Peter Fitzpatrick (Louth, Independent) | Oireachtas source

I welcome the opportunity to speak on this important issue and thank my colleagues in the Regional Group for tabling the motion. Yesterday, I spoke about the recruitment and retention issues in respect of recognition, pay, resources, working hours and poor working conditions within the National Ambulance Service. With this motion, my colleagues in the Regional Group and I are seeking to overhaul the delivery of pre-hospital emergency care services. We are seeking to provide better training for staff in schools and childcare facilities with an expanded role for paramedics.

How, though, can we expect paramedics to take on an expanded role when, under the Health and Social Care Professionals Act 2005, the paramedic profession is not even recognised as a profession? Paramedics do not even get recognition from the HSE, the largest employer of paramedics in the State. This lack of recognition limits career progression, negatively impacts retention, restricts alternative pathways of care and, in the case of HSE employees, limits access to health and social care profession education opportunities within the HSE. As a result, the retention of employees within the field of paramedicine is an area which needs to be addressed. Since 2019, the National Ambulance Service College has brought in 472 staff who commenced training under the three-year paramedic studies programme. Of those, 55 dropped out. That is less than 160 recruits a year. The National Ambulance Service Representative Association warns that, due to poor pay and conditions, ten staff a month are being lost. With the National Ambulance Service estimating a requirement of more than 3,000 paramedics within the next four years to meet its workforce plan targets, these numbers of recruits are abysmal, yet this is a familiar tale. This is a reflection of a service which is under-resourced, under-appreciated and not recognised. We must establish a commission on paramedicine as a matter of urgency to establish primary legislation to recognise and regulate the profession appropriately; ensure that all paramedics have access to an appropriate initial and ongoing education; institute an expanded scope of practice and specialisms; address retention and career progression; and tackle the ongoing workforce issues within the paramedicine field.

We all rely on our ambulance service in times of medical emergencies, whether it is a heart attack, a stroke, an allergic reaction or a choking incident in a child. With this motion, we want to specifically reduce the risks in such emergencies.

At local level, the National Ambulance Service is supported by volunteer-run community first responder schemes, which are an integral part of dealing with an emergency in the community. They have the potential to provide vital life-saving CPR and defibrillator treatment to patients while an ambulance is en route. A local business owner in Dundalk had a heart attack and it was only for the first responders in his community that he made it to the hospital and, thankfully, survive. However, the lack of a national first responder register precludes many of the community first responder scheme volunteers from responding to a local medical emergency. This needs to be resolved. I congratulate Joan McAdam on the implementation and creation of a local register of working automated external defibrillators, AEDs, and first responders in a local parish in Dundalk. That needs to be done at a national level. We know that any delay in accessing treatment has an impact both on survival rates and for the level of care needed in the hospital setting. For example, for every minute that elapses after a cardiac arrest, a person's chance of survival decreases by 7% to 10%, and for every minute stroke treatment is delayed, a person loses 2 million brain cells. Faster emergency response times are required. With that in mind, and on the back of the technological revolution, we are pushing for the development of a public app that allows the 94% of the population with a smartphone to automatically alert ambulance and community first responders to an emergency and to be provided with vital advice on CPR in the interim.

We know from the headlines this week that the National Ambulance Service is struggling to meet timelines. Concurrently, emergency service demand is significantly increasing, with the number of emergency calls in 2022 up 15% on 2021. Increasing population numbers and life expectancy will increase future public health demands. The reality is that if recruitment targets are not met and demand continues to rise, performance will continue to decline and people will die, unless community paramedics and first responders are trained. We need to fund the provision of epinephrine auto-injectors for emergency use in schools and childcare facilities and revise current legislation to facilitate the roll-out of additional emergency community medical interventions, such as the provision of epinephrine auto-injectors, inhalers and aspirin in locked defibrillator cabinets, similar to or in tandem with public access defibrillators. Most importantly, we need to provide the required training to all staff in schools and childcare facilities by enforcing the completion of a paediatric first aid response course funded by Tusla and the Department of Children, Equality, Disability, Integration and Youth.

Adults and children have unquestionably suffered harm due to ambulance delays. Overall, we need to overhaul the delivery of pre-hospital emergency care services, from better training for staff in schools and childcare facilities to an expanded role for paramedics. In order to succeed, however, we need to look into the career recognition of paramedics and the recruitment and retention issues as well as training issues for paramedics and community first responders. We need to act now before patients die.

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