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LAST MONTH SAW the launch of the Irish Community Rapid Response air ambulance service based in Cork. Funded entirely by charitable contributions, this is a much-needed emergency medical service.
In my view, however, a comprehensive nationwide Helicopter Emergency Medical Service (HEMS) ought to be a part of the critical infrastructure of our health service. This is especially so given the geographical spread and pattern of dispersal of Ireland’s population.
Access by road to emergency departments in regional centres in Ireland can be difficult even at that best of times. In recent years, after a period of austerity that has negatively impacted on our health service provision, there has been a critical focus on ambulance response times throughout rural Ireland – particularly in the case of acute medical emergencies.
In 2011, HIQA recommended a response time of no more than 7 minutes 59 seconds for ambulance crews responding to life-threatening incidents countrywide. The National Ambulance Service and Dublin Fire Brigade have at times struggled to meet these response times and there have been some high-profile and tragic incidents involving loss of life where a slow or delayed response time was a factor.
A 2016 report commissioned by the HSE recommended that a further 250 ambulances were needed across Ireland to match the optimum call-out times and critical infrastructure for emergency response demanded by HIQA.
The scale of the problem facing the National Ambulance Service is immense, with underfunding and understaffing identified as the key contributory factors in slow or delayed response times to acute medical emergencies.
A follow-up report, published by HIQA in March 2017 indicated that there are still serious challenges for our fleet of road ambulances in meeting the optimal response times required to service our emergency health needs.
It is in this context that the state should complement and support our National Ambulance Service with a flexible Helicopter Emergency Medical Service.
Ireland needs at least 4 or 5 helicopters nationwide
Ireland is one of the last European Union member states to have a comprehensive – doctor led 24/7 HEMS service. For example, our nearest neighbours Britain have approximately 40 such helicopters with both day and night time flying capabilities.
France operates a similar number of HEMS helicopters and bases. Austria, with a population of just 8.7 million has a fleet of 28 HEMS choppers. Italy has over 50 HEMS bases. On average within Europe, there is approximately one HEMS aircraft per million of the population.
Just over the border in Northern Ireland, there is a doctor-led HEMS service operated by Babcock Mission Critical Services in conjunction with the NHS.
Their HEMS aircraft are supported by a team of 6 advanced paramedics, 14 doctors and 2 pilots. Costing approximately 2 million sterling per annum, this service represents a useful model for implementation throughout the Republic.
The Irish Community Rapid Response initiative launched in Cork is a credit to those involved. Much credit is also due to the HSE for responding positively and flexibly to the initiative – working in partnership to provide National Ambulance Service advanced paramedics and emergency medical technicians to crew the aircraft.
The Community Rapid Response initiative in Cork is expected to cost approximately 2 million per annum with around 500 call outs expected annually. The service is based on one Augusta Westland 109 helicopter.
Based on European norms, with a population of 4.6 million, Ireland needs to expand this HEMS service to at least 4 or 5 helicopters based at strategic locations nationwide. A state-funded, doctor-led nationwide HEMS service could be provided for the Republic relatively quickly and more cheaply than by private sector provision.
The Irish Air Corps has operated a helicopter emergency medical service out of Athlone since June 2012. The HEMS service, designated Air Corps 112, operates in partnership with the HSE and has responded to approximately 3000 incidents saving thousands of lives – mostly in the west and north west of Ireland.
The large Air Corps Augusta Westland 139 helicopters used in this service have extended range and flexibility and are capable of providing a much needed nationwide service.
‘The envy of our European neighbours’
Currently, No 3 Operations Wing in Baldonnel has a fleet of 6 – state of the art – AW 139 helicopters that would be perfectly suited for an expansion of the HEMS service throughout the Republic. These aircraft are currently under-utilised due to pilot and other staff shortages in the Air Corps.
At present, the Air Corps is operating with approximately two-thirds of its normal number of pilots – with dozens more expected to retire in the next year or two. There is also a chronic shortage of essential ground crew and air traffic controllers – a shortage of approximately 150 key personnel overall.
