are arranged in alphabetical order.
Accident Service Organization
There are four designated casualty departments: Queen Mary Hospital and Tang Shiu Kin Hospital on the Island, and Queen Elizabeth Hospital and Kwong Wah Hospital in Kowloon. When the Princess Margaret Hospital becomes operational its casualty department will become the fifth. The control of ambulances is in the hands of the Fire Services Department. There is an operational plan in which Hong Kong is divided into different zones, and each casualty department takes care of casualties from a number of these zones. With traffic becoming heavier on the congested roads, and the steady increase of the number of factories accompanying the progress of industrialization, in addition to the hazards of fire, rain-storms and typhoons, there is already evidence that the incidence of accident cases is rising. Whether the present methods and resources for dealing with accident cases by the various services, first aid and rescue, casualty, hospital and rehabilita- tion, are adequate or not clearly requires a detailed study. What can be said initially is that the regionalization scheme proposed in Chapter 5 would help to meet the need for an improved accident service. Advice has been received from three visiting experts that a two-tier system of designated accident centres (DAC) and accident centres (AC) should be created. Appendix 10 shows in diagrammatic form how the system would work. A designated accident centre is one "planned, equipped
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and staffed to enable every necessary investigation and treatment of any case of trauma of any part of the body at any time of the day or night'.
District Nursing
109. If, by means of a district nursing or similar service, a degree of medical care could be provided in the home it would be possible to discharge some patients from hospital earlier. The effect on hospital bed requirements could be significant-for example, a reduction of one day in average lengths of stay of one-third of general surgical and medical cases would reduce needs in 1982 by 430 beds. On the basis of some rough assumptions this could be achieved at a cost of $12 million per year.
110. Unfortunately, because of travelling time, a district nurse treats very many less patients in a given time than a nurse in a clinic or hospital, and with the likely staff shortages it seems quite impossible for Government to think of starting a district nursing service itself in the decade under review. Besides this, the introduction of district nursing tends to throw up a need for social service for the convalescent patient as well, such as food delivery or cooking, laundering etc. In the United Kingdom a service of such home helps exists to support the district nurse by fulfilling these needs. For a district nursing service to work well it must fit into something bigger, a comprehensive social welfare scheme.
111. Currently an experiment in community nursing is being carried out by voluntary agencies, and a study is needed to establish whether they should be encouraged by Government to continue the experiment and expand the service.
Drug Addiction
112. The Medical and Health Department has recently become involved in the treatment of drug addicts with methadone. An out- patient centre has been established in the Old Mental Hospital's male block, into which drug addicts are admitted in the first instance. When the dosage of methadone given is stabilized they are discharged and continue to attend as out-patients, taking their daily dose of methadone under strict and direct supervision. They are also routinely investigated for evidence of continuing to take heroin or any other drug besides methadone. However, the accent of the pilot scheme is on the evalua-
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