Tuesday 25 October 2016

Rude health: Tragedy at home

Ireland seems content to tolerate its poor-man's emergency service, say our GP, who uncovers a few painful truths. Can 254 ambulances really be enough for 4.5 million people?

Maurice Gueret

Published 14/12/2015 | 02:30

Minister for Health Leo Varadkar with Chief Ambulance Officer Pat Grant at the announcment of 64 brand new ambulances
Minister for Health Leo Varadkar with Chief Ambulance Officer Pat Grant at the announcment of 64 brand new ambulances
Dr Maurice Gueret

With 12 days to go to the 12 days of Christmas, I am finding it hard to remain jolly. The recent death of a Dundalk father who severed an artery in his arm in a domestic accident received a lot of media coverage. His young partner told the nation of the long 40-minute wait for an ambulance in the middle of the night. This wasn't in rural Ireland. It was a house in a very large town, five minutes away from a hospital. An inquest will be held, and if the coroner makes recommendations, some benefit may accrue from what must be an awful loss for a young family in the run-up to Christmas. Much of the media focus that week was on conditions in the emergency department of Tallaght Hospital. This deflected from the fact that the real calamity for our health service took place in County Louth.

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New ambulance

Minister Varadkar was quick out of the blocks to extend his sympathies, have his photograph taken with a new ambulance and state that 80pc of urgent ambulances arrive within 19 minutes. Two suggestions were given as to why it took 40 minutes for an emergency ambulance to arrive. In the Dail, it was suggested that sick leave played a part. Another story was circulated about there being a number of local emergencies on at the same time of 3am. The story made way for another. We had some truth. But not the whole truth.

Dire shortage

Ireland, rural and urban, has a serious and, dare I say, dire shortage of emergency ambulances. No amount of ministerial photo opportunities handing over the keys of 'the first of 64 new vehicles' can hide this fact. When these new vehicles arrive to replace clapped-out ones we will have a grand total of 254. That's 254 properly-equipped emergency ambulances for 4.5m people living on our 70,000sq km. Wales has a population of 3m singing souls who all live on a green valley of 20,000sq km. Guess how many emergency ambulances they have? They have 372. If Ireland had the equivalent Welsh number on the basis of our population, we should have 558 emergency ambulances. Based on size of the country, we should have 1,302 ambulances. We can debate the true figure of what we need, but the fact is that our country has about half the number it should have.


It's not easy to point a finger at why we have such a deficiency in this area. The old failing of health, where all the notes go on salaries and overtime, and coins are left for capital investment, plays a part. Some years ago, the HSE commissioned a report on our ambulance service. Its findings conveniently suggested that Ireland was 'too rural' to meet international response times, which are usually calibrated in response times of eight minutes. So instead of expanding a fleet of emergency ambulances, the powers-that-be pretend that 18 or 19 minutes is good enough for Ireland. They talk up community responders, parish defibrillators and paramedics on bikes, hallmarks, in my tiring eyes, of a poor-man's ambulance service. Local hospitals have been abandoned or threatened with redundancy with only lip-service paid to ensuring that access improves to so-called 'centres of excellence'. Across the border, in equally rural Northern Ireland, they measure their response times to life-threatening emergencies in eight minutes. And in about two out of every three cases, they even manage to do it. Our lot are told they are simply too rural in the country and too urban in the towns.

Dr Maurice Gueret is editor of the Irish Medical Directory drmauricegueret.com

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