Kathleen Lynch (Cork North Central, Labour)

I thank the Deputy for raising this topical issue, which I am taking on behalf of the Minister for Health, Deputy Reilly. When an emergency ambulance is requested, the nearest available ambulance crewed by paramedic or advanced paramedic staff is dispatched by the control and command centre. On arrival at the incident, the ambulance crew assesses and stabilises the patient and provides ongoing treatment, as required, during transport to an emergency department. Clinical protocols require patients to be transported to the nearest accident and emergency department. Accordingly, patients in the catchment area of St. Luke's Hospital, Kilkenny, are brought to the accident and emergency department at that facility, where their condition can be appropriately assessed and clinical decisions made on further treatment. Where, following assessment by an accident and emergency department consultant, a decision is made to transfer a patient to another hospital for treatment, this transfer is carried out by intermediate care transport, where available, or by emergency ambulance. Where an emergency ambulance is to be used for the inter-hospital transfer of a stabilised patient, as with 999 calls, priority is always given to emergencies involving injuries or conditions that are life-threatening in nature. Consideration is also given to maintaining a level of emergency ambulance cover in the area.

The national ambulance service works closely with both local GP services and out-of-hours family doctor services in all areas. While some level of emergency care and assessment may be possible at this level at the scene of an incident, most often full assessments, including a range of diagnostic tests, take place in the emergency department. This is the position where an X-ray is required, particularly as an assessment in respect of to treatment cannot be carried out prior to the X-ray. On occasion, where a specific specialty is known to be required, a clinical decision may be made to go directly to another hospital where that specialty is available. Such a decision may be based on factors such as an on-scene assessment of the patient's condition or his or her known medical history. Where an X-ray is required, this is not possible.

In the recent case to which the Deputy refers, a local GP was present at the incident and was liaising with the ambulance service until the nearest emergency ambulance with an advanced paramedic on board arrived. The patient received treatment at the scene from the ambulance crew, including analgesia, and was transferred to Kilkenny accident and emergency. Following further assessment and diagnosis, a clinical decision was made to transfer the stabilised patient to Waterford. The transfer was made and the patient received appropriate treatment in respect of his injury. Our pre-hospital emergency care standards for paramedics and for the ambulance service are at the forefront of best practice. I am satisfied that, in this instance, appropriate clinical protocols were followed and that the clinical decisions made were in the best interests of the patient.

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