A major review of the emergency ambulance service by the Health Information and Quality Authority has found that staffing levels in some control centres is unsafe, the fleet is ageing and co-operation between the National Ambulance Service and Dublin Fire Brigade is poor.
The ageing profile of the ambulance fleet poses a breakdown risk and the number of emergency ambulances and other response vehicles may need to be expanded, the report says.
HIQA has also called for its previous recommendation that the call-taker and dispatcher roles be separated must be implemented in all ambulance control centres.
The recommendation arise from a HIQA investigation last year into a case where an emergency call was made to the NAS but an ambulance was not dispatched to the scene and following a sequence of additional events, the patient subsequently died in hospital.
The report also says that nearly all patients who call for an emergency ambulance and agree to travel are brought to an Emergency Department, when alternatives should be available.
Internationally, over 40% of patients are successfully treated by paramedics without the need to transport patients to hospital.
In its examination of monthly performance between January 2013 and March 2014, HIQA found the the best monthly performance was 58% of cardiac-related calls responded to within the target of eight minutes.
For other life-threatening emergencies, the best performance in a month was 34% within eight minutes.
The report also calls for better operational efficiency, including address verification, to avoid delays and an increase in advanced paramedic numbers, in both the National Ambulance Service and the Dublin Fire Brigade, with the latter covering most parts of Dublin.
HIQA says that the NAS and the DFB need to work better together as a matter of urgency.
The report shows variations in the time taken to deal with a 999 call and send assistance.
A survey by HIQA over a 24-hour period found that of 40 cases of life-threatening emergencies relayed to the NAS from the DFB, 11 cases had significant delays of 4-8 minutes, due to poor communications between both sides.
The report says that the services provided by both are not integrated and the review found poor levels of co-operation, which is not in the best interests of patients.
The DFB ask the NAS, over the phone, for assistance in responding to calls, but neither has oversight of the other’s ambulance resources and organising assistance takes time and this can lead to delays for patients.
Last year, the DFB requested NAS assistance in responding to calls nearly 27,000 times and of these requests the NAS was able to provide assistance for just over 8,000 calls.
The remaining 18,844 calls either received a response from a Dublin Fire Brigade, mobilised from a relatively long distance away from the incident, or where no resource was available, the call had to be queued until a resource became available from either service to respond to a call.
HIQA says that many legacy issues associated with the fragmented nature of the original nine providers remain and the NAS has struggled to fully integrate these into one entity.
The NAS is moving to one national ambulance control centre, located over two sites, each acting as a back-up to the other.
HIQA has also expressed significant concern that the well-known ambulance ‘black spot’ areas of Tuam, Co Galway and Mulranny, Co Mayo, and Loughglynn, Co Roscommon, remain without a dedicated ambulance service.
HIQA’s Chief Executive Phelim Quinn said: “HIQA has identified a range of challenges in the areas of operational efficiency, leadership, clinical governance, risk management and quality assurance.
“We are calling on the National Ambulance Service and Dublin Fire Brigade to publish a joint action plan that will outline steps to improve individual and collective performance on all of the matters identified as a result of this review.
“Systems need to be put in place to monitor progress and performance against HIQA’s review recommendations”, he said.