Ms Mary Dunnion:

One of the issues the Deputy raised was the model of care. This year there has been a 10% increase in the number of people calling an ambulance and the natural pathway for patients is that once they call, an ambulance is dispatched and they are dealt with and transported to a main emergency department. If they consent to a main emergency department, 99.9% of patients will be transported. That model is not sustainable nor is it in line with what is happening in other jurisdictions. For example, elsewhere some services have managed to reduce by 40% the number of patients transported to a main emergency department. That is not simple to do because it requires investment and planning and embracing the concept and moving with it. We have made a recommendation that a properly trained person should triage people over the telephone to find out exactly what is happening and whether they need to go to a hospital or whether there is another pathway for them. Trained practitioners can go to see the patients and treat them there, discharging them if appropriate. This is based on the development of the competencies of advanced paramedics and paramedics and involving medical staff in taking calls and the management of patients. That opportunity is there and it needs to be worked towards.

I refer to community first responders. When something tragic happens to somebody such as in the cases cited by the Deputy, an ambulance with advanced paramedics needs to be dispatched. Equally, however, somebody who is trained and competent as a first responder is also required. He or she can be a trained lay person, an advanced paramedic in a fast mobile vehicle, a GP, a garda or whomever. The response times in the west and the south are the least good but they are also the areas, particularly, the west, that have the lowest number of community responders. The areas with the biggest problem have had the least local investment in the context of community responders. We have made a recommendation that the NAS immediately begins the training of people as responders and, aligned with that, introduces a communications system at local level engaging with the public to bring them on stream to work towards an effective first response scheme.

In that context, first response in seven minutes 59 seconds is not publicly reported. We looked at the data, which is collected, and it shows that are poor response times to the seven minute 59 seconds target. It is for that reason we have made a recommendation in that regard because we firmly believe as a review team that unless the service providers are collecting data, there is no way they will drive improvement. We have, therefore, made a recommendation specific to that for all Echo and Delta calls, which are the critical calls, and we have said the service providers, NAS and Dublin Fire Brigade, must specifically report heart attack, cardiac arrest and stroke response times. It is to create momentum to drive improvement that we are requesting the implementation of that recommendation.