Dublin has ‘inferior’ ambulance service
Health Minister warned there is ‘unacceptably high risk’ to city patients
DUBLINERS who find themselves in life-threatening situations cannot be guaranteed the nearest ambulance will be dispatched to collect them, Health Minister Simon Harris has been warned.
An internal departmental memo said that the capital’s residents were getting an ‘inferior [ambulance] service’ where significant resources were also being wasted every day. The problem comes from having two separate ambulance services, one run by Dublin Fire Brigade (DFB) and the other by the National Ambulance Service (NAS) operating in the city, officials said.
In a submission from civil servants in the Department of Health last November, Minister Harris was told there was an ‘unacceptably high risk’ to patients because ambulances were being used for low priority cases – instead of being dealt with over the phone by nursing staff.
However, because not all calls are routed through the National Emergency Operations Centre (NEOC), this cheaper option – which keeps ambulances on the road for high priority cases – is not available most of the time in the capital. The submission stated: ‘Every call in Dublin will result in the dispatch of an ambulance to bring the patient to an emergency department, whether the patient needs to be transported or not.’
Officials admitted problems with the service were not acceptable, saying: ‘We cannot oversee a situation where the people of Dublin receive an inferior service to the rest of the country.’
They also recommended the Department supports plans to consolidate all Dublin ambulance calls at a specialised dispatch centre in Tallaght. Minister Harris was also informed of a series of incidents where lack of information had led to hold-ups including one involving the medical director of the NAS, Dr Cathal O’Donnell.
The emergency medicine consultant had been stuck in a traffic jam in Dublin oblivious to the accident ahead of him that was causing it.
The submission said: ‘Had he been aware of the incident he could have used his blue light to get to the scene quickly.’ However, there is no integrated system between the DFB and the NAS to notify medical personnel of such incidents, which the documents highlight ultimately present a patient risk.
They also cited an item on RTÉ Liveline where a caller rang in to complain about an ambulance delay in Drumcondra after an elderly person fell. ‘HSE communications heard the report, made contact with RTÉ to get the patient’s address, and immediately dispatched the nearest available resource,’ said officials.
‘NAS paramedics were attending to the patient when the DFB fire tender arrived.’
The submission said the lack of integration between the two services was ‘negatively affecting patient safety’ and risked ‘undermining public confidence’.
It also said that the DFB were using a telephone system that was ‘outdated’. Emergency calls in Dublin go through the fire brigade in the first place with the NAS only called in when no resources are available or too far away.
The submission added: ‘Requests for NAS assistance are more than 60 requests per day. More recently, the DFB pass calls in batches of 10 to 15 which present increased challenges to the NAS in terms of rapid prioritisation.’
The Department of Health said Minister Harris should back a plan to transfer DFB personnel to the National Emergency Operations Centre in Tallaght where the two services could be integrated.
Officials said this would cost in the region of €2.2m a year would but lead to a far better service. They said alternate plans to upgrade DFB headquarters in the city would be ‘totally unnecessary’.
‘What is proposed is the development of a partnership approach to service delivery which would be overseen by a person agreed by both sides,’ they said.
In a statement, the Department of Health said: ‘The Department fully supports the current Dublin City Council and HSE proposal to consolidate all Dublin ambulance call-taking and dispatch to the internationally accredited National Emergency Operations Centre.
‘The current call-taking arrangements represent an unacceptably high patient safety risk and give rise to delays in the allocation of ambulance resources to patients, including in potentially life-threatening situations.’
Ambulances being used for low-priority cases Telephone system is ‘outdated’