Jerry Buttimer (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I welcome the Minister of State, Deputy Butler, to the House. She is very welcome. Senator Currie, tá ceithre nóiméad agat.

Emer Currie (Fine Gael)
Link to this: Individually | In context | Oireachtas source

Gabhaim buíochas leis an gCathaoirleach. I welcome the Minister of State and thank the Taoiseach for the announcement last night that emergency medicine doctors are to crew the helicopter response service alongside paramedics for four months in a new trial. That is a huge step forward for the thousands of people who desperately need major pre-hospital trauma care. Ireland is an outlier in pre-hospital care. This has been highlighted through several years by a consultant expert group of Irish helicopter emergency medical service doctors. It has been driven by the fact that Northern Ireland has had this service since 2017. The UK and other European countries have it but we do not.Our pre-hospital system relies on paramedic-led emergency care, as opposed to physician-staffed helicopter emergency services that could complement what we already have. We lose critical time in getting patients to hospital to access physician-led emergency care. Other countries bring the hospital to the scene of the emergency, whether this is at the roadside, a home or a farm, or in an urban or rural area. It could be a road traffic accident, a gunshot or knife wound or a workplace injury.

In Northern Ireland, helicopters are dispatched by specially trained doctors to deliver lifesaving treatment undertaken by physicians. This includes surgery, emergency anaesthetic administration, blood transfusions and the management of airways in a way that can alleviate the impact of trauma and prevent brain injury. A review of the first five years of the service in Wales found that 63% of patients received pre-hospital care they would not have received otherwise. The number of patients dying as a result of blunt trauma injuries was 37% lower than if they had been attended to by an ambulance service only. The medical intervention was, on average, 29 minutes to 41 minutes faster than the standard 999 response time. Almost 5,000 cases of major trauma were treated in Irish hospitals in 2021 alone according to the most recent major trauma report of the National Office of Clinical Audit, NOCA. It is the biggest cause of death among children and young adults in Ireland. Apparently, these figures also do not capture those trauma patients who die before they reach hospital. We could be saving at least 300 lives annually and improving the outcomes for many others.

My questions relates to the announcement made yesterday. Will the doctors involved be specifically trained to operate with helicopters? I encourage engagement with the members of the international medical expert group who led this campaign, including Dr. Cunningham, Dr. Burns and Dr. Passmore. It should be ensured that they are consulted and this trial is successful. I believe Dr. Lisa Cunningham is the only trained helicopter emergency medical care consultant in Ireland.

Are our statistics working as they should? Does this aspect need to be addressed, especially in light of the increasing number of deaths on the roads? Regarding Northern Ireland, we have already established health co-operation on an all-island basis. It is an area we can be proud of and that we wish to build on. It seems to me that if we have the relevant expertise already with HEMS in the North we should be looking at this as an area for all-island co-operation. We need health equality.

Jerry Buttimer (Fine Gael)
Link to this: Individually | In context | Oireachtas source

Go raibh maith agat.

Emer Currie (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I refer to the situation in Ireland compared with the rest of Europe and the world, as well as the disparity on the island itself and in rural versus urban areas. This is an opportunity we need to grasp with both hands.

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I welcome the opportunity to address this House on behalf of the Minister, Deputy Donnelly, regarding the Senator’s request for information relating to physician-led helicopter emergency medical services, HEMS, in Ireland. I was sitting in the Dáil yesterday when Deputy Berry, who is also a medical doctor, raised this issue with the Taoiseach. It was a positive engagement. One of the requests he made was that the Taoiseach would engage with those physicians mentioned by the Senator and the Taoiseach responded by saying he would. Everybody was delighted to hear that answer, that we are progressing in this regard and that we are going to have the pilot scheme.

Just to be clear, it is important to note that the HSE's National Ambulance Service, NAS, currently provides two consultant-led, paramedic-delivered, dedicated HEMS responses in Ireland. I will briefly outline what this entails. The emergency aeromedical service, EAS, operates in conjunction with the Air Corps from Custume Barracks in Athlone and predominantly serves the west and north west. The south-west HEMS response, a publicly-funded service operated by the NAS in conjunction with a commercial operator, serves the south and south west. In addition to these dedicated services, the Irish Coast Guard provides further HEMS support from its four bases in Shannon, Sligo, Waterford and Dublin on an as-available basis. It does phenomenal work. HEMS in Ireland provide fast access to lifesaving pre-hospital emergency care interventions at the scene by highly-trained advanced paramedics. HEMS is also used to rapidly transport patients to the hospital with the specialist facilities and treatments best suited to their lifesaving needs. This may not always be the closest available hospital.

