THE FATHER OF a young man who died after suffering a suspected asthma attack, described how he watched his son take his last breaths while waiting two hours for an ambulance.
Karl McCarthy said he believes his son Ian’s life could have been saved had emergency crews reached the 29-year-old sooner.
The dad-of-three passed away at his Co Tipperary home earlier this month after suddenly taking ill.
He had a history of serious asthmatic attacks which previously required 999 assistance with crews previously responding within 15-20 minutes, according to his family.
At the time of his death, the young dad lived just five minutes from a local ambulance hub.
His death is one of a number of fatalities that Noteworthy can today reveal have raised serious questions over the National Ambulance Service (NAS) emergency response system.
They include claims that the service has a shortage of appropriately qualified paramedics and a 999 call categorisation system described by some staff as “not fit for purpose”.
“Unless action is taken by senior management to address the serious issues raised by both NAS staff and the public, more people will continue to die,” one NAS whistleblower told Noteworthy. “The situation is dire.”
The HSE, responding on behalf of the NAS, said it operates a “dynamic model of ambulance deployment” in line with “international best practice” to prioritise resource allocation to the “highest acuity calls.
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Ian McCarthy passed away in the early hours of August 1 after collapsing in the Roscrea home he shared with wife Celine and their three young children.
His father described how family, friends and neighbours tried in desperation to save the 29 year-old as they waited for paramedics.
“When I got there that night, people were already there with him,” he told Noteworthy.
“One of the lads was holding his hand and taking his pulse.
“He was shouting down the phone, where is the ambulance? Will we put him in our car and take him ourselves to the hospital? It’s 20 minutes away.
“And we were told no, leave him.”
Mr McCarthy said at this point, his son remained unconscious, however he still had a pulse.
“After telling the emergency services that his pulse seemed strong, within 15 minutes I could see him taking his last few breaths,” he said.
I shouted at the lads, he’s gone, he’s gone. We couldn’t find a pulse, so we started doing CPR.
An hour-and-a-half after first contacting 999, there was still no sign of an ambulance.
However, both gardai and the fire brigade had arrived at the scene.
“After an asthma attack, Ian needs pure oxygen to inflate his lungs again,” Mr McCarthy explained. “Only an ambulance could provide him with that.”
“In fairness to the gards, they were shouting down the radio to get one here as soon as possible.
“Maybe that’s why two ambulances came at the same time.”
Mr McCarthy said it was around two hours after the initial 999 call when paramedics finally arrived.
“It felt like forever and ever and ever,” he said.
“I confronted one of the paramedics coming out and I used a couple of swear words.
“And she stood there and she just took it. She put her head down and said nothing.
“And then I backtracked. I said, ‘Look, I’m sorry. I know it’s not your fault…I just want to know, why?’”
The devastated dad said he was advised by the paramedic to lodge a complaint with NAS.
He told Noteworthy: “I remember pointing at Ian on the floor and I said, complain? A Joe Soap like me complain? What can I do?
“And she looked up at my face and she said, ‘If you don’t complain, it won’t change’.”
After posting about his son’s death on social media, Mr McCarthy was inundated with messages of sympathy and support, including from those who work within the NAS.
He said many of those people, including paramedics, had told him staff have previously raised concerns with management over ambulance response times and call handling issues.
“There’s an actual ambulance hub in town here, it’s less than five minutes away,” he said.
“But even an ambulance coming from Dublin would have been here before the one that did arrive the night Ian died.”
Mr McCarthy now plans to lodge an official complaint over his son’s death with NAS.
“I won’t know Ian’s cause of death until the coroner’s report and maybe the ambulance might not have been able to save him, I don’t know.
“But it would have given him a chance.”
In a statement to Noteworthy, the HSE said it cannot comment on individual cases.
“We can confirm that we received a call about an incident on the night of 31 July/1 August in Roscrea and that the National Ambulance Service attended,” the spokesperson said.
“However, the HSE cannot comment further on individual cases when to do so might reveal information in relation to identifiable individuals, breaching the ethical requirement on us to observe our duty of confidentiality.”
Given there was no response given to our queries, it is unclear whether other ambulances within the local town hub were out on call or out of commission.
A Noteworthy investigation has uncovered how the young Co Tipperary man’s death is not the first to raise serious questions over the country’s 999 response system.
In 2021, an investigation was carried out by the National Emergency Operations Centre’s (NEOC) Quality Review Unit following the death of a 60 year-old man in the carpark of a service station in Leinster.
