Hospital emergency departments are not prepared for the threat of another winter of record overcrowding and are at risk of becoming "war zones" within weeks, nurses have warned.
As temperatures are set to dip and the cold and flu season beckons, union representatives warned the HSE is still without a "winter plan" to ease the trolley crisis.
The Irish Nurses and Midwives Organisation (INMO) claimed yesterday the HSE more or less admitted it did not have a plan during a meeting at the Workplace Relations Commission yesterday.
The INMO also said HSE officials admitted that they have been unable to fill 169 nursing posts in emergency departments across Ireland, for which they have funding.
INMO director of industrial relations Tony Fitzpatrick said: "On top of this, an additional 57 nurses would be required to provide minimum levels of safe care, according to recognised staffing ratios. Yet extra funding for the posts is not available."
The union is facing into talks with employers after the report of the Public Services Pay Commission last week failed to recommend an overall wage increase. It recommended that the nurses allowances be increased and the time it takes to reach maximum pay reduced from 20 to 17 years.
Mr Fitzpatrick said that during the meeting officials also revealed that they have not decided how to ensure safe staffing in emergency departments this winter.
He claimed they also could not say how they would re-allocate services to ease emergency departments, and health officials also were not able to guarantee replacements for nurses who are on maternity leave.
"It's impossible to think that things could get any worse. But winter is coming and there's still no plan. It will simply be impossible to provide safe care.
"Emergency departments are overcrowded now, in summer. They'll be war zones once winter comes.
"Despite record overcrowding this summer, the HSE still don't have a plan to deal with winter. Community health services are being cut, so emergency departments will face a tsunami of desperate patients with nowhere else to go.
"The recruitment and retention crisis is deepening, with hundreds of nursing vacancies in hospitals across Ireland. Nurses and midwives will be protesting at some of the worst-affected hospitals in the coming weeks. We cannot go on like this. The HSE has to be honest with the public."
In response a spokesman for the HSE said emergency department attendances and admissions continue to rise.
He said: "A&E departments are under increasing pressure to meet this new level of demand and ensure the provision of timely, safe and effective care for patients. The HSE remains committed to minimising delays for patients."
The HSE told the WRC hearing the number of nurses employed in emergency departments had increased from 1,231 at the end of 2015 to 1,500 now.
"Winter planning is currently well under way and the HSE is working with the Department of Health, hospital groups and community health organisations to finalise plans as quickly as possible to ensure preparedness for winter."
While 169 posts are currently vacant, across 29 emergency departments including the children's hospital, a significant number are filled through overtime and agency staff.