A damning report into the country's ambulance service said there is a "critical" lack of response to 999 calls due to delays.
The investigation into the ambulances service, carried out by the Health Information and Quality Authority (HIQA), highlights the ongoing problem of some vehicles being held up for hours at a time outside hospitals.
The Review of Pre-Hospital Emergency Care Services sets out 12 specific recommendations and other opportunities for improvement which HIQA believes will increase the safety and quality of pre-hospital emergency care services that are provided by the HSE's National Ambulance Service and by Dublin Fire Brigade.
And it notes "serious concern" about the "disjointed arrangements" between the HSE's service and Dublin Fire Brigade.
The HIQA report states that critical ambulance capacity is being lost due to delays in handing over patients to the care of the hospital emergency departments and that this is a "complex problem".
Overcrowding in emergency departments, which means there is no trolley available for the ambulance patient, is one of the reasons for the delay.
It wants the HSE-run ambulance service and the Dublin Fire Brigade to make better use of the information "readily available" to them to improve the quality of care they provide.
"It is of serious concern to HIQA that current governance arrangements between the National Ambulance Service and Dublin Fire Brigade are disjointed, with inadequate quality assurance and accountability controls," HIQA's chief executive Phelim Quinn said.
"As a matter of urgency, both services must act to ensure that there is a fully integrated ambulance service in the greater Dublin area.
"This should be underpinned by a binding service level agreement, which should include quality and performance assurance reporting mechanisms."
"This report sets out areas for improvement within and across the National Ambulance Service and pre-hospital emergency care services provided by Dublin Fire Brigade, which relate to many aspects of service provision," he added.
The most recent figures show target response times for ambulances needed at the scene of a patient with a life-threatening or respiratory arrest are not met 15pc of the time.
The target is missed in up to one-third of cases in critical situations such as accidents.