Patient transport is causing ripples in the West, reports Lorna Siggins, Western Correspondent.
WEST COAST doctors believe the bureaucracy which is already bedevilling parts of the health service may be having a negative impact on transport of patients to hospital.
A "patchwork" system is developing which is still well short of the dedicated helicopter emergency medical service (HEMS) required, according to Mayo GP Dr Jerry Cowley.
However, of more immediate concern to Dr Cowley and west coast colleagues is a move by Health Service Executive (HSE) administrators to bypass local medical advice on best transport options. The use of Aer Arann for non life-threatening cases involving islanders appears to have been downgraded in favour of the more expensive and more time-consuming use of the Irish Coast Guard and Air Corps.
Aer Arann was founded in the early 1970s by the late Coley Hernon of Inis Mor as both a transport and medical service for islanders, and this section of the now highly successful airline run by Padraig O Ceidigh is still retained as a vital community service.
The fixed wing Brittan Norman Islander aircraft which commutes between the islands and Indreabhan and south Connemara is within seven minutes of Inis Mor if required for medical reasons.
The charge is normally €400 a flight to cover fuel costs, which is up to 20 times cheaper than flying an Air Corps helicopter from Baldonnel, according to aviation sources. This is independent of staff costs.
In a number of recent incidents on the Aran islands, the HSE's ambulance service opted to use Air Corps helicopters instead of Aer Arann aircraft which would have ensured faster delivery.
Cowley says if there are compelling budgetary reasons for this decision, these should be made known. He welcomes improvements in the existing services, but believes that these fall short of HEMS, which is a standard service in other European countries.
Under several new service level agreements (SLAs) negotiated with the HSE, the Irish Coast Guard can now airlift paramedics trained with the National Ambulance Service to marine emergencies, while a separate agreement with the Air Corps renews existing arrangements for medical evacuations or "medevacs".
The marine ambulance response team has been given its own acronym - Mart - by Minister for Transport Noel Dempsey, who publicised the development in early March. Co-ordinated by the Irish Coast Guard, Mart will "provide experienced, well-equipped, self-sufficient pre-hospital care at major marine incidents nationwide", he says, and is "the first team of its kind in the country".
The Mart team will "build on the expertise gained from the HSE National Ambulance Service Incident Response Team set up in 2004", Dempsey says. "The new teams have received rigorous training in major incident medical management and support, chemical decontamination, rope access, helicopter operations, prolonged entrapment casualties and restricted breathing apparatus training. The work that these highly trained individuals will conduct will be enormously important in saving lives," he says.
Mart has been welcomed by Cowley and by Aran island GP Dr Marion Broderick, who has been a supporter of his HEMS campaign.
However, the Irish Coast Guard's primary responsibilities relating to marine rescue also extend to pollution response; similarly, the Air Corps has a number of obvious responsibilities, which means that it cannot provide the dedicated HEMS which Cowley envisages.
The Air Corps has withdrawn from air/sea search and rescue, but its air ambulance and medevac roles has been renewed in the new SLA between the HSE and the Department of Defence covering the new Agusta-Westland AW139 helicopter acquisition.
An AW139 has been fitted out for air ambulance duties to replace the Alouette helicopters, which carried out medevacs for decades. Unlike the Alouette, the AW139 service has night-flying capabilities.
Air ambulance has been well established for 40 years, according to Air Corps, which says its staff undertake this with a "sense of duty and pride". The first such flight from Baldonnel dates back to February 1964, when an Alouette was fitted with snow skis to take a patient from Wexford to Dún Laoghaire, Co Dublin, for treatment.
The service from Baldonnel allows for day and night patient transfer, organ delivery, neo-natal and international patient transfer, and an average of 100 such missions are carried out every year.
The HSE has confirmed that the Irish Coast Guard helicopters at Shannon and Sligo are to be summoned for "extreme emergencies", and the Air Corps for non-life threatening but ill patients.
"The procedure for offshore emergencies is to use the coastguard. For planned transfers we use the Air Corps as a first option. In the event the Air Corps are unable to provide this service we charter an air craft from Aer Arann for the transfer," the HSE West says.
West coast doctors say the new SLAs were drawn up without local consultation and without taking into account the existence of the Aer Arann link and the clear distinction that can be made between air ambulance and medevacs.
Neither service will be available for land-based emergencies, such as road incidents or other situations where emergency transfer for specialist treatment within the vital "golden hour" is critical.
"We welcome any upgrading of existing services, of course,but we don't want more bureaucracy, which seems to be developing," Cowley says.
A dedicated HEMS would not have any other calls on its time, and would be run by the national ambulance service, he says.
The feasibility of HEMS was examined in a cross-Border consultancy study published for both health departments in April 2004, he points out.
The study, which Cowley has spent many years campaigning for as part of a group of rural GPs, found that inter-hospital transfer would be the "most appropriate" in an all-island context.
"All the research suggests that the further you have to travel [ the at-risk time] to the national neurosurgical unit at Beaumont in Dublin, the greater chance of dying or being disabled for life," he says.
"HEMS would save money, as international research shows that the time spent in intensive care units can be reduced by one-third without altering hospital care by using HEMS for inter-hospital transfer."
A charity established in Kerry last year is raising funds for an air ambulance service, but Cowley believes the State must take primary responsibility.