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Dublin: 20 °C Wednesday 30 July, 2014

Missed last night’s Prime Time investigation into ambulance delays? Here’s what we learned….

‘Rapid Response Vehicles’ — which cost the taxpayer over €100,000 each — are effectively being used by managers as ‘company cars’…

Updated 28 March, 9.53am
ONLY ONE IN every three people with life-threatening conditions were responded to by the ambulance service within the stated target time last year.

… That’s the shocking headline stat revealed by RTÉ earlier this week, ahead of the broadcast of a Prime Time investigation into response times for patients with life-threatening emergencies.

Broadcast of the programme was delayed by 48 hours as a result of the GardaGate revelations and subsequent fallout.

The full documentary, aired last night, examined the personal stories behind the statistics.

One whistleblower currently working in an ambulance control room described her concerns about the ongoing and repeated failures in the service.

And the programme-makers also revealed how ‘rapid response vehicles’ which cost the taxpayer over €100,000 each, are effectively being used by managers as ‘company cars’.

The whistleblower

Early on in the documentary, we met Shirley McEntee…

image

[RTÉ/Screengrab]

She’s an ambulance controller in Limerick for the Mid West region. Here’s what she had to say about the current failures in the system…

The most delays would be caused by not enough crews, not enough am balances, not enough vehicles on the road.

It would be daily and it would be part of the system and it’s the way it operates…

Interviewer: How frequently do you find yourself scrambling for resources?

Very often, very very often…..at some point in a 24 hour period you’d be scrambling for an ambulance in some part of this county between the Mid-West.

Interviewer: And how serious can those cases be?

They can be anything from a fall to a cardiac arrest.

Case studies

The programme focused on the cases of numerous people around the country who had lost loved ones or whose family members had suffered serious health effects as a result of not being attended to in time.

In Kerry, there was Michael Riordan…

image

[Image: RTÉ screengrab]

Last November, Michael was out for a meal with his wife Elizabeth, when she choked on her food.

He had initially thought about driving her to Tralee General hospital which was just minutes away… Instead he phoned an ambulance and got assistance from a passerby…

He tells the interviewer:

We commenced CPR, we did our 30 compressions and 2 breaths, we requested where was the ambulance, we were told it was on its way.

However, it took more than 20 minutes for an ambulance to arrive. One emergency vehicle assigned to the region was on an emergency call. Another was on a patient transfer.

As the voiceover states:

Michael was entitled to expect an 8 minute response – his records suggest it took 28 minutes.

Elizabeth passed away. Michael remains deeply upset that he wasn’t told about the ambulance delay.

The Director of the National Ambulance Service, Martin Dunne was asked:

Is it the policy of the National Ambulance Service to tell the person at the other end of the phone that your ambulance is 20 mins away?

image

[Image: Screengrab RTÉ]
  • Dunne: Not unless they specifically ask
  • Interviewer: Why don’t you tell?
  • Dunne: Because it is unfair on the patient in the first place…. What we do do is stay on the line until the vehicle arrives. People now stay on the telephone until the ambulance arrives giving the confidence and ability to look after that patient.

The system

Here’s what else Dunne had to say — when the programme team put it to him that there simply weren’t enough ambulances in the country…

What I’m saying to you is that the number of vehicles we have are now augmented by intermediate care vehicles and also by accident and response vehicles.

Do you have enough ambulances?

Let’s be honest with you.  I’ve said I’m 27 years in the ambulance service.  I suppose the answer to any paramedic will give you is – No we never have enough – however in the climate we are in and the type of work we are actually doing, we have actually seriously been resourced across the last couple of years.

As the documentary team state at the start of the programme: “In 2008 there were 320 ambulances. Last year there were 265. That’s a drop of 55 ambulances.”

Shift dropping

image

[Image: RTÉ]

The documentary revealed how massive stealth cuts that came about as a result of ‘shift dropping’ affected patients all over the country.

