10 August 2000 Edition

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Ground ambulances can't fly

Mayo doctor campaigns for Air Ambulance Service


Well, wouldn't it be great. You fall off a hayrick or a roof, a tractor runs over your head, or your child is hit by a passing motorist, and within 20 to 30 minutes a fully equipped helicopter is on the scene, with doctor and paramedic, loaded with all the most modern intensive care equipment. Churning gently along at two miles a minute, it has you to hospital in no time, from the remotest rural area.

But such a dedicated service does not exist in the 26 Counties. To put this lack of facilities in context, every other EU member state has an emergency helicopter medical service, bar one of the most peripheral. But while the need for such a service to cover the island as a whole clearly exists, the Dublin Government is still considering the provision of a Helicopter Emergency Medical Service (HEMS).

They have been considering it since 1993, when the first report, under Frank Ahern, raised the issue of a dedicated purpose-equipped air ambulance service for Ireland.

The golden hour that counts

Dr Jerry Cowley, from West Mayo, who has campaigned relentlessly for the provision of the service, explains: ``It's the golden hour that counts, or even the golden two hours. Someone who may be able to move, talk, when in the field, by the time he gets to hospital, may be disabled for life. The brain and spinal cord cannot regenerate after injury, nor be replaced or transplanted. Immediate neurosurgical care is essential to minimise the effects of the injury and to prevent secondary damage. It is a matter of getting the injured person to intensive care unit within the first hours, or irreparable damage sets in.''

When an accident happens in North Mayo, far West Cork or Kerry, or North West Donegal, it takes an hour or more to get an ambulance to the scene, and several hours to bring the injured to the local regional hospital, down long, uneven roads, through often heavy traffic. Although a study across Ireland showed that 80% of ambulance call outs get to the scene in 20 minutes or under, breaking this figure down by the different regions, less than 60% of the calls get a response within the 20-minute period in the West.

Castelbar CAT scan weekend off

And even when the patient gets to the regional hospital, it may be hours or more before they are transferred to specialist hospitals like the Beaumont Hospital in Dublin for head injuries, which is yet again more travelling, more traffic, more time lost. If it happens to be a weekend, then, like at Castlebar General Hospital, you have to wait for the CAT scan until Monday morning. CATs get the weekend off in Mayo.

``There is huge inequality in the provision of acute emergency (trauma) services between periphery and centre in Ireland, and people from the West are at a distinct disadvantage,'' says Dr Cowley. ``HEMS, a 32-county service with a helicopter based in the four corners of Ireland - Belfast, Castlebar, Cork and Dublin - will go some way to right this inequality.''

The campaign for HEMS is not a competition with the ambulance services, which also need further development, he points out. ``The ambulance service does a great job. Every doctor knows this. But we are talking about something else. It's the need for a dedicated service, to ensure that in neurosurgical cases, immediate response and fastest possible travel are available, for situations where it is a matter of minutes to save someone's life or prevent total paralysis and disablement. Ground ambulances can't fly.''

Unnecessary disablement costs more

At the moment, the Air Corps runs injured people about from hospital to hospital ``but this is not a dedicated service'', says Cowley. When the Air Corps craft arrives, it does not come fully equipped. He recalls the case of the wife of a seriously injured man, who had to watch helplessly as the helicopter took off from the hospital, leaving her injured husband behind because it did not have the necessary equipment on board.

Dr. Cowley tells of many instances of young people who lie totally disabled in hospital when, had they got to specialist units within the golden hour, they would not have suffered severe disability for the rest of their lives. ``Four young people in Beaumont Hospital are dead now,'' he says. ``They didn't need to be.

``Reduce it to economics and the case becomes more obvious. Long term care of a severely disabled patient, according to one recent study, costs over £10 million, whereas the capital costs of a 32-county scheme such as HEMS, with four dedicated helicopters, might not be far in excess of £12 million.

``In this day and age, the fact that there is no helicopter landing pad at Beaumont or the Mater in Dublin, that a patient must fly from a regional hospital to Dublin airport and then be taken by ground ambulance into the city hospitals through the traffic jams, beggars belief.''

Minster's response

On 12 July, Dr Cowley led a delegation to see the new 26-County Minister for Health, Mícheál Martin, about getting HEMS. The delegation brought with them the support of professional bodies like the consultant neurosurgeons, hospital consultants, GPs, and their representative organisations (the IMP and the ICGP), but also support from the Mayo Irish Farmers Association, the Consumers Association of Ireland and so on. Cowley also brought several thousand petition signatures. Minister Martin did not seem to have been convinced.

The next day, 13 July, Sinn Féin TD Caoimhghín Ó Caoláin asked the minister to make a statement on the question of the provision of an Air Ambulance Service. The minister replied that he was doing a great deal with extra funding for pre-hospital care, and in particular improvements in the ambulance service, and he had introduced ``a pilot scheme to provide GPs in remote regions with training and equipment to deal with emergencies in advance of the arrival of an ambulance''.

The reply shows stupefying ignorance. It treats HEMS as a rival to the ambulance service and talks of equipping GPs to deal with emergencies `in the field', where in these neurosurgical cases you are talking about anaesthetists and highly specialist equipment. According to a study of the `Careflight' project in Britain, in more than a quarter of such cases, no land ambulance could have provided sufficient quantities of electricity or oxygen to allow the patient to be moved, never mind the local GP.

Dangerous for the Air Corps

``What is the hold-up? Is it the general miserly attitude of this government to health care provision; the government reluctance to provide any direct service, when they can alternatively get corporate interests to do the job for them, or is it a more specialist dispute between government departments?

The counter argument to HEMS so far appears to have been put by the Air Corps itself, which at present fills in for an air ambulance service, that is when it is not transporting ministers about the country. Last year, the Air Corps undertook 165 missions conveying the sick and injured. It undertook 310 missions transporting government ministers.

The Air Corps is quite reluctant to see the development of HEMS, but should the government decide to make provision, then the Corps certainly believes it should be under its aegis. But a helicopter equipped to transport Mary Harney to a luncheon engagement is not equipped to collect a person with head or spinal injury, still less a baby with brain damage. The HEMS campaigners have stressed throughout that what is needed is a dedicated service, under the Department of Health, with specially equipped helicopters and staff.

A spokesperson for the Air Corps explained how ``most such injuries as spinal or head injuries happened between 1am and 4am, often on roads, where very often drink was involved.'' He argued that ``landing out to the most desolate spots in the far West to collect injured parties where drink was involved, is a dangerous pursuit''.

Cabn he be serious? Too dangerous for the Air Corps, which undertakes, to its credit, the most dangerous of air sea rescue operations?

Dedicated service for Gardaí

``Fine Gael's Nora Owen, when she was Minister for Justice, saw fit to allocate a second dedicated helicopter to the Gardaí in `the fight against crime'. ``Surely,'' said Dr Cowley, in his submission to the minister, ``saving lives and preventing a life of disability for young west of Ireland victims of road traffic accidents matters as much as catching criminals''.

Cowley is hopeful that a meeting he intends to hold with Six-County health minister Bairbre de Brún in Belfast may break the log jam and help to encourage what in its very essence is a 32-county scheme for the betterment of all the people of Ireland.

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