Report criticises response after woman (70) hit by car in Donegal

A five-hour back-up of ambulances at Letterkenny general hospital last December led to an elderly woman waiting almost an hour for an ambulance after she was knocked down near her home, a HSE investigation has concluded.

Maura Porter (70) died in Altnagelvin hospital, Derry, several hours later.

Ms Porter was hit by a car shortly before 5.45pm in Carndonagh, Co Donegal, on December 30th. She waited 50 minutes for an ambulance to arrive from Letterkenny, 62km away, before being brought to Derry.

The incident was one of several recent incidents which gave rise to concerns about the capacity of the National Ambulance Service (NAS) to respond to life-threatening situations.

In January, the deputy director general of the HSE instructed that a review of the circumstances surrounding Ms Porter’s case be conducted.

The report, dated October 1st and marked "Strictly Private and Confidential", has been seen by The Irish Times.

It finds there was just one emergency ambulance available in Co Donegal at 5.45pm on December 30th when the 999 call was received. It was almost two hours away from Carndonagh.

Of the eight other ambulances rostered for duty in the county, five were queuing outside Letterkenny hospital’s emergency department waiting to transfer patients in for treatment. They were delayed for between two hours and 11 minutes and four hours and 42 minutes.

Timely manner

The report said if these ambulances had been released from the hospital in a timely manner, “the delay in responding to the patient in Carndonagh almost certainly would not have occurred”. Another ambulance was at Sligo hospital emergency department, while two others – one based in Carndonagh – were already dealing with emergency calls.

There were between five and 10 in-patient beds empty at all times that day in the hospital, the report finds. It says difficulties seem to have arisen “with moving patients in the emergency department, who were to be admitted as patients, into the hospital beds”.

The report says, as in other hospitals, patients were being kept in the emergency department until being formally processed by a member of the in-house speciality team.

“In particular, consideration was not given to moving patients referred from the emergency department to inpatient beds for processing by inpatient teams.”

The report says the hospital’s bed-management escalation plan was not followed. A situation where there were more than three ambulances waiting to offload patients should have triggered urgent moves to resolve system blockages.

Patient flow

Escalation plan “black” should have been declared. This is the highest escalation point in the hospital’s bed-management escalation plan and would have “triggered a number of actions designed to resolve patient flow difficulties in the hospital”.

The report is also critical of how National Ambulance Service personnel interacted with the hospital. The “urgency of the situation was not communicated in a robust and structured manner to hospital personnel, which may have led to a relative lack of urgency on the part of hospital personnel in resolving the issue”.

The review team also found there was “a lack of awareness around the gravity and the consequences of emergency ambulances being unavailable for prolonged periods”.

It said consideration should have been given to requesting a helicopter ambulance from the emergency aeromedical service, which is jointly run by the Irish Air Corps and the National Ambulance Service.

Common protocols

Among the report’s nine recommendations is that the national ambulance service and the HSE develop “a common position on ambulance offload delay and develop common protocols on how to respond.

“The explicit aim of these protocols should be that all ambulances arriving at hospital emergency departments should be clear to respond to another emergency call within 20 minutes of arrival.”