Dr. Cathal O'Donnell:

Senator Crown is correct in what he says, particularly around Dublin. Dublin is divided up into very specific catchment areas from an ambulance service perspective, so if we get a 999 call within the catchment area of a particular hospital, we will always bring the patient to that hospital. The reason is that it is the nearest hospital. If someone dials 999, the assumption is that this is an emergency and thus there is a time element to it, so we will bring the patient to the nearest hospital. I understand that this can sometimes cause frustrations, for example, in the Senator's own practice. An oncology patient living in the St. James's Hospital catchment area will be brought to that hospital instead of St. Vincent's Hospital. If the patient's general practitioner has attended the patient and contacts us, we will then follow the direction of the GP and bring the patient to the hospital the GP deems best. A patient might have an active cancer problem but the reason for his or her 999 call may or may not be related to that. Sometimes the nuances of that are quite subtle and it might be asking a lot of paramedics to try to make those distinctions in some cases, but I accept the point. I know it does cause some frustration.

The Senator's second question related to head injuries and bringing patients directly to a neuro-surgical centre. There are two adult neuro-surgical centres in Ireland - Beaumont Hospital and Cork University Hospital - and a single national paediatric neuro-surgical centre at the Children's University Hospital Temple Street. Many, if not most, of those patients have other injuries.

Isolated head trauma can happen, but it is less common than multiple injury. If someone has, for example, a splenic or liver injury or internal bleeding, that issue needs to be addressed prior to dealing with the head injury in many cases. If one is working at the side of the road in the middle of the night and the rain, it can be difficult to make these distinctions. Our ability to transfer patients from the initial hospital to which they are brought to a neurosurgical centre has been enhanced in the past 18 months by our significantly increased use of helicopters. We have been able to bring patients from the west to Beaumont Hospital and from all over Munster directly to Cork because helicopters have allowed us to cut transport times significantly compared to land-based vehicles.