COUNTRY people live with the risk inherent in their isolation all year round.
But few city dwellers, as they travel to the wilds for their holidays, think about what would happen if they were to suffer a head injury in remotest Connemara, have a heart attack in the depths of West Cork or become pinned under a bus on the Conor Pass.
For the rural GP and the hospital consultant alike, there are few sights more tragic than to see patients die or become disabled because they did not get the treatment they needed quickly enough. Yet it happens all the time and for one main reason Ireland, unlike the majority of European countries, is still with out a Helicopter Emergency Medical Service (HEMS).
"In 15 years as a GP, I've seen it all," says Dr Jerry Cowley a GP in Mulranny, Co Mayo and chairman of the National Helicopter Emergency Medical service steering committee based at Knock International Airport in Co Mayo.
"From the instant the accident happens, the dying process begins," Dr Cowley says. "The sooner the medical team can get to the accident victim and offer appropriate care, the greater their chances of survival and a normal life.
"But despite the best efforts of the ambulance personnel and doctors, it can take hours for an ambulance to get a patient to hospital because our roads are so bad.
"Every summer we are with visitors, many of them continentals used to driving on the right side of the road trying to get to the scene of an accident is a nightmare. It's so hard to make progress because of the sheer physical barriers of poor roads, mountains and rough terrain.
"These can make it impossible to get to a patient in time whether they have been in an accident or are critically ill. This can have disastrous consequences," he says.
Which is why the Irish Medical Organisation, many hospital consultants and the Irish College of General Practitioners are among those clamouring for a flying intensive care unit" to be set up here.
Such flying units literally bring the hospital to the patient at the scene of an accident. This rapid response saves not only lives, but can prevent needless long term disability such as paralysis and brain damage. This is an important point for the doctors, like Dr Cowley, who support HEMS because they believe it is as crucial to prevent morbidity as it is to prevent mortality.
International research has shown that what happens to an accident or heart attack victim within the first precious 60 minutes of the accident known as "The Golden Hour" can not only make the difference between life or death, but between disability and a normal life.
"There are examples out there known to the medical profession that if they had received prompt specialist treatment lives would have been saved or complications reduced," says Dr Tony Healy, an anaesthetist at St Vincent's Hospital, Dublin and another member of the committee.
Trojan work is done by both land ambulance crews all over Ireland and by the Air Corps, which has transported emergency cases since 1965 and carries out nearly 150 "air ambulance" missions in a typical year. But Air Corps helicopters, the HEMS committee points out, are not available "at the roadside" and lack those vital on board intensive care units. They are multi function helicopters with many competing demands on their services, including military priorities and the transportation of Government ministers.
HEMS helicopters, on the other hand, are dedicated medical helicopters permanently outfitted with all the equipment and drugs, required by an intensive care unit and available at a moment's notice to fly to the scene of an accident. The steering committee envisages four such helicopters based in Cork, Knock, Belfast and Dublin, which would mean that an accident or heart attack victim anywhere on this island could always be reached within 30 minutes.
The helicopters would be manned by a paramedic and by a doctor who specialises in resuscitating and stabilising the critically ill often an anaesthetist These medical professionals provide "pre-hospital care" at the site of the accident so that instead of merely being kept alive while on the way to hospital (or worse, dying on the way to hospital), the patient is actually treated so that his or her condition does not deteriorate.
Supporters of HEMS argue that the State can save money in the long run by investing the £12 million the service would cost to set up. This figure is based on a fleet, of four helicopters at a cost of £2.85 million each, with annual running costs of £785,000 per year.
AMONG the most frequent users of the service would be those seriously injured in car accidents. An estimated people will die and 12,500, people will be injured in road accidents this year according to Dr Cowley's research, the majority of those killed and injured will be under the age of 45. Half of those who die, will die at the roadside. Many of these people will have families to support and if they die or become disabled will cost the State large sums in the long term.
An example of such an accident victim would be a young person with a ruptured spleen. With the proper emergency helicopter facilities, he or she could be reached within half an hour, put on a drip, resuscitated and stabilised while being brought quickly to hospital for surgery to stop the internal bleeding and remove the spleen. The patient would then recover fully with far less long term damage (a good recovery is possible after removal of a spleen).
It, on the other hand, there is a delay of possibly several hours while the patient is being brought to a county hospital by ambulