A new £6.7 million accident and emergency department at Withybush Hospital could be in the pipeline.
Work may begin in less than two years, if funding is made available by the National Assembly.
The present unit is inadequate in space and facilities. It also fails to meet health and safety standards.
Either a complete refurbishment is needed or a new unit must be built, says a report to tomorrow's meeting of the Pembrokeshire and Derwen NHS Trust.
The preferred option is a new unit and the trust has already approached the National Assembly for £5.7m capital funding.
Major Kafeel, lead clinician of the A&E department until last week, said: "Quite literally this department is a shop window for the hospital and the trust, particularly during the summer period when there are a lot of visitors.
"But it is such a small place that at times it is surprising that we have been able to manage so far. We urgently need a new department."
The current trauma service at Withybush Hospital provides for a population of 114,000.
But during the summer months this number is quadrupled. In August alone, an average of 56,000 visitors per day visit the county.
The department has also come under more pressure because of changes in the treatment of minor injuries by GPs and the introduction of the doctors-on-call system.
Pembrokeshire is already considered a high risk area because of the presence of oil refineries and military bases. The proposed LNG terminals for Waterston and Milford Haven will bring increased pressure.
Ferry traffic and the rural road system also add to the stress on the unit.
The attendance level at Withybush's casualty department has increased year by year. In the next 12 months, it is expected to reach 46,000 - 86% up on the 1992/93 figure.
"When comparing trauma admissions to the A&E at Withybush Hospital, it is clear that Withybush has a higher incidence of major trauma compared with the West Wales General Hospital, Carmarthen, and Prince Philip Hospital, Llanelli," says the report.
The new accident and emergency department, which would be built adjacent to the present unit, would be able to deal with an attendance of 50,000.
It would also incorporate a ten-bed observation and assessment area, and a room for the Pembrokeshire Care on Call service. Additional land for the development has already been bought by the trust.
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