Dr. Mark Doyle:

We looked at the travel time issue when the acute coronary syndrome programme was first set up, because obviously there were implications for Waterford then. The determination in this report that an 88-minute timeline is somehow acceptable is totally unacceptable to me. Moreover, this is an average time. If that is average, by definition some of those times were well over the 90 minutes. For a clinician in the emergency department in Waterford to say, "you will probably get there in 88 minutes so I will let you off", is not an acceptable clinical scenario and it is not one the doctors in Waterford will stand over. That is one piece that simply does not stand up. Last week, members of the committee who live in that area will be aware that there were major road works on the road to Cork and there were huge traffic delays. Somebody told me that they saw an ambulance get through, but it got through slowly. It certainly was not going to get there within the timelines described. Again, the 90 minutes is an absolute figure. What should happen is that people should get this treatment as close as possible to when the diagnosis is made because every minute that passes without treatment is loss of heart muscle. One can pick this timeline but, in fact, that travel time is only a surrogate in any case from the internationally recognised time which is from point of diagnosis to point of the vessel being opened. When one adds in those parts at each end, the time is well exceeded. To assert that this timeline of 88 minutes is acceptable is just not okay, for a start.