Advanced paramedics could relieve UHL logjam – councillor

ADVANCED paramedics should be permitted to use their clinical judgement to treat patients for non-life threatening injuries in their own homes when they deem this is safe and appropriate.

That’s according to Councillor Cillian Murphy, who has claimed patients are being brought to the ED in University Hospital Limerick (UHL) for relatively minor injuries or illnesses, which could be treated elsewhere.

However, the HSE West Forum member stressed because of the current HSE system ambulance personnel haven’t the authority to treat people in their own homes and must bring them to a public hospital.

“If you have a patient that is transported in an ambulance for something that could be treated in a Local Minor Injury Clinic, and the ambulance is now gone from West Clare for three and a half or four hours, this could be very serious for someone with a life-threatening condition.

“This also has an impact on overcrowding in ED after recent figures I obtained show that almost 60% of patients who were brought by ambulance to UHL didn’t require a bed.

“An advanced paramedic should be allowed to make a clinical assessment to establish if a person really needs to be taken by ambulance to the ED, not someone at the end of a phone who hasn’t seen them in a dispatch centre.”

He said if someone rings the emergency number for an ambulance, they are triaged by a person on the phone who are assessed in terms of the acuity of their condition before an ambulance is tasked.

“From that point it is an inevitability they will end up in ED because our ambulance paramedics don’t have the clinical capacity to reassess that patient.

“When the ambulance crew get to the patient, they have no other option but to bring them to the ED. The ED is a GP practice for a huge number of people because they can’t see a doctor.

“Why is the first port of call to ring 999 and ask for an ambulance instead of looking elsewhere for minor injuries such as broken bones?

“Can we x-ray these patients in Ennis Hospital and then send them for treatment in Croom Hospital?

“It is time the HSE adopted a different approach. According to an old saying, the best candle makers in the world couldn’t think of an electric light,” he said.

In 2021, the ED at UHL saw a record 76,473 attendances, an increase of 17% on the previous year. In the first five months of this year, we have seen a further 33,288 ED attendances, an increase of another 17% on the corresponding period for 2021. The number of over 75s attending our ED has also risen by an even greater proportion.

Members of the HSE West Forum received a recent request from the UL Hospitals’ Group asking the public to look at alternative healthcare treatment options for non-life threatening conditions to try and reduce the number of patients being referred to the ED.

The UL Hospitals’ Group has confirmed patients have been attending the ED in record numbers over the last 15 months and it is essential that seriously ill or injured patients who require emergency care continue to do so.

Injury units, GP, GP out-of-hours and pharmacy services are all available as alternatives to the ED and the group encourage members of the public to consider these options.

In 2021, the ED at UHL saw a record 76,473 attendances, an increase of 17% on the previous year. In the first five months of this year, the group has seen a further 33,288 ED attendances, an increase of another 17% on the corresponding period for 2021.

The number of over 75s attending our ED has also risen by an even greater proportion.

In 2021, 22,423 patients were brought by ambulance to the ED in UHL and 8,345 required in-patients beds in UHL, 14 in Croom Hospital, 351 in Ennis Hospital, 13 in Nenagh and 299 in St John’s Hospital.

In total, 9, 222 patients needed a public acute hospital bed in the region. Just less than 30% of all attendances in the ED were brought in by the National Ambulance Service (NAS).

One of the interestingly findings from the figures is almost 60% of patients who were brought by ambulance to UHL didn’t require an in-patient bed.

Acknowledging these patients may have received diagnostic or other treatments such as an MRI or CT scan, Councillor Murphy said a different approach needs to be taken by the UL Hospitals’ Group to tackle chronic overcrowding.

“If about 60% of patients didn’t require a bed, we should look at a different pathway for these patients to establish did they need to brought to the ED?

“Could they have been brought to a different health pathway that would have excluded ED as an option? We have to examine and see if this 60% can be treated elsewhere,” he said.

Councillor Murphy has also sought a geographic breakdown of the 22,423 patients who were brought by ambulance to the ED to try and establish where they originated from.

Acknowledging the number of patients attending ED are increasing on a huge scale, he asked why isn’t the HSE looking internally at what it can do to reduce the number of patients being brought to the ED.