The Irish Association for Emergency Medicine (IAEM) welcomes the proposed operational launch of Ireland’s first community-funded air ambulance in the south of Ireland. This service marks a significant development in delivery of pre-hospital care and represents an opportunity to bring more timely critical care capability to those, ill or injured, at the roadside. This service should complement the Department of Health’s (DoH) proposed introduction of a genuinely integrated trauma system for the people of Ireland outlined in A Trauma System for Ireland.
IAEM is concerned however with plans to staff this service with an Advanced Paramedic/Emergency Medical Technician (EMT) crewing model. This crew configuration will not have the necessary skills or scope of practice to meet the emergency needs of the most seriously ill or severely injured in our communities. IAEM seeks a helicopter emergency medical service (HEMS) that meets international best practice and is staffed by a doctor/paramedic team. This is the accepted model of HEMS staffing in the United Kingdom, mainland Europe, and Australia and is supported by a significant body of scientific evidence showing optimal patient safety and clinical outcomes.
Despite a national shortage of hospital Consultants in Ireland, IAEM understands that there are a number of specialist-trained helicopter emergency medical service (HEMS) doctors who have returned from overseas fellowship training and are working in Ireland. These doctors have expressed a willingness to work with this service. Moreover, a number of trained Irish Consultants in Emergency Medicine and Critical Care Consultants, currently working overseas, may well be encouraged to return home and work in our hospitals with a part-time HEMS clinical commitment.
A recent statement from the HSE has suggested that the existing Emergency Aeromedical Service (EAS), based in Athlone and using an Advanced Paramedic/EMT crew, met the clinical needs of 92% of patients. This study has not been published and therefore not subject to the usual peer-review process so we cannot comment on the accuracy or validity of these results, however self-evidently the needs of at least 1 in 12 patents are clearly not being met. The hope that this new service will simply be an extension of the current EAS is at odds with the DoH’s A Trauma System for Ireland publication. In it, a key recommendation states “The HSE should examine how existing HEMS resources can be enhanced and further developed, recognising the critical role of aeromedical transport in the timely transfer of high acuity patients and the implementation of a trauma system.”
The Association’s strongly-held view is that it would be a matter of serious regret if the opportunity was not taken to develop a service that accords fully with international best practice and calls on all stakeholders to review this decision accordingly.