The ambulance service provided by Dublin hospitals for the transfer of critically ill patients between hospitals only operates five days a week and is restricted to office hours, according to a group representing anaesthetists here.
Recommending the introduction of a nationwide, 24-hour, seven-day hospital transfer service for such patients, the Association of Anaesthetists of Great Britain and Ireland also notes that such services are only available to intensive care patients.
Similarly, they say that due to insufficient funding, many Irish hospitals caring for critically ill patients on a 24-hour basis do not have adequate resources to provide the "modern standard" of care initially required before these patients are transferred.
The guidelines also recommend that the transfer of critically ill patients between hospitals should be accompanied by a Garda escort, if necessary, "to facilitate travel through traffic black spots or other delays".
But they stress that such transfers should be undertaken calmly. "A seven-day, 24-hour inter-hospital retrieval service should be available for all critically ill patients needing transfer. This would include trauma patients," the guidelines state.
"Pending this arrangement, all hospitals should have enough levels of anaesthetic cover to ensure that there is a continuous in-house anaesthetic presence even when inter-hospital transfers are taking place."
From an inter-hospital transfer perspective, there are three main types of hospitals in Ireland, according to the guidelines.
These are urban hospitals with tertiary specialisations to which all hospitals may refer; other "regional" hospitals with varying degrees of capability to handle complex cases; and over 20 acute units in general hospitals, many of which have 24-hour accident and emergency service, but do not have the ability to cater for more complex emergencies.
For example, many do not have an out-of-hours A&E consultant, or a CT scanner available to them on site 24 hours a day.
"It is difficult to justify having an A&E department open for emergencies such as major head injuries . . . without a CT scanner being made immediately available," the guidelines state.
"The role for this third layer of hospitals . . . is primarily triage, stabilisation, treatment and/or transfer for further management."
Among the other key recommendations in the guidelines are that care of the patient during transfer should be to a standard as close as possible to that available in an intensive-care unit.