Sir, - Mr Brian Cowen TD, Minister for Health and Children, has asked me to refer to the Editorial of June 18th and to articles on the training of ambulance personnel (The Irish Times, June 14th). The thrust of these articles is to suggest that the development of the ambulance service, including the training of ambulance personnel, has been neglected by the Minister and the Department of Health and Children. The Minister has asked me to bring to your attention the following, which demonstrate the priority which he and the Department attach to the development of the ambulance service and which shows that the service is undergoing a comprehensive programme of improvement and development.
The training of ambulance personnel is considered by the Minister to be a central and fundamental element in the delivery of an efficient and effective ambulance service. Towards this end, over two-thirds of all ambulance personnel have now completed the basic training course recommended by the Review Group on the Ambulance Service and the National Ambulance Advisory Council.
When an overall improvement in training is achieved, the question of paramedic training will be addressed, in line with the recommendations of the Review Group that "the national priority should be to provide a significant improvement in the quality of the training provided for current personnel across the eight Health Boards, on a national basis".
The basic life-support training which Irish ambulance personnel receive compares very favourably with the best international standards. This training covers all areas of basic life-support, including emergency cardiac care, trauma care, emergency, childbirth and head/spinal injuries. The use of a defibrillator in the treatment of cardiac emergencies and specialised pre-hospital trauma life-support treatment is included in basic training. The standard of basic life-support training which Irish ambulance personnel receive at least equals and often exceeds the level of training provided to ambulance personnel in other countries.
The Minister has also asked me to point out that, since the publication of the Report of the Review Group on the Ambulance Service, approximately £23 million in additional funding has been provided for the implementation of the report's recommendations. Of this, the present Minister allocated a total of £12.6 million (i.e. nearly 50 per cent of the total additional funding. The additional funding has resulted in major improvements in the service, including:
the improvements in the training of ambulance personnel mentioned earlier;
improvements in the specification and age profile of the ambulance fleet; e.g., 68 per cent of emergency ambulances are now less than five years old, compared with 48 per cent in 1994;
regional command and control centres are operational in five health board areas, a joint fire and ambulance command and control centre for the Dublin area has recently been commissioned and construction and equipping of similar centres is at an advanced stage in the remaining health board areas;
the progressive provision of 24 hour "on duty" cover in ambulance stations nationally;
the opening of additional ambulance stations;
the provision of training for, and equipment to, GPs in remote rural areas, on a pilot basis, to enable them to deal with emergencies in advance of the arrival of an ambulance.
The introduction of paramedic training for ambulance personnel is a complex issue, involving several considerations. For example, its introduction has to be preceded by an improvement in the general level of training for ambulance personnel and complex medico-legal and organisational issues have to be addressed. In addition, there is still considerable debate as to the benefits of paramedic training.
The primary objective of the ambulance service is to ensure that it responds to emergencies quickly, so that effective pre-hospital care is available to all who need it. This involves addressing the issue on several fronts, including training, and the infrastructural and other measures being implemented currently will ensure that this objective is achieved.
The Minister wishes to point out that, far from being indifferent to the development of the ambulance service, as stated in your articles, he has given the implementation of the Report of the Review Group a high priority since taking up office and is implementing the recommendations of this report in a planned, structured and appropriate manner. This is evident from the points outlined in this letter and, in particular, from the increased funding which he has secured for the ambulance service over the past three years. - Yours, etc.,
Gerry Steadman, Communications Manager, Department of Health, Hawkin's House, Dublin 2.