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Access to emergency departments in rural Ireland can be hard - so why don't we have an air ambulance service?

Security expert Tom Clonan raises concerns about why Ireland is one of the last EU member states not to have an air ambulance service.

Tom Clonan Security specialist and columnist,

LAST MONTH SAW the launch of the Irish Community Rapid Response air ambulance service based in Cork. Funded entirely by charitable contributions, this is a much-needed emergency medical service.

In my view, however, a comprehensive nationwide Helicopter Emergency Medical Service (HEMS) ought to be a part of the critical infrastructure of our health service. This is especially so given the geographical spread and pattern of dispersal of Ireland’s population.

Access by road to emergency departments in regional centres in Ireland can be difficult even at that best of times. In recent years, after a period of austerity that has negatively impacted on our health service provision, there has been a critical focus on ambulance response times throughout rural Ireland – particularly in the case of acute medical emergencies.

In 2011, HIQA recommended a response time of no more than 7 minutes 59 seconds for ambulance crews responding to life-threatening incidents countrywide. The National Ambulance Service and Dublin Fire Brigade have at times struggled to meet these response times and there have been some high-profile and tragic incidents involving loss of life where a slow or delayed response time was a factor.

A 2016 report commissioned by the HSE recommended that a further 250 ambulances were needed across Ireland to match the optimum call-out times and critical infrastructure for emergency response demanded by HIQA.

The scale of the problem facing the National Ambulance Service is immense, with underfunding and understaffing identified as the key contributory factors in slow or delayed response times to acute medical emergencies.

A follow-up report, published by HIQA in March 2017 indicated that there are still serious challenges for our fleet of road ambulances in meeting the optimal response times required to service our emergency health needs.

It is in this context that the state should complement and support our National Ambulance Service with a flexible Helicopter Emergency Medical Service.

Ireland needs at least 4 or 5 helicopters nationwide

Ireland is one of the last European Union member states to have a comprehensive – doctor led 24/7 HEMS service. For example, our nearest neighbours Britain have approximately 40 such helicopters with both day and night time flying capabilities.

France operates a similar number of HEMS helicopters and bases. Austria, with a population of just 8.7 million has a fleet of 28 HEMS choppers. Italy has over 50 HEMS bases. On average within Europe, there is approximately one HEMS aircraft per million of the population.

Just over the border in Northern Ireland, there is a doctor-led HEMS service operated by Babcock Mission Critical Services in conjunction with the NHS.

Their HEMS aircraft are supported by a team of 6 advanced paramedics, 14 doctors and 2 pilots. Costing approximately 2 million sterling per annum, this service represents a useful model for implementation throughout the Republic.

The Irish Community Rapid Response initiative launched in Cork is a credit to those involved. Much credit is also due to the HSE for responding positively and flexibly to the initiative – working in partnership to provide National Ambulance Service advanced paramedics and emergency medical technicians to crew the aircraft.

The Community Rapid Response initiative in Cork is expected to cost approximately 2 million per annum with around 500 call outs expected annually. The service is based on one Augusta Westland 109 helicopter.

Based on European norms, with a population of 4.6 million, Ireland needs to expand this HEMS service to at least 4 or 5 helicopters based at strategic locations nationwide. A state-funded, doctor-led nationwide HEMS service could be provided for the Republic relatively quickly and more cheaply than by private sector provision.

The Irish Air Corps has operated a helicopter emergency medical service out of Athlone since June 2012. The HEMS service, designated Air Corps 112, operates in partnership with the HSE and has responded to approximately 3000 incidents saving thousands of lives – mostly in the west and north west of Ireland.

The large Air Corps Augusta Westland 139 helicopters used in this service have extended range and flexibility and are capable of providing a much needed nationwide service.

‘The envy of our European neighbours’

Currently, No 3 Operations Wing in Baldonnel has a fleet of 6 – state of the art – AW 139 helicopters that would be perfectly suited for an expansion of the HEMS service throughout the Republic. These aircraft are currently under-utilised due to pilot and other staff shortages in the Air Corps.

At present, the Air Corps is operating with approximately two-thirds of its normal number of pilots – with dozens more expected to retire in the next year or two. There is also a chronic shortage of essential ground crew and air traffic controllers – a shortage of approximately 150 key personnel overall.

In response to a recent parliamentary question by Sinn Fein TD, Aonghus O’Snodaigh the Department of Defence stated that – if properly crewed and staffed – the Air Corps could provide a 24/7 aeromedical service for 1.3 million euro per annum.

This year, the government awarded a contract to the UK-based private company, Air Alliance, to provide a night-time air ambulance service for 7 million euro per annum.

Instead of contracting this vital service to the private sector abroad, if the government were to invest a smaller sum in recruitment and retention within the Air Corps, we would be in a position to provide a state of the art HEMS service nationwide – at a fraction of the current outsourced cost.

Recent experience has taught us that such a service is essential throughout the state. The Air Corps, given its corporate skill set and critical mass, is also capable of the paradigm shift in training and investment that could provide Ireland with a state of the art 24-hour HEMS service – with both day and night time operations a possibility.

This would require investment in training, recruitment and a liaison with the Irish Aviation Authority to formalise such an initiative. The investment required would again be a fraction of what is being paid to overseas private operators contracted by the state to provide a limited service.

Consistent with calls this week from emergency medical hospital consultants for such a service to be physician-led, the Air Corps AW 139 aircraft – capable of carrying up to 15 passengers – would provide an aircraft and crew solution that would allow for doctor-led teams of advanced paramedics and emergency medical technicians.

For a very modest investment, the Minister for Health could build a 24/7 HEMS service in Ireland, using existing resources that would be the envy of our European neighbours.

Dr Tom Clonan is a former Captain in the Irish armed forces. He is a security analyst and academic, lecturing in the School of Media in DIT. You can follow him on Twitter here.  

About the author:

Tom Clonan  / Security specialist and columnist,

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