Serious concerns have arisen about the arrangements between the two groups that supply the ambulance service to Dublin.
In a review of pre-hospital emergency care services, the Health Information and Quality Authority (HIQA) said current governance arrangements between the HSE's National Ambulance Service (NAS) and Dublin Fire Brigade (DFB) are disjointed, with inadequate quality assurance and accountability controls.
Both have been asked to come up with a joint action plan to improve their systems for transporting sick and injured patients.
HIQA set out 12 specific recommendations and other opportunities for improvement, which it believes will increase the safety and quality of pre-hospital emergency care services that are provided by both the NAS and DFB.
"We have identified a range of challenges in the areas of operational efficiency, leadership, clinical governance, risk management and quality assurance," said HIQA's chief Executive Phelim Quinn.
"As a matter of urgency, both services must act to ensure that there is a fully-integrated ambulance service in the greater Dublin area," he explained.
HIQA also called for a service model that changes from the current one of bringing everyone to hospital, saying it is unsustainable, and contributes to delayed patient hand-overs at emergency departments.
Both DFB, which is governed by Dublin City Council, and the NAS, which is controlled by the HSE, welcomed the publication of the review.
"The issues raised are consistent with concerns previously raised by Dublin Fire Brigade in the best interests of patients and we are pleased to see them reflected in the main recommendations," said a DFB spokesperson.
"We welcome the call to publish a joint action plan and binding service level agreement with the NAS, and especially the recommendation that there should be a more integrated working relationship between the NAS and DFB," they added.
The HSE said the report will be carefully considered by the NAS in conjunction with the ongoing reviews being carried out by the HSE into the capacity of the ambulance service and the review of the services in the Dublin region.
Mr Martin Dunne, director of the NAS, said the migration to a single national control centre, the new call and dispatch system implementation are all part of the 2015 service plan for NAS.