Pat Deering (Carlow-Kilkenny, Fine Gael)
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I thank the Ceann Comhairle for accepting this issue which is of grave importance to the people of Carlow, especially since an issue arose in the recent past which has created much media attention, both nationally and locally. The issue concerns a lack of common sense in the management of the ambulance service in the area. I point out that there is no issue with the level of care and attention the particular individual in question received in the past week.

The incident arose during a Leinster minor football championship match in Dr. Cullen Park in Carlow on Wednesday of last night week when, unfortunately, a 17 year old player broke his leg just before half-time. I bring to the attention of the House the farcical comedy of errors that arose as a result. The player in question broke his leg and a call was placed to the ambulance service at 8.05 p.m. Because there are only two ambulances available in Carlow, both of which were out on duty at the time, an ambulance had to be dispatched from Portlaoise. It arrived in Carlow at 8.47 p.m. The player was attended to in Dr. Cullen Park in Carlow by the doctor on duty and it was obvious his leg was broken badly. He was cared for by the doctor while waiting for the ambulance to arrive.

The player arrived in St. Luke's Hospital in Kilkenny at approximately 9.55 p.m. He was assessed and an ambulance was requested to bring him to Waterford, which is the main centre of excellence in the particular area. An ambulance had to be dispatched from Dublin to bring him to Waterford. On its way from Dublin, an emergency arose in Naas and the ambulance was diverted to Naas. As I pointed out, there is no issue with the care and attention the player was getting.

Another ambulance was requested from Carlow, which was the original place of the incident. The ambulance arrived from Carlow to Kilkenny at 1.43 a.m. to bring the player to Waterford Regional Hospital. The player arrived in Waterford Regional Hospital at 3.20 a.m. and was looked after, and was got to bed at 4 a.m., which was eight hours after the original incident took place. It was a comedy of errors.

It was obvious that the player's leg was badly broken. I accept there was no threat to his life. However, when the doctor on duty diagnosed the break, the player should have been transferred directly to Waterford Regional Hospital rather than to St. Luke's in Kilkenny. It did not seem to make sense to oblige him to wait in St. Luke's for six hours before transporting him to Waterford.

We are seeking a common-sense approach to this matter, which has given rise to concern both locally and nationally. I am interested in ensuring there will be no recurrence of these events. I accept that if there had been a life-threatening condition involved and if there had been a wait of six hours, then matters would be much more serious. Fortunately, in this instance the player had broken his leg but it was not a life-threatening injury. Common sense must prevail in respect of the management of the ambulance service in the area. If a doctor is on duty and if he or she diagnoses the extent and nature of an injury, then he or she should be in a position to decide the hospital to which the patient should be brought. In this instance, Waterford Regional Hospital, the main centre of excellence for orthopaedics in the area, should have been the destination to which the patient was transported. I ask that the position in this regard be reassessed in order that common sense will prevail in future.

Kathleen Lynch (Cork North Central, Labour)
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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.

Pat Deering (Carlow-Kilkenny, Fine Gael)
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I thank the Minister of State for her comprehensive reply. I reiterate that the level of care provided in this particular case is not in question. The patient involved received very good care. However, it did not make sense that the doctor on duty, who is a specialist in this area and who regularly attends GAA matches and other sporting events, could not decide on which hospital to send the player who had sustained a bad leg break. It was obvious that the best place to transport the player was the nearest orthopaedic centre of excellence. That centre of excellence is, of course, located in Waterford. As a result of what happened in the Celtic tiger era, there are good roads in the area and the journey from Carlow to Waterford, which used to take 90 minutes, now takes less than an hour. Rather than obliging the patient involved to spend six hours sitting in the accident and emergency department in Kilkenny following his X-ray, it would have made more sense to transport him directly to Waterford to have everything done in one go. He would, by 3 a.m., have been well on the way to recovery.

There is a need to ensure the management of the ambulance service in the area is more streamlined in nature. This will ensure that people will not be obliged to wait for long periods to be treated and that we can get the best use of the service available. I reiterate that there is no doubt that the patient in this instance received the best care possible.

Kathleen Lynch (Cork North Central, Labour)
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In all situations, local knowledge is clearly invaluable. In this instance there was a GP present and this individual was in constant contact with the ambulance service. We must, therefore, assume that the decisions made were in the best interests of the person who required treatment. I have taken on board what the Deputy has said and I will ensure the Minister for Health is made aware of his concerns.