Pat Breen (Clare, Fine Gael)
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I thank the Ceann Comhairle for the opportunity to raise this matter. The removal of 24-hour emergency care from Ennis General Hospital has left people living in remote and peripheral areas of County Clare isolated. We were assured by the Government and the HSE in County Clare that the reconfiguration of accident and emergency services in the mid-west region was being implemented for patient safety reasons and to provide us with a better service. The people are not convinced and the reality is that many of them are worse off, as acute emergency care at Limerick regional hospital is further away from them.

When the issue of advanced paramedics replacing 24-hour emergency care was first mooted I warned that they should not be centrally located and, instead, they should be available 24-7 in each local ambulance station. With the best will in the world, the advanced paramedics and the ambulance service, who are doing their very best, cannot replace acute hospital treatment within the "Golden Hour". In the absence of 24-hour emergency care and, bearing in mind the isolated and remote areas where people live, the provision of an air ambulance service in the mid-west region must be fully examined and investigated. The one trolley, one patient rule causes particular problems, especially if there is a major road accident where two, three or four people who have sustained injuries require hospitalisation. Recently, there was a road accident near Lisdoonvarna, County Clare, and two people had to wait two hours for an ambulance. Thankfully, their injuries were not life-threatening. The ambulance crews did great work but they cannot be in two places at the one time.

When the HSE made the decision earlier this year to bypass Ennis General Hospital and transfer all future trauma cases from Clare to Limerick, I highlighted the need for the introduction of an air ambulance service. Thankfully, a helicopter pad is in operation at the Mid-West Regional Hospital in Limerick. I had campaigned for this since 2005 because, prior to this, patients had to be transferred by road. During a recent briefing of Oireachtas Members by Professor Drumm and his team from the HSE, I pressed them on the need to base an advanced paramedic team in Kilrush. They highlighted the huge expense of training paramedics and claim this expense could not be justified because of the low turnover of patients and it would not be viable. However, during the briefing, Dr Drumm urged Members to campaign for an air ambulance service to be based at Shannon Airport, which could service isolated areas in Clare and the entire region. It could be crewed by a medical team from the Mid-West Regional Hospital in Limerick and the HSE told us that it would cost approximately €5 million a year to run.

This is not a large amount of money if it saved one life. The emergency coastal air service is already working exceptionally well in Shannon. The Air Corps has new helicopters and has the necessary experience. Similarly, the Garda helicopter is working successfully in its work, also.

As an island nation the provision of an air ambulance service is necessary. The ball is now firmly in the Government's court and the Minister must take the lead. Negotiations with the HSE must be initiated with the Department of Transport and the Department of Defence with a view to providing an air ambulance service in the mid-west region. It should not be left to charities to fund this essential service.

I welcome the efforts being made by the All-Ireland air ambulance to launch an air service, but it is a charity-funded service and will require over €85,000 per month for it to happen. It is hoped that future funding will be raised through fund-raising events and donations. However, Ireland is the only country within the EU that does not have a dedicated air ambulance service. No such essential service should have to depend solely on fund-raising to survive. We know how difficult fund-raising is at the moment.

It is already well proven that air ambulances save lives and that the mortality rate for patients who are transported to hospital increases the further one is away from a hospital. Over 44,000 people living in Clare are outside what is termed the "golden hour". The geography of the area creates huge difficulties, whether a person is in Loop Head, Kilbaha, Carrigaholt, Fenor or Ballybaughan. If the Minister is serious about patient care then the highest standard of clinical care should be available to everybody irrespective of where they live. It is about time that serious consideration is given to the provision of an air ambulance service. All avenues should be explored to encourage and support the provision of such a service for the people of the mid-west region. This should be done in conjunction with the Minister's colleagues in the Department of Defence and the Department of Transport.

John O'Donoghue (Kerry South, Ceann Comhairle)
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I call the Minister of State, Deputy Áine Kitt.

Áine Brady (Kildare North, Fianna Fail)
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I thank Deputy Breen for raising this Adjournment matter, which I am taking on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

As the Deputy is aware, the reconfiguration of acute hospital services in the HSE mid-west area involves the reorganisation of the regional accident and emergency structure. As part of this reconfiguration, HSE ambulance services in the mid-west have been significantly enhanced and an advanced 24-hour paramedic service is now in operation. Protocols are in place to ensure that all trauma, paediatric and obstetric emergency cases will be brought directly to the major tertiary centre at Limerick Regional Hospital.

Advanced paramedics are trained to a high standard which equips them to provide more complex pre-hospital care than their colleagues in other ambulance service grades. Advanced paramedics can administer a wider range of drugs and carry out urgent assessment and treatment of patients with life-threatening conditions prior to arrival at the hospital, including immediate resuscitation as necessary. These skills constitute an invaluable contribution to maximizing outcomes for patients who become seriously ill or injured.

As the Deputy may be aware, an air ambulance service is currently provided by the Air Corps on behalf of the HSE. The service operates on the basis of a service level agreement prepared by the Department of Defence and the Department of Health and Children, in consultation with the Health Service Executive and the Defence Forces, including the Air Corps, all of which are signatories to it.

The air ambulance service is provided for the following categories: inter-hospital transfer of patients with spinal or other serious injury or illness, neonates requiring immediate medical intervention in Ireland, patients requiring specialised emergency treatment in the UK, organ retrieval teams within Ireland, and paediatric patients requiring immediate medical intervention in Ireland. In addition, the Irish Coast Guard provides air ambulance inter-hospital transfers as part of its work and also provides for emergency medical evacuation from the islands around Ireland. In situations where the coast guard service is not available, the Air Corps may transport patients from offshore islands to mainland hospitals.

The focus of ambulance service policy for the medium term is on the consolidation and development of land ambulance services. This includes ensuring that ambulance personnel have the requisite skills and training to enable them to provide more complex pre-hospital care. The continuing development of control and deployment arrangements will also enable the most effective and efficient use of available resources.

There are no plans at present for the HSE to become involved in the development or use of private air ambulance services, as any funding that might be diverted to another air ambulance initiative would be at the expense of the ground fleet. However, the Minister will bear the question of air ambulances in mind as a possible option in the longer term.

Pat Breen (Clare, Fine Gael)
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With all due respect, the Minister of State did not answer my question. I wanted to have an air ambulance service to bring patients in as quickly as possible from around the region.