Ireland’s first community air ambulance draws concern from doctors

Doctors from around the world have written an open letter to express concern about Ireland’s first community air ambulance.

A total of 22 Helicopter Emergency Medical Service (HEMS) experts from the US, Australia, New Zealand, Canada and Norway have raised issues that the life-saving service will not be doctor-led as most services are across the world.

The country’s first charity air ambulance landed in Kerry on Friday and will officially enter full-time daylight hours next month.

The air ambulance is expected to respond to up to 500 calls per year (Don MacMonagle/PA)

The service will cost two million euro to run annually and is to be funded through community and donor contributions.

It will have an advanced paramedic and an emergency medical technician (EMT) leading the medical care.

The air ambulance is expected to respond to up to 500 calls per year and bring the population of a 10,000 square mile area within 20 minutes of critical medical care.

Irish Community Rapid Response (ICRR) – a charity dedicated to pre-hospital care – is running the service in co-operation with the HSE National Ambulance Service.

It will be tasked through the National Ambulance Service 999/112 call system and is supported by the HSE and Department of Health.

The international flying doctors have expressed concern that the service is paramedic-led.

ICRR CEO John Kearney, left, and pilot captain John Murray (Don MacMonagle/PA)

In a five-page open letter, they said: “This is not up to the standard expected of a HEMS and will not be able to provide advanced pre-hospital medical and trauma care to the critically ill and injured patients it is tasked to.

“It will not be a flying ED (emergency department) or ICU.”

The letter stated that a doctor-led service would “improve clinical outcomes, decrease morbidity and mortality”.

It added: “This model brings the ER resuscitation room and intensive care unit to the patient.

“Recently the UK National Institute for Health and Care Excellence (NICE) published a benchmark guideline entitled, ‘Major trauma: assessment and initial management’.

“The life and limb-saving pre-hospital interventions listed in this guideline cannot be provided outside of a physician-staffed model in Ireland.

“Examples include and are not limited to pre-hospital blood transfusion to a bleeding patient, general anaesthetic in severe head injury and advanced trauma resuscitation including surgical eye, life and limb-saving interventions.”

The international flying doctors have expressed concern that the service is paramedic-led (Don MacMonagle/PA)

It called for the HSE to enhance the current HEMS resources, saying it is “imperative” that the correct model is in place.

Among the signatories were Scotland’s lead consultant in retrieval medicine, Stephen Hearns and the clinical director of trauma at Royal London Hospital, Anne Weaver.

A spokeswoman for the Department of Health said: “With regard to the content of the open letter, it should be noted that from the outset, any new air ambulance service will operate as an extension of the existing Emergency Aeromedical Service (EAS).

“The EAS, based in Athlone, has been successfully operating for many years in partnership with the Irish Air Corps with the crewing model of an Advanced Paramedic and an Emergency Medical Technician.

“The spectrum of patients dealt with by our EAS differs from aeromedical services in other countries who have physician led crews. Our EAS deals with less trauma, and more acute medicine (STEMI heart attacks and stroke in particular).

“Last year the National Ambulance Service (NAS) analysed EAS activity and found that 92% of our patients’ needs were met within the Advanced Paramedic scope of practice.

“Since then, the NAS medical director has extended the scope of practice of EAS advanced paramedics by privileging them for ketamine use for sedation (over and above the Clinical Practice Guideline for analgesia).

“As our aeromedical service evolves, we will continue to review how we can provide the best possible level of care for patients.

“That might include physician crewing, or it might include further expanding the competencies of EAS advanced paramedics or introducing specialist critical care paramedics.”

- Press Association

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