The man had called 999 after suffering from chest pains whilst driving.
Documents seen by Noteworthy show that over the course of almost 27 minutes, five separate ambulance crews were diverted away from responding to the call.
That’s despite a call handler logging the fact the man was in suspected cardiac arrest – the most critical call response category.
Logs also show that the emergency operator disconnected the line after failing to receive a response from the patient.
Numerous failed attempts were made to call the man back, as well as NAS attempts to contact staff at the service station in question.
On arrival, paramedics found the man slumped in his car, unresponsive.
Despite numerous attempts to revive him, he was pronounced dead at the scene.
According to the NEOC internal report, a review was carried out into the circumstances of the incident.
It stated that the call out had been “audited with a compliant result of 90%” with 10% “deducted” due to a failure to assign a crew which could have been on the scene within 10 minutes.
Asked about the incident, a HSE spokesperson told Noteworthy: “The NAS is unable to speculate on the cause of death of patients, which is only determined following medical certification or a coroner’s inquest.
“For some patients, their death is expected, while for others they may have injuries which are not compatible with life.”
The HSE also stated that the NAS “does not routinely have information on whether or not a quicker ambulance response time may have prevented death in individual circumstances”.
Noteworthy is aware of two other deaths which occurred in recent months, in different parts of the country, where patients died before an ambulance arrived.
They included the death of a young person with the serious, but treatable, condition of diabetes.
It’s understood the NAS is currently investigating the circumstances of the death.
The HSE said it does not comment on individual cases.
The details were brought to light by an NAS whistleblower who told Noteworthy that ambulance staff, including paramedics, are “petrified” of patients’ lives being “needlessly lost”.
The individual, who has spoken to Noteworthy over the last number of months, listed a number of serious concerns raised by staff to senior NAS officials.
They include a lack of “appropriately qualified paramedics” which they say has left the service unable to respond to some life-threatening calls.
Training of advanced paramedics – the only grade capable of providing what is known as “advanced life support” to seriously ill patients – has also stalled, they said.
Advanced life support can range from the administering of pain relief medications, airway management to other life saving interventions.
This shortage “is worsening delays and patients are suffering harm”, the whistleblower said.
“Crews are frequently being tasked to calls that are too far away or the crews being tasked do not hold the appropriate clinical level,” they told Noteworthy.
“For example, a cardiac arrest would require an advanced paramedic but there are increasingly less available on the road to respond.”
They added: “Delays and lack of advanced life support is a daily occurrence.”
The whistleblower said there is a “large existing panel of staff” awaiting training. However, training is not progressing quickly enough, they said.
The HSE said the number of advanced paramedics working in the NAS has more than doubled from 160 in 2016 to “approximately” 375 in 2024, with “ongoing educational opportunities” under review.
However, the department did not confirm how many of those advanced paramedics are no longer working in ambulance response roles.
Addressing staff concerns surrounding the lack of advanced paramedics within the NAS, the HSE said it currently prioritises support for staff undertaking a Masters in Specialist Paramedic Practice.
“To date, three groups of Paramedics have commenced this programme with the first group expected to graduate in September 2025,” said a spokesperson.
NAS staff who spoke to Noteworthy said a number are working within NAS management or non-patient facing, and non-clinical, roles.
A HSE spokesperson added: “It has become increasingly clear that in the context of an ageing population with the prevalence of more chronic diseases, diversification of skill sets is required to meet the growing needs of our patients in the future.”
Noteworthy understands that a number of NAS staff have also raised as to whether it was fit for purpose in the context of increased calls and operational changes.
Speaking on behalf of the 999 service, the HSE said it operates a “dynamic model of ambulance deployment” in line with “international best practice” to prioritise resource allocation to the “highest acuity calls” requiring an immediate emergency response.
The NAS whistleblower also told Noteworthy that “some calls involving serious burns are regularly being categorised as the second lowest priority call determinant”.
“While a call about a perfectly healthy teenager having a panic attack is categorised as serious and life threatening.
“This is a higher priority than an older person laying on the ground outside in any weather with a broken hip.”
The NAS staff member added: “It is also higher than someone suffering a stroke, a true time critical emergency.”
In response, the HSE also said that despite a “year-on-year rise in demand” for services, the NAS has improved ambulance response times for both purple and red 999 calls – the most serious categories.