In response to a recent parliamentary question by Sinn Fein TD, Aonghus O’Snodaigh the Department of Defence stated that – if properly crewed and staffed – the Air Corps could provide a 24/7 aeromedical service for 1.3 million euro per annum.
This year, the government awarded a contract to the UK-based private company, Air Alliance, to provide a night-time air ambulance service for 7 million euro per annum.
Instead of contracting this vital service to the private sector abroad, if the government were to invest a smaller sum in recruitment and retention within the Air Corps, we would be in a position to provide a state of the art HEMS service nationwide – at a fraction of the current outsourced cost.
Recent experience has taught us that such a service is essential throughout the state. The Air Corps, given its corporate skill set and critical mass, is also capable of the paradigm shift in training and investment that could provide Ireland with a state of the art 24-hour HEMS service – with both day and night time operations a possibility.
This would require investment in training, recruitment and a liaison with the Irish Aviation Authority to formalise such an initiative. The investment required would again be a fraction of what is being paid to overseas private operators contracted by the state to provide a limited service.
Consistent with calls this week from emergency medical hospital consultants for such a service to be physician-led, the Air Corps AW 139 aircraft – capable of carrying up to 15 passengers – would provide an aircraft and crew solution that would allow for doctor-led teams of advanced paramedics and emergency medical technicians.
For a very modest investment, the Minister for Health could build a 24/7 HEMS service in Ireland, using existing resources that would be the envy of our European neighbours.
Dr Tom Clonan is a former Captain in the Irish armed forces. He is a security analyst and academic, lecturing in the School of Media in DIT. You can follow him on Twitter here.
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Because they spent all our money on bailing out banks etc
@Lambo Moonski: no, the money to bail out the banks, i.e. 64 billion was borrowed. This service would be paid for from yearly revenue that fell off a cliff in 2008 because our government at the time, Fianna fail, were too busy narrowing the tax base and giving money away in budgets to every Tom, dick and Harry. All the opposition parties were saying they weren’t giving enough away. And here we are 10 years later doing the exact same thing, we have learned nothing. Government, keep the few euro that I might get in the budget and invest in something like this that will actually benefit the people of Ireland.
@The next small thing: That is the best post made on here this year.
@Lambo Moonski: wrong, vast bulk to National debt is down to paying for social welfare and public service during the recession
Despite approaching full employment cost of social welfare hasn’t reduced, money should be found for this necessary life saving service, rather than going on Sky Sports for permanent idle
Because we have a sh%t medical serivce. I really feel bad for people that get sick in this country. 3rd world health service
@Joe Mc: you should go and see a third world health service in real life. No money, no service and your family will be the nurses, and to boot they also do your laundry and provide meals, and that if your lucky.
@Joe Mc: you either have never been to the third world or else don’t know what the words mean.
@Joe Mc: go back to bed….
@Keith Hutchinson: tell that to nearly 1million people who are still waiting to see a consultant. Or to that 93 yr old lady old sat in a chair waiting on a doctor. Rubbish it is
FFG are bucketing our money off to Brussels and some seem to forget this. Keeping themselves the darlings of EU the Irish people live on the streets and die with lack of medical services. But vote em again, and hope for change, the Irish way..
@Willy Mc Caul: You realize that money comes back? Not long ago we got more than we put in.
When rural areas are lacking half decent facilities/services/jobs etc is it a wonder why people flock/stay in cities
Clearly FFG place no priority on medical care.
@Rathminder: I’m a supporter of neither party.
But there is a possibility that they could implement improvements. The other party’s have no solution other than pay existing staff more for the same service. Even Harriss plan to have taxpayers pay for unlimited abortions is supported.
Because it would make too much sense
It’s costs money and our government (what ever party is in power makes no difference) don’t care about the people at all.
@Vincent: You’re talking about Rural Ireland, so please get one thing into your head, THE RURAL PEOPLE JUST DON’T COUNT, any thing outside of Dublin is of no consequence!
