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Challenging times for air ambulance services

The Government made a promise in its Programme for Government to expand air ambulance services on the island of Ireland.

This continues to be the aim, according to the Department of Health. Officials are looking at the impact of Brexit on the cross-border aspect of air emergency services.

A Department spokesperson commented: “The current Emergency Aeromedical Support (EAS) was established on a permanent basis in 2015 and operates from Custume Barracks, Athlone. The EAS is tasked to high-acuity patients and has been very successful to date in providing an emergency aeromedical service in daylight hours.

 “The National Ambulance Service (NAS) undertakes cross-border ground ambulance transfers. While the EAS does not operate on a cross-border basis, the Irish Coast Guard can be tasked to provide cross-border transfers. The impact of Brexit is being examined by officials and appropriate agreements will be undertaken where appropriate.”

The Department noted that the Irish Coast Guard “is also tasked by the NAS to emergencies. It operates a 24-hour service from its four bases at Dublin, Waterford, Shannon and Sligo.”

The work and sacrifice of the Irish Coast Guard have been underlined following the recent tragedy of Coast Guard helicopter Rescue 116 off the coast of Co Mayo last month.

According to RTÉ, the Air Accident Investigation Unit (AAIU) said it “believed the tail of Rescue 116 hit rocks on the western end of the island as it returned from supporting a rescue mission to refuel at Blacksod”.

There were four crew on board. At the time of going to press, the bodies of Captain Dara Fitzpatrick and Captain Mark Duffy had been found, while the search continued for missing crewmen Paul Ormsby and Ciaran Smith.

Dr Keith Swanick is a GP based in Belmullet, Co Mayo, a Fianna Fáil Senator and the party’s Seanad Spokesperson on Health and Mental Health. Last week, the Medical Independent (MI) spoke to Dr Swanick, who was at the Blacksod Lighthouse at the scene of the continuing search operation.

Tragedy

“My role here is to support the families… it has been a great community effort, as you have probably heard. It is an honour to work here on the west coast,” Dr Swanick told MI.

Based in Co Mayo for many years, Dr Swanick has much experience with the emergency services.

“We very regularly use the Air Ambulance, Air Corps and the Coast Guard, because we are 50 miles away from Castlebar Hospital and over two-and-a-half hours from University Hospital Galway by road,” he says.

He noted that the Irish Coast Guard would handle about 2,500 marine emergences a year, assist 4,500 people and save around 200 lives.

In February, Dr Swanick raised in the Seanad his concerns over the lack of legislation surrounding the Irish Coast Guard.

“When a casualty is taken ashore and dispatched via road in an ambulance or via an air ambulance and the emergency services discuss matters on the pier or wherever else, all of the responders are not treated fairly,” Dr Swanick told Minister for Transport, Tourism and Sport Shane Ross.

“I support the call for the Irish Coast Guard to be designated as a stand-alone primary response agency. On a daily basis, its members sacrifice and place themselves at the peril of the Atlantic Ocean and the dangers of the jagged coastline.

“It is within the Minister’s remit to legislate for this cohort of volunteers to put them on the same footing as other emergency service personnel.”

‘Two-tier’

Dr Swanick told MI that his concerns remain.

“What I brought up with Minister Ross in February was that I believe that the Coast Guard needs to be designated as a stand-alone primary response agency, so they have all the other emergency response agencies, the guards, RNLI, the fire services, etc. But the Coast Guard lies beyond and outside these groups of people. 

“Often, after an emergency at the side of a pier or… when the patient has been evacuated, they are the only emergency units that I believe are being discriminated against because obviously they don’t get paid and I know it’s a volunteer service, [but] there are also some insurance issues that may need to be looked at. In the case of loss of life, would family members be compensated adequately? So I think we need to put some legal structure around the whole system here.

“I think we have a two-tier emergency response system, just like the way we have a two-tier health system. At that time [February] I asked Minister Ross to come down to Belmullet and to see the perils of the Atlantic Ocean.

“He promised he would come down.  I didn’t realise that he would be down so soon, with the tragic loss of life with R116.

“I think the focus is going to particularly intensify on this now and I know certainly when this rescue is complete and things wind down, I will certainly be pushing it on the floor of the Seanad again very vigorously.”

However, a spokesperson for the Department of Transport, Tourism and Sport told MI that any change in the legislation surrounding the Coast Guard remained unlikely.

“The Minister has publicly advised on a number of occasions that neither he nor the Department plan to bring forward any legislative proposals at this time,” said the Department spokesperson.

The spokesperson pointed MI towards comments made by Minister Ross in response to Dr Swanick in February.

Legislation

Speaking to Dr Swanick in the Seanad, the Minister said “we certainly have one thing in common, namely, a very healthy and large admiration for the work of this extraordinary group of people”.

The Minister admitted he had received “a number of requests to introduce legislation in respect of the Irish Coast Guard”, especially from Coast Guard volunteers.

However, he added: “I am satisfied that the Irish Coast Guard, as a division of my Department, has sufficient powers to carry out its functions. These are augmented by the various items of merchant shipping and sea pollution legislation to which I previously referred in the Dáil.

 “Legislating for a voluntary group would give rise to very complex matters. In all probability, the volunteer sector would not be covered under any such legislation, as is evidenced by the Civil Defence Act, which does not contain any provisions in respect of its large volunteer force.”

Air Corps

Recent concerns have also been raised in the Dáil over the impact on the transport of paediatric cardiac and liver transplants caused by recruitment difficulties in the Air Corps.

Last month, Minister for Health Simon Harris told the Dáil that a Service Level Agreement (SLA) is in place between the Department of Defence and the Department of Health/HSE in relation to the provision of air (inter-hospital) ambulance services.

However, the Minister noted that the Department of Defence had informed him that “in the coming months, availability of aircraft will be restricted due to a shortage of pilots and difficulties arising from the loss of Air Traffic Control personnel. I understand, however, that every effort is being made to address the personnel shortages faced by the Air Corps.

“The restrictions notified are particularly problematic for paediatric transplant patients who require urgent transfer to the UK when organs become available,” said the Minister.

“I am assured that the HSE has taken every step possible to ensure that contingency arrangements are in place in light of the reduced Air Corps availability. The contingency plans in place include access to the Irish Coast Guard resources and private air ambulance services.”

The scale of the recruitment challenge in the Air Corps is made clear by new figures provided by the Department of Defence to this newspaper.

At the end of last year, there were 208 vacancies in the Air Corps. These were broken down as 47 officers, 57 non-commissioned officers and 104 airmen/airwomen.

 “In relation to the Air Corps, there are currently 28 cadets in training,” said a Department of Defence spokesperson.

“In addition, a new apprentice class will be inducted in March, along with general service enlistment, amounting to some 30 personnel.”

In terms of increasing the numbers within the Air Corps, the spokesperson said that this will also be done as part of a general recruitment drive.

“A major recruitment drive for the Defence Forces for 2017 is already underway. The recruitment campaign is part of the Government’s commitment to maintaining the strength level of the Defence Forces, incorporating the Army, Naval Service and Air Corps, at 9,500 personnel. The recruitment drive is targeting an intake of 860 personnel.”

However, the spokesperson added that the Air Corps has “at all stages kept the Department of Health and the HSE fully informed of the situation in the Air Corps, so that they can ensure the arrangements they have for the transplant transport service are as robust as possible”.

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