Dr. Niall Herity:

The short answer is: no, I do not. The management of the ST segment elevation myocardial infarction programme that has been set for the Republic of Ireland as a whole includes a certain number of standards. I will outline the standards. First, the programme should be provided on a 24-7 basis. Second, patients who are brought to a centre should be within a 90-minute travel time in order to be brought directly for primary percutaneous coronary intervention. The British Cardiovascular Intervention Society, BCIS, standard I have recommended is that patients should be treated in high-volume centres. Each of these aspects feeds in not only to the programme in the south east but to the programme throughout the country. This is the reason that these are the circumstances in which best quality care is delivered.

It is absolutely the case, not only in Ireland but in every country, that a percentage of the population sits outside those 90-minute isochrones. This is the case in the United Kingdom, Denmark and the Netherlands. It is very much the case in countries like Canada. In those countries, the health care systems implement targeted systems for those populations to ensure they get equal quality of care. I referenced some of those towards the end of the document.

I outlined the options. The first option is to do what they do in Denmark: accept that people may have an extra five or ten minutes of travel time and transport the patient anyway. The second option is to give a specialised drug, which committee members will be familiar with, called thrombolytic therapy, then put the patient in the ambulance and transfer the patient immediately to the centre that provides the service. That is called drip-and-ship. Another option is to look at alternative means of transport. The example I gave was the helicopter system implemented fairly successfully in Donegal, as I understand it, for bringing patients to Galway prior to the establishment of a 24-7 centre in Altnagelvin Area Hospital in Derry. I did not reach any final conclusion on how that additional protocol should be implemented for the patients of the south east because I thought it was too much work to reach a sensible conclusion.