As a more frequent then average user of the public health system, it’s not too bad. I get good treatment (maybe I’m lucky). We need a smaller number of larger high-spec acute hospitals for the best treatment of serious/complex illness. This can be done, without affecting everyone’s access to care, if we had a high quality air ambulance service. I.e., you can have a 1 hour journey on the ground to a local hospital or a 30 min journey by air to large-scale one. Obviously the hospital needs to be efficient as well. This would save money while improving care.
We have no infrastructure in Ireland, of any world-standard.
…Because Enda Kenny cut the nuts out of the service while he was in office.
The ramification of his chopping it, has possibly led to loss of lives.
Why don’t we have 100% broadband connections?
Why don’t we have an “Amber alert” system?
Why don’t we have a wireless national emergency alert system?
Why don’t we have universal health care?
Why don’t we have…?
Not a bad suggestion. However, the problem is that many rural areas would be unsuitable for helicopter landing. A more comprehensive local fully equipped ambulance service with trained personnel would be better and possibly cheaper.
@John Campbell: I would have thought rural are far more suitable for helicopter landings than urban. Fields are pretty handy that way. I think the argument would be that a helicopter could cover a greater area than a land ambulance could.
@John Campbell: I really don’t get your logic here, rural areas are perfectly suitable for helicopters, hence the whole concept.
@John Campbell: the local GAA pitch could be designated as the helipad.
@Y U no spell good?: not where I live. Its not just a matter of landing in any old field, trust me.
@John Campbell: in this instance I’ll choose not to trust you John. I’ve been flying helicopters commercially for the last 20 odd years (ATPL(H)), mostly offshore but almost ten years of that doing HEMS in the UK. You’d be quite surprised at how much it is “a matter of landing in any old field”. Once the size is suitable, the slope is within the aircraft limits and the area is free from overhead wires, you’re in good shape. Company AOCs and insurance requirements might add some additional caveats to those but since we’re talking about military operators, those guys could probably get a helicopter into your living room!
@John Campbell: rubbish the sar helicopters use all our local gaa pitches sure there everywhere perfect for landing helicopters
And the problem now in the northwest if you need any major treatments you are helicoptered to galway which is 4 to 6 hours in an ambulance. Hence the gaa pitches been used.
@John Campbell: You do realise that not everywhere outside the M50 is bog and mountain ?
Someone forgot the Tech companies with tax of 0.5%
Department of Defence claiming that for €1.3 million they could crew a 24/7 HEMS service is an absolutely ludicrous statement.
HEMS services provided in the UK using H145 cost approx £3 million stg to operate on a 24/7 basis. To state that an AW139 could be run 24/7 for €1.3 million should be taken for what it is, more Air Corps propaganda.
@Aaron Hyland: The €1.3 million per year cost figure quoted in the articled is neither provided nor confirmed by the Dept of Defence (DoD), as per official record found here: https://www.oireachtas.ie/en/debates/question/2018-06-26/36/#pq-answers-36
Good man Tom, you must have been into Bal for a cup of tea. Not one mention in your article about the 4 HEMS capable helicopters that do on some occasions provide a fully certified HEMS service to the country. It’s down to the tasking agency that this is not utilized properly.
Instead you talk about a military aircraft working off military rules filling the void. It’s not Medevac 112 for a reason it’s Air Corps 112 for a reason, if you researched this you would know why.
1.3 million, best of luck with that.
Getting more than one of the Air Corps helicopters on call everyday good luck with that the current service is not 24/7 let alone get another one up and running.
Bottom line 4 x SAR/HEMS 24/7/365 helicopters not utilized correctly.
It’s a no-brainer JDI !
he €1.3 million per year cost figure quoted in the articled is neither provided nor confirmed by the Dept of Defence (DoD), as per official record found here: https://www.oireachtas.ie/en/debates/question/2018-06-26/36/#pq-answers-36
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