There’s a high sick rate in the service — and any time a staff member calls in sick, local management have the discretion not to replace staff if one member of a two-person crew isn’t available due to illness.

As the whistleblower, Shirley McEntee, explains:

Dropping shifts means if someone calls in sick that’s one crew down. So if you have two crews in one station now you have one …

What’s supposed to happen is that if an ambulance goes down as a result, the remaining crew member is put into a response car.

However, not all staff can drive the cars as they’re not trained as ‘solo responders’.

The official figures for these ‘stealth cuts’ show there were 14,500 shift hours dropped across the country.

However, according to the Prime Time team:

Rosters shown to us by concerned paramedics suggest that the number of ambulances dropped is much higher than the official figures.
At the end of last year, in the Leinster alone – each week 22 ambulances were dropped for a 12 hour shift period.

Pressure

The effects of ‘shift dropping’ were brought to light as the documentary focused on an incident where a fire engine had been sent as a first responder to an emergency in Tallaght.

image

[RTÉ Screengrab]

This was on 23 January last year. Two out of six early shifts had been dropped at St. James’s.

By 3.54pm, the programme details how the fire truck had already been at the scene for eight minutes. This radio conversation then took place between the fire crew and dispatch…

  • Delta 72: Do you have an ETA for an ambulance…
  • Control: No ambulance attached at the moment
  • Delta 72: Child is semi-conscious, going in and out of seizures
  • Control: Ok, we will have a quick look now

Two minutes later, this message from the control room:

image

[RTÉ screengrab]

As the programme team explain:

“Almost 15 mins after an ambulance was required, the control centre locates one — except it is another 15  minutes or more away.

“The fire crew can’t wait any longer…”

  • Control: 24 is being made up from town, if that is any better to you…
  • Delta 72: We are going to go.
  • Control: OK, we’ll send them to a different case.

image

[RTÉ screengrab]

‘Company cars’

There were further revelations regarding supposedly ‘on call’ Rapid Response Vehicles before the programme wrapped up.

First we hear a montage of clips from the past 12 months of ambulance service director Martin Dunne, celebrating the fact that such vehicles are changing the way the service operates…

We are developing different types of service delivery…
The cars or four-by-fours, staffed by paramedics or advanced paramedics. They can start immediately to administer care.

Costing around €100,000 each, 60 of the kitted-out cars are designated to officers as ‘Officer Responder Vehicles’. They’re allocated to senior managers who have paramedic training.

Though officially they’re ‘on call’, the programme reveals… “they can be parked up for an entire day while managers attend meetings”.

The investigation team tracked use of the cars over several months. There were some eye-opening revelations:

A senior officer,  based in Phoenix Park  took his emergency vehicle home four nights a week to Donegal.

At no point during the 2 month period,  did he go on any calls either travelling to and from work or when he was at home

He also left his car at home unused over the busy Christmas period.

And also:

In a two month period, a senior officer in the South took his car home… and travelled to and from work in it. He went on one emergency call during this time.

His car was parked idle at his home for two weeks, over Christmas.

The car was driven to a business with which he is closely associated on two occasions: a use of the vehicle authorised by management.

Martin Dunne, the ambulance service boss, is given the last word by Prime Time journalist Oonagh Smyth, who asks him: “What do you say to people that say you are running a substandard service?”

image

[RTÉ screengrab]
His answer:
I would say we are probably running the best Ambulance Service in the World, that’s a fact.
Our staff are more highly trained than probably most other countries, our vehicles are built to the highest standard of regulations, our equipment is the best you can buy, and everything is maintained in line with manufacturers recommendations…
We have a very positive national ambulance service which is going to improve….

You can watch the full documentary here >

Read: ‘Why did it take a Prime Time programme to highlight the problems at Portlaoise maternity unit?’

Read: RTÉ has explained Prime Time ‘Irish Ukrainians not Russians’ meltdown

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