Traditional role of ambulance of moving patient to hospital could face change

A number of high-profile controversies in recent times have put Ireland’s ambulance service under serious scrutiny.

They included the case of a woman (70) who was hit by a car in Co Donegal and who lay on a road for 50 minutes before an ambulance arrived. In another incident, a woman who choked on food in Kerry had to wait for half an hour after her husband called 999.

A further case involved a 30-year-old man who was left bleeding so long after being stabbed in Co Louth that a Garda car had to bring him to hospital.

A number of reports have been commissioned to look at the ambulance service. The conclusions in some cases appear to differ and in other cases would involve a major change to traditional views.

Last month, health watchdog Hiqa published a report which, while paying respect to recent improvements, also highlights a lack of co-ordination, poor performance and failure to meet targets.

Hiqa acknowledges the ageing of the ambulance fleet – one in five vehicles is over eight years old – and points to some examples of unsafe staffing levels, but it suggests major improvements could be made within existing resources – a finding rejected by the trade union Siptu.

The most alarming finding in the Hiqa report relates to a lack of co-ordination between the fire brigade, which covers Dublin city, and the National Ambulance Service which covers the rest of the country, including Co Dublin.

Meanwhile, a report from UK consultants into the national ambulance service, commissioned by the HSE, says improvements in response times would require significant investment.

This report by Lightfoot Solutions UK also argues that given the large rural catchment area that it serves, the Hiqa targets for responding to life-threatening and potentially life-threatening calls – known technically as echo and delta calls – could not be met even if the service was fully resourced and was operating to best international practices.

Lightfoot Solutions says it identified 100 locations around the State where there was one call a week. “It would not be sensible to deploy dedicated ambulance resources to these locations and alternative solutions are required.”

It says community first-responder schemes, under which members of local communities are trained in basic life support and the use of a defibrillator, are used in many countries and proved to be very effective in saving lives. However, it says these are not a replacement for the ambulance service.

It maintains that community first-responder schemes in Ireland have grown from what was originally a network of cardiac responders. These were designed to deal with life-threatening calls only and this restriction has remained in place, the report says.

“In many other services, community first responders also respond to delta [potentially life-threatening] calls which provides improved patient experience and response times,” it says.

“In Ireland, this extension to respond to delta calls will require a major retraining programme and cultural change. This will clearly take come considerable time and financial investment to achieve.”

Hiqa says the current model, under which the ambulance service’s main role is to bring patients to a hospital, is not in keeping with international best practice “which, when it is safe to do so, now looks to treat patients with certain conditions via telephone consultation, treat patients at the scene and then discharge them or treat patients at the scene and then refer them to an alternate healthcare provider for follow up care”.

Lightfoot Solutions notes that in some countries, more than 40 per cent of patients are successfully treated by paramedics without the need to transport patients to hospital. “Transporting what is an annually increasing number of patients to the emergency department is not sustainable for the two ambulance services or acute hospitals.”