All HEMS aircraft are tasked through the 999-112 emergency system by a specialist aeromedical co-ordinator in the NAS National Emergency Operations Centre, NEOC. Last year, HEMS services attended 904 incidents in Ireland and such deployments have greatly reduced scene-to-hospital times, particularly in more rural parts of the country. We often think about road traffic accidents in this context, but there are many accidents in farms and around our lovely mountains and lakes that equally make this service important.

On the question of HEMS in Ireland being physician-led, I confirm that the overall delivery of HEMS services in Ireland is consultant-led but the service is delivered by highly-trained advanced paramedics. Clinician-crewing models for HEMS can vary across jurisdictions, with various configurations including paramedic-only, paramedic-physician- and paramedic-nurse-delivered services. In Ireland, HEMS is primarily focused on providing rapid access for patients to the most appropriate clinical care. This is particularly important due to Ireland’s remote and dispersed population. The provision of HEMS ensures equity of access to care for acutely ill and injured patients. The national trauma strategy acknowledges the importance of HEMS in Ireland as being a vital part of the pre-hospital care and retrieval stage of the trauma system, as the Senator mentioned.

The important point to be made here is that the NAS is due to commence a feasibility study next month which will see, on a trial basis, the deployment of physicians as part of its HEMS responses. The trial is expected to last approximately four months. As part of the study, NAS-affiliated emergency medicine consultants, with considerable experience in pre-hospital emergency medicine, will undertake a number of rotations each week on HEMS aircraft alongside NAS advanced paramedics. During this trial, key metrics and outcomes, such as the types of interventions performed by each physician on the scene and average on-scene time, will be measured.

Emer Currie (Fine Gael)
Link to this: Individually | In context | Oireachtas source

When I initially submitted this question, we did not have this extremely positive news. The important line in the Minister of State's contribution was the confirmation that the overall delivery of HEMS services in Ireland is consultant-led but the service is delivered by highly-trained advanced paramedics. She also stated: "emergency medicine consultants, with considerable experience in pre-hospital emergency medicine ... undertake a number of rotations each week on HEMS aircraft."

As can be imagined, however, it is very different to be an emergency-trained doctor in the environment of a helicopter. We have the talent and expertise available from the members of this expert medical group. They have gone out of their way in the last few years to really campaign for and secure this trial. I am delighted the Taoiseach made this announcement and will meet the expert group. I would like the Department of Health, however, to reassure me that the expertise available in the expert group will be utilised-----

Jerry Buttimer (Fine Gael)
Link to this: Individually | In context | Oireachtas source

Go raibh maith agat.

Emer Currie (Fine Gael)
Link to this: Individually | In context | Oireachtas source

-----and the benefit of the North-South is going to be availed of. We have the North-South Ministerial Council up and running for the first time since 2017. Let us add this matter to the list of things where we co-operate.

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Senator. As I mentioned, the NAS will soon begin trialling the physician-advanced paramedic crewing model for HEMS. Plans are being finalised for physician deployments to commence next month. A great deal of work has been going on in the background concerning this issue for quite a while. It is very positive that the trial is going to commence. On completion of this trial, the HSE NAS will evaluate the information gathered from it to determine the clinical competencies to suit HEMS delivery in Ireland. I imagine that much work will be done in relation to the initial call and triaging exactly what response will be needed. This would be my experience of it.

The Senator asked if the doctors will be trained to operate with helicopters. I am sure they would have to be. I am only speaking off the cuff now, but I would assume that this would be the case. Statistics are important, so this pilot will determine the statistics.

To address the Senator's other point, we fully buy into North-South co-operation. I continually engage with my counterparts in mental health in Northern Ireland. This is crucially important. The fact that the North-South Ministerial Council is back up and running is also extremely important.