Hiqa recommends State air ambulance services to UK

The Government should look at designing an integrated airborne medical service for Ireland capable of transporting patients in need of urgent treatment to hospitals abroad, the health service watchdog has said.

In a new report, the Health Information and Quality Authority (Hiqa) reveals that from this month neither the Air Corps or the Irish Coast Guard are in a position to provide such "Priority 1" transfers of patients to the UK between the hours of 7pm and 7.30am due to capacity constraints and regulatory rule changes.

The majority of patients requiring such Priority 1 transfers are children who need to be brought urgently – within a matter of hours – to UK hospitals for heart or liver transplants which are not carried out in Ireland.

In the report to Minister for Health Simon Harris, Hiqa sets out a number of short- and long-term options to deal with the current night-time gap in capacity to provide urgent patient transfers.

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Hiqa’s director of health technology assessment, Dr Máirín Ryan, said in the immediate term, the optimal option was to engage a private provider to deliver a dedicated night-time service.

Alternatively, the Irish Coast Guard could be requested to recruit a dedicated aircrew to operate its Dublin-based helicopter at night, if available.

Night-time transfers

However the report warns “these options are of a similar high cost to provide”. It says that on average, not more than four night-time transfers a year would be required and these immediate proposals are likely not to be financially sustainable in the longer term.

The report says quotes given to the HSE for an aircraft with dedicated pilots on either 7pm-7am standby or permanent 24-hour standby and, based at Dublin airport, ranged from €900,000 to €3.7 million a year.

“The service costs quoted do not include the charge per flight which would comprise airport landing and handling charges and hourly flight costs.”

The report concludes that the long-term development of an integrated aeromedical service for Ireland “could provide a more sustainable approach and allow for more efficient use of resources than can be achieved by a service designed only for Priority 1 transfers”.

The report notes transfers of children for transplant operations in the UK are “rare”.

“Unfortunately, organs from child donors are in very short supply and the ever-increasing demand further exacerbates this problem.”

It says patients must present at the transplant centre in the UK within four hours of notification of a donor heart becoming available and within six hours of a liver becoming available.

Waiting

At the end of October there were three Irish children actively waiting for a transplant in the UK.

The Hiqa report recommends in the short term – within six months – the optimal solution may be to negotiate changes to the existing Irish Coast Guard contract to allow for 12-hour rosters at one or more bases to facilitate such nighttime transfers.

"Additional short-term recommendations are that the Department of Health both explores the use of an air ambulance service supported by philanthropy and examines whether the Irish Coast Guard can fly patients to the UK under a 24-hour shift following changes to the regulatory framework."

The report reveals that health authorities are in discussions with a charity around the possible provision of a helicopter emergency medical service in the south of the country.

“Discussions have recently broadened to include the potential provision of fixed-wing support to provide additional capacity for priority 1 transfers. A written proposal from the charity is awaited.”

The Hiqa report says the preferred long-term alternatives are those provided by the Irish Coast Guard or the Air Corps. It says the next contract for coastguard services in 2022 could provide for an additional aircraft and aircrew to provide air ambulance services.

Dedicated aircrew

It says the Air Corps options include the provision of an air ambulance service on an “as available” basis or through a model similar to that used by the Garda Air Support Unit, where aircraft would be provided by the HSE and dedicated aircrew would be provided by the Air Corps.

However Hiqa maintains that ideally, Priority 1 transfers should be considered as part of the wider patient transport services.

The HSE welcomed the publication of the report, noting it had implemented an interim solution for the provision of night-time Priority 1 air ambulance transfers while it worked with the Department of Health to assess all of the options.

“The HSE would like to reassure families of paediatric cardiac and liver transplant patients of our commitment to them and to ensuring safe and timely transfer,” it said.