It's a commotion that stops everyone in their tracks from time to time - the flashing lights and wailing siren of an ambulance making its way to the latest accident scene or cardiac arrest incident. But just how much can ambulance personnel do for a patient when they arrive at the scene? The answer is: less than you might have hoped.
Ambulance personnel in the Republic are trained to the level of emergency medical technician (EMT). This means they are allowed to stabilise and provide some basic treatment to patients suffering from cardiac problems, traumas and head and spinal injuries. However, if you're involved in a serious road traffic accident, most ambulance personnel do not have the training to administer fluid replacement therapy or to connect you to a drip.
If you have a heart attack, ambulance personnel can shock your heart by using an automated defibrillator, but they cannot insert a tube into your airway to prevent you from suffocating on your own vomit. Nor can they administer cardiac drugs or any other drug therapy. Even those who are trained in the procedures, some of which are fairly simple, are not allowed to use them.
In 1997, the now defunct National Ambulance Advisory Council (NAAC) submitted a syllabus to the Department of Health which would train ambulance personnel in all three areas. Five-and-a-half years ago, the report of the Review Group on the Ambulance Service had gone even further and recommended setting up a paramedic pilot project. However, the proposed pilot project never saw the light of day and the NAAC never received a definitive response to its proposed syllabus.
The Ambulance Review Group quoted a number of studies in its report, which suggested that advanced training for emergency ambulance personnel could save lives. One foreign study quoted by the group reported a 24 per cent reduction in trauma deaths after the introduction of an emergency medical care service. As far back as 1981, the US National Centre for Health Services Research reported a 15 per cent increase in admissions and a 10 per cent increase in discharged survivors of cardiac arrest after the implementation of a paramedic service in King County, Washington.
Some Irish ambulance personnel already have training in advanced life-support techniques and are very frustrated that they are not allowed use their skills for the benefit of the patient.
"I think some of the people in charge and parts of the medical profession still see us as little more than van drivers," says one EMT. "They've never been in the back of an ambulance. I've watched people die before me because I'm not allowed use simple techniques like taking a plastic tube and putting it into the patient's airway."
The Department of Health says it remains unconvinced of the case for introducing paramedics, or for ambulance personnel being allowed to use advanced life-saving techniques at the scene to which they're called.
"The standard of basic life-support training which Irish emergency medical technicians receive at least equals and often exceeds the level of training provided to EMTs in other countries including the UK and the US . . . There is still considerable debate as to the benefits of paramedic training. "It is generally agreed that advanced life support such as intubation and establishing intravenous access is best provided in a hospital setting," a recent statement from the Department said.
A former member of the NAAC, Prof Gerard Bury, was involved in submitting a syllabus to the Department of Health two years ago.
It proposed training ambulance personnel in many of the emergency care skills they currently lack or are not allowed to use.
HE favours training EMTs to an advanced level, and having them follow strict protocols, rather than setting up a corps of independent practitioner paramedics immediately.
"Some parts of the US have independent paramedics who work up to medical standard virtually. That's not something we think is appropriate at this stage in the Irish system. It would involve leaping straight to a very costly system which would be difficult to supervise and maintain.
"What we would like to see are advanced emergency technicians who are allowed to administer certain drugs for certain conditions, and who are also trained in advanced airway management. We would also reserve the right to eventually introduce full paramedics." Prof Bury says some criticism of the level of training of our ambulance personnel is unfair.
"It's easy to exaggerate how far behind the rest of Europe we are because our ambulance personnel are increasingly well trained in basic emergency care techniques. "However, most European countries have some emergency practitioners with advanced skills, and the impression is that the availability of those skills in major serious trauma and emergency situations makes a big contribution.
"To be fair to the Department of Health, there are legislative changes that would be necessary to allow lay personnel to administer drugs and there are also organisational and funding issues. However, this is still something we would like to see a move on as soon as possible.
Prof Bury has sympathy for the frustration expressed by ambulance personnel.
"As it stands you have a substantial number of ambulance personnel who are trained in advanced emergency care. It's a tribute to the commitment these guys have.
"They train nurses and doctors in these skills in a hospital setting, even though they aren't allowed to use them in the course of their own duties. "Can you think of anything more frustrating for these people than to be in a situation where they feel they can help a patient if they used the skills they learned but aren't allowed to use?"