There would be fewer than six hospital A&E departments in the entire country if international standards and catchment areas were applied here, according to Health Minister Leo Varadkar. He said the definition of an "emergency department" has changed and the catchment area for such a major trauma centre in the UK would be about one million people.
"The international standard now for an emergency department is very different from what it was in the past," he said.
Essentially, it is a department that can take undifferentiated patients who have anything wrong with them.
"For example, that is someone with a major head injury who needs neurosurgery or someone with a major injury to their chest who needs cardiothoracic surgery."
He was speaking in the Seanad during a debate on the future of Portlaoise Hospital.
He said: "Portlaoise Hospital has never provided those services and it has never been what we would now describe as a major trauma centre or an emergency department in an international context. In Scotland, there are only two of them.
"In London, there are only four, and the catchment area required for that type of emergency department, a major trauma centre, is a population of about one million.
"Obviously, that would mean four, five or six in Ireland, but no one is suggesting for a second that we have only four, five or six emergency departments in Ireland.
"However, we will have to look at emergency medicine and reconfigure it to ensure we have the right services in different places."
He added: "The only guarantee I can give people is that any decisions will be made based on what is best in terms of patient safety and clinical outcomes, and not based on financial considerations, political bias or political interference."
Earlier, Labour Senator John Whelan said the midlands and all of Co Laois is in turmoil over "bombshell" proposals which could mean downgrading the A&E department in Portlaoise and reducing its opening hours.
"It is, unfortunately, groundhog day for the hospital and we are back in the throes of not knowing where we stand or what the future holds," he said.
Mr Varadkar said investment is being made to strengthen Portlaoise Hospital but complex surgery will be removed.
"There is no question, therefore, of its being closed. The only question that has emerged is whether 24-hour services are sustainable."
"In the case of Navan, for example, surgical services are no longer provided, but the hospital continues to offer a 24-hour emergency department for medical patients and those with minor injuries," he said.
"I strongly agree with the Senator that any proposal to end 24-hour services at Portlaoise could not be advanced without a clear and credible plan to provide additional capacity at Tullamore, Naas and Tallaght, which are already very overstretched."
But he said he could not give any cast-iron guarantee that it will stay a 24/7 unit.