The most recent figures on the time it takes for ambulances to reach the scene of a call-out show that response times vary substantially by region. The Comptroller and Auditor General's (C&AG) report on the emergency ambulance service, completed in November 1997, found that on a national average, calls for ambulances were responded to within 20 minutes in 87 per cent of cases. However, in the Midland, North Western and Western Health Board areas, fewer than 60 per cent of calls were reached within 20 minutes.
In England, emergency response times are measured against national performance standards which were first introduced in 1974. Emergency ambulance services are expected to respond to half of all calls within eight minutes. Urban services should respond to 95 per cent of calls within 14 minutes, while rural areas are expected to achieve the same success rate in 19 minutes. Only 10 of the UK's 37 ambulance services failed to reach the 95 per cent target response time in 1996-97.
Northern Ireland also outshines the Republic when it comes to response times. The target set by the Northern Ireland Ambulance Service is for 95 per cent of calls to be responded to within 21 minutes. In the period January to March 1997, around the same time as the C&AG's office was collecting figures for the Republic, all four Northern Ireland health board regions achieved the 95 per cent target.
While the C&AG's report concluded that performance targets set for emergency ambulance services in England were "not necessarily appropriate" for the Republic because of differences in "population and geographical circumstances", it said the Republic's poorer response rates were also attributable to the fact that the resources provided for the ambulance services in the Republic "are considerably less".
The report singled out the north-western area, where only 53 per cent of calls are responded to within 20 minutes and just one in five calls were responded to in 10 minutes. It said that "even allowing for the fact that the population served is widely dispersed over difficult terrain and poor roads, it is surprising that the average speed of response to emergency calls in the region was the lowest achieved".
However, the North Western Health Board is attempting to address the problem by operating a project under which selected GPs in remote rural areas are trained and equipped to deliver pre-hospital emergency care, both as a first response to emergency calls, and in support of ambulance crews. The Department of Health says the scheme has been very successful and it may be introduced in other parts of the country.
In the Western Health Board area, fund-raising by the charity Croi contributed to the introduction in 1996 of a special heart ambulance operating out of University College Hospital Galway. The ambulance, which cost an initial outlay of close to £150,000, is crewed by a doctor and a specially-trained team and effectively acts as a mobile, coronary care unit. The customised ambulance allows cardiac patients to be treated en route to hospital, and means they don't have to be assessed in casualty before being admitted to the hospital's coronary care unit.
However, because Croi has been raising funds for heart surgery facilities in Galway, i it has had to delay a campaign for heart ambulances for Roscommon and Castlebar.
The Western Health Board's consultant cardiologist, Dr Kieran Daly, says the ambulance allows the doctor on board to transmit ECGs to the hospital, where they can be analysed by senior doctors. The doctor on board can also administer thrombolytic drugs to the patient, and deal with electrical instability caused by the attack. He has "no doubt" that the service, which deals with up to 40 calls per month, has improved patient survival rates.
Other measures were considered by the 1993 Ambulance Review Group including the introduction of new dispatch systems, which would enable ambulance dispatch units to prioritise call-outs according to their urgency rather than answering calls consecutively. The report also called for greater public education in cardiopulmonary resuscitation techniques which would enable bystanders to keep patients alive while the ambulance was on its way.
While it is notoriously difficult to estimate how significant an impact such improvements could have on survival rates, the review group felt that up to 100 out-of-hospital cardiac arrests could be resuscitated in Dublin alone each year, if such reforms were successfully implemented.