According to figures provided to Noteworthy by the HSE, 76% of purple calls were responded to within the HSE target of 19 minutes or less to date in 2024.
While 48% of red calls were responded to within the same time frame and period.
This is a rise of 2% and 1% respectively since 2023, and both response rates were just over the HSE’s key performance target.
However Noteworthy has seen a number of internal NAS documents which back up serious concerns raised by ambulance staff.
They include a number of incidents where the service was unable to deploy staff to provide advanced life support to some of the most critical of calls.
At times, dispatchers recorded that they had no advanced paramedics available across entire regions for a whole 12 hour shift, sometimes longer.
NAS staff have also told Noteworthy that there have been “multiple” serious adverse events recorded in the service “all over the country”.
A serious adverse event is an incident that results in death or serious injury/illness to a patient, or with the potential to cause death or serious injury.
One ambulance worker claimed these incidents, recorded by staff on a National Incident Report Form (NIRF), are not lodged into the actual government system.
In May, Noteworthy requested records of serious adverse incidents recorded within NAS under the Freedom of Information Act.
In response, HSE data officers said the records “don’t exist”.
Noteworthy asked the HSE about the claims that serious adverse incidents aren’t logged into the main government system, and why we were told that no records of serious adverse events exist.
A spokesperson responded that “the number of adverse incidents uploaded by NAS staff is not a metric we are required to report on”.
When asked why there are no records of serious adverse events, a HSE spokesperson told Noteworthy that “the number of adverse incidents uploaded by NAS staff is not a metric we are required to report on”.
Staff say the problems they face within the emergency service is “the worst it’s ever been”.
In a lengthy statement to Noteworthy, the HSE said that in 2008, ambulance services in Ireland started a phased change over to a new triage system.
This, a spokesperson said, coincided with a move to a fully national ambulance service, “rather than a service that existed as regional entities”.
“This change included a departure from regional control centres to a national control model at the National Emergency Operations Centre (NEOC) and made it possible to have oversight and visibility of all pre-hospital emergency resources nationally to be utilised in the most efficient and effective way possible,” the statement read.
“This change did result in ambulance resources travelling outside of their region where typically they would not have under the previous regional model.”
The HSE said advantages of the new national system include better cross county border support and greater deployment coordination and utilisation of assets in event of major emergencies.
“We understand being deployed over longer distances can be a point of frustration for our staff,” the statement added.
“Every effort is made by control dispatchers to task resources within a reasonable distance of 80km where at all possible.”
However, a spokesperson said it was “necessary to breach this on occasions” where callers would otherwise have to wait “inordinate amounts of time for a response due to a conflict between demand and resources in their area”.
The HSE said that the primary factors that impact ambulance response times are “staffing/resource levels and demand”.
“In line with other Health Sectors, NAS is seeking to both fund and recruit the appropriate levels of staff to maintain the desired levels of performance,” the spokesperson said.
The department said that “recent” increases in staffing has seen response times to the most serious of calls increase to 48-49% within 18 minutes and 59 seconds.
The key performance indicator set for this is 45%, the HSE said.
The spokesperson added: “Call answering performance has also improved, with call answering times reducing from an average of 10 seconds per call in 2015 to the current figure of 4 seconds per call.”
The HSE said it acknowledged there are occasions where spikes in call volume do result in answer time increasing.
“During 2024, NEOC staff have been consistently answering 95% of calls in 15 seconds or less,” they said.
The move to the national model of service provision was supported by HIQA, the HSE told Noteworthy and addresses “many of the inherent deficiencies noted” in the regional system.
“Based on this rationale it is not planned for NAS to return to a regional control model,” the department said.
In February, HSE figures released to Aontú party leader Peadar Tóibín revealed that the number of people deceased by the time an ambulance reached their home had increased by 70% in the last eight years.
A total of 1,108 emergency callouts last year had recorded that the person had died by the time of paramedic arrival – an increase of 100 deaths from 2022.
The figures, released under parliamentary questions, also showed that the number of ambulances that waited more than an hour to hand over patients at hospitals had reduced in the last year.
There were 94,639 occasions in 2022 when an ambulance waited more than an hour for a handover. While in 2023, NAS recorded 76,970 occasions where it took more than one hour for a hospital handover.
Are lives at risk from ambulance delays?
By Patricia Devlin of Noteworthy
Noteworthy is the crowdfunded investigative journalism platform from The Journal. This project was proposed and part-funded by our readers, with significant support from our investigative fund:
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