An air ambulance service would save lives

MEDICAL MATTERS: On Ash Wednesday, a 15-month-old baby was taken to her GP's surgery in Co Kerry with convulsions.

MEDICAL MATTERS: On Ash Wednesday, a 15-month-old baby was taken to her GP's surgery in Co Kerry with convulsions.

She was quickly transferred to hospital in Tralee, where her condition deteriorated. The consultant requested an urgent transfer to Our Lady's Hospital for Sick Children in Crumlin; he wanted a team of paediatric specialists to travel from Dublin to collect her. The Dublin hospital was unable to respond and so the young child was placed in an ambulance, along with her mother and a nurse, and began the long journey. About 20 minutes short of Portlaoise, her condition deteriorated further and despite the best efforts of a paediatrician in the Portlaoise Hospital, she died. The young girl was subsequently found to have pneumococcal meningitis.

While it can never be said with certainty that this child would not have died anyway, the experience points to two major deficiencies in our national health service. We do not have a dedicated air ambulance and we do not have a national retrieval service whereby specialists could travel from Dublin to regional hospitals and ensure the safe transfer of very sick children to a specialist centre.

The Republic and Northern Ireland are the only two places in the European Union without a specialised helicopter emergency medical service (HEMS).

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It is not for the want of trying; campaigners have been looking for such a service for over eight years. Dr Jerry Cowley, a GP in Mulranny, Co Mayo, is chairman of the HEMS committee. In a recent issue of the journal Ambulance he writes that, while he welcomes a recent decision to undertake an all-Ireland feasibility study, "the evidence is already there for the need for such a service".

While researching a series on the Canadian health service last autumn, I witnessed the effectiveness of the Toronto Air Ambulance Service. Working in close co-operation with the Toronto Emergency Medical Services and based at the main hospital in the city, the air service consists of both fixed-wing and helicopter aircraft. And the service is not just used for transferring sick patients from sparsely populated northern regions of Ontario; a major road traffic accident on Toronto's equivalent of the M50 meant that a doctor and paramedics were dispatched by helicopter to the scene.

Experts in trauma care speak about the "golden hour", during which it has been shown that the lives of critically ill patients can be saved by expert intervention given at the location of a major trauma. Dr Cowley estimates that four lives are lost every year, with 16 people permanently disabled because they arrive too late at the National Neurosurgical Centre in Beaumont Hospital. In addition, international research shows that the time spent in intensive care units can be reduced by one-third by using an air ambulance for inter-hospital transfer.

The cost of setting up HEMS is €6 million with a running cost of €2 million a year. This compares to an estimated saving of €16 million to €20 million a year based on avoiding the costs associated with the current loss of life and disability reported by Beaumont Hospital alone.

A helicopter emergency medical service would help those with severe head injuries, as a result of road-traffic and sporting accidents; people with severe cardiac disease; seriously ill children and patients with severe burns. A dedicated air ambulance service could save the lives of up to half of those who die with these conditions.

And to return to the infant who lost her battle with meningitis, the Department of Anaesthesia and Critical Care Medicine at Our Lady's Hospital for Sick Children in Crumlin has estimated the cost of a paediatric retrieval service. Not including the cost of transport, the three-man team - including an anaesthetist, a paediatric ICU nurse and a clinical engineer - could be equipped at a cost of just under €100,000. They and their specialist equipment would be available to travel seven days a week in order to transfer safely a critically ill child to Crumlin or Beaumont hospitals. In addition, they could also transfer a patient to a specialist centre in Britain.

Given that the cost of both a helicopter emergency medical service and a national paediatric retrieval service would be small in comparison to our overall health budget, is it not time we plugged this critical and life-saving gap in our health services, North and South?

Dr Muiris Houston is at mhouston@irish-times.ie or leave a message at 01-6707711, ext 8511. He regrets he cannot reply to individual medical problems.