PARAMEDICS BASED IN the south of the country are being asked to accept new crewing arrangements which some staff members say dilutes patient safety. They could face having to postpone annual leave if they refuse to go ahead with the new setup.
Usually, each ambulance operated by the National Ambulance Service contains two fully trained paramedics or advanced paramedics.
However due to staffing gaps a new contingency plan means intermediary care operatives (ICOs) are being asked to join paramedics on shift.
The move by ambulance service management has resulted in serious concerns being raised around the standard of care being given to the public.
Due to recent staffing reductions, there have been times when the entire NAS fleet has reached capacity. Private suppliers have also been drafted in to fill the gaps left by staffing issues, especially during the peak of the Covid crisis.
The newly conceived contingency plan will result in paramedic crews being split up with one paramedic per ambulance now working alongside an ICO, instead of working beside another paramedic.
The difference, according to well-placed sources, is down to experience. ICOs are trained for six weeks while it takes three years to become a paramedic.
The HSE has said that all ICOs working with paramedics have been trained to an acceptable level.
However, one paramedic source, who spoke on condition of anonymity, said that the safety of people who use the service is being put to the side in favour of better statistics for management.
While the new service will result in more ambulances on the road, it will also mean, according to the source, that “less experienced people are being forced into situations that they might not have any experience of or any training for”.
“It’s not their fault at all and I don’t wish to sound like I am attacking ICOs – they do an important job. But it all comes down to experience.”
Typical training for ICOs involves 120 hours of classroom-based learning, 40 hours of clinical placement and two days of exams. To qualify as a paramedic, it can take up to three years of study and training.
If the paramedics do not agree to the new crewing arrangements, management has said that certain NAS regions may have to return to Level 3 Capacity protocols.
This means that all annual leave will be postponed for paramedics and that private services will have to be brought in to fill the shortfall in service.
Sources said this is effectively “putting a gun to the head” of paramedics who now are faced with “either taking part in a service that’s endangering service users or else we face losing our holidays that we’ve paid for”.
Political Reaction
Labour TD Duncan Smith told The Journal that we are reaching “a perfect storm” in relation to ambulance service in the country.
He said: “Unfortunately, we’re dealing with a sub-optimal system in terms of our emergency ambulance care and cover and we have a stretched ambulance service across hse and Dublin Fire Brigade.
“We have had countless examples of delayed responses because ambulances have been sent miles away from centres to pick up and deal with calls well outside their geographic location.
There are also serious issues with morale in the service, he said.
We don’t have enough paramedics and our ambulances are going to be staffed to a skill level that’s left is sub-optimal. There seems to be no real appetite from the Minister to resolve this. People are going to suffer as a result of this and those who will suffer most are those who are sick and rely on the ambulance service.
Social Democrats Co-Leader and Health spokesperson Róisín Shortall TD said it was “a matter of concern” that the HSE cannot fully staff the National Ambulance Service.
At a time when there are serious pressures across all our hospitals, it is vital that the NAS is fully functioning. It’s literally a matter of life and death.
Questions arise as to why sufficient numbers of paramedics have not been trained and available. The HSE must set out a clear work-force plan to ensure adequate training places are provided, so that we have enough paramedics to meet demand.
In the meantime, management must sit down with the unions and urgently agree ambulance service arrangements which ensure patient safety while also respecting staff leave arrangements.
In a statement to The Journal, the HSE said that the National Ambulance Service is currently experiencing a high demand for 999 services for patients with immediately life-threatening injuries and illnesses.
A spokesperson said: “In the South region there continues to be significant pressure on emergency ambulance cover especially over the summer period. This is largely due to accumulation of annual leave due to earlier Covid demands, sick leave and vacancies that exist within the system.
“In that regard we are prioritising all resources to ensure emergency ambulance cover is maintained at agreed levels. All managers are committed to ensure staff can avail of annual leave where possible as it is very important that staff take up their annual leave entitlements.
“We have been engaging with staff representative bodies on an ongoing basis to ensure a degree of flexibility in relation to staff expectations on the granting of leave and that service delivery is prioritised for emergency ambulance cover in the first instance.
“To assist with these priorities Intermediate Care colleagues, trained to the appropriate levels, have been requested to work with Paramedics and Advanced Paramedics on Emergency Ambulances until further notice.
“The National Ambulance Service complies with Pre-Hospital Emergency Care Council (PHECC) crewing standards for emergency ambulances.”
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