HSE on red alert over eight-minute emergency response target

EXTRA staffing and equipment are needed to ensure ambulances and advanced paramedics in Clare have a more realistic chance of responding to life-threatening cases within eight minutes.

That’s the verdict of Clare County Councillors who have asked the Health Service Executive (HSE) to prioritise the provision of satellite navigation systems (sat navs) on all ambulances and first responder vehicles, as well as extra paramedics and vehicles. The introduction of a national postal sort code system for every dwelling is also vital if emergency services are to achieve the eight minute response time recommended by the Health and Information Quality Authority (HIQA).
HIQA published a report last January recommending the development and implementation of response-time indicators for life-threatening emergency calls.
Entitled Pre-Hospital Emergency Care Key Performance Indicators for Emergency Response Times,  the blueprint recommends all life-threatening incidents are responded to by a first responder, including advanced paramedics, paramedics or cardiac first responders in eight minutes or less in 75% of all cases. It called on service providers to ensure there is a patient-carrying vehicle at the scene of an incident within 19 minutes.
Councillor Tom McNamara warned the response-time indicators are not practical to achieve in rural parts of the county, where people can expect waiting times of at least 30 minutes.
While the eight-minute target might be met inside the Ennis town boundary because of the proximity of the largest ambulance station, Councillor McNamara said it would be extremely difficult to achieve outside that area.
He noted Kilmaley Development Association has trained 35 people to use a defibrillator at the Kilmaley Day Centre and one in Connolly in the event of cardiac arrest, while a rota is drawn up for one person to carry a contact phone at all times.
He proposed the HSE should train more people in how to use a defibrillator in the event of an emergency.
Councillor Tony Mulqueen called for the introduction of sat navs in all ambulance units and the fast-tracking of the proposed postal sort code for every dwelling in the county.
Councillor Joe Arkins stressed the same standards for response times in Loop Head and Dublin should apply and argued that people living in West Clare should not get a service that does not meet the recognised standard because of their isolated geographical location. Unless proper resources are allocated for ambulances in Clare, he said the HIQA standards would effectively be hypothetical.
The family of the late Patricia O’Neill, Caherdavin, Limerick, whose case was highlighted in last week’s Clare Champion, has highlighted that it took almost 30 minutes to respond to a 999 call on September 5 last at 1.21am, almost four times longer than the recommended HIQA response time.
Her daughter, Emer O’Neill, said she is “horrified” that these guidelines are not being implemented in the Mid-West as evidenced by the time it took to respond to the 999 call for her late mother.
She called on the HSE to implement the guidelines as quickly as possible and queried what is the point in HIQA publishing a report if it is going to be ignored.
Following the HSE’s response to the family’s initial queries last week, she asked whether her father’s initial call was categorised as an emergency. She said when her father rang, he stated he wanted an ambulance and indicated it was an emergency as he thought his wife had suffered a heart attack.
Unlike her father’s experience, she said the ambulance control centre stayed on the phone with her for about 12 minutes to provide guidance on performing CPR. She asked why this wasn’t done when her father made the first call and questioned what authority is responsible for ensuring the HIQA guidelines are being implemented.
The Mid-West HSE stated last week that the Ennis ambulance, which was on route to Limerick, responded to cover the area as all Limerick ambulances were on emergencies at the time. It stated it is normal practice to deploy ambulances to other areas during busy periods, whenever possible, to make the best use of resources.
Based on best international practice, HIQA concluded the development and implementation of response-time indicators would improve the quality and safety of pre-hospital emergency care in Ireland. It said implementing these indicators would ensure patients with the most serious emergencies would receive the fastest on-the-scene response, while less urgent cases will wait longer.
The introduction of response-time indicators is also dependent on the successful roll-out of the Advanced Medical Priority Dispatch System (AMPDS) across the National Ambulance Service, as well as appropriate data and information management systems. HIQA stated it is aware the HSE has taken steps to meet the recommendations.
“The National Standards for Safer Better Healthcare, which are awaiting approval by the Minister for Health, set out what a high quality safe service looks like. Following their approval, the authority will commence monitoring the HSE’s compliance with the standards, which will include HSE pre-hospital emergency care services,” a HIQA spokeswoman said.
National HSE statistics for the first seven months of the year reveal 52.74% of all ambulance call-outs were responded to in eight minutes or less for cardiac or respiratory arrest. This drops to 28.6% for other life-threatening conditions. The percentages are based on a figure of 1,511 for the first category and 40,380 for the latter.
The Mid-West HSE hadn’t responded to a number of Clare Champion queries about response times in the region and the O’Neill family’s  latest concerns at the time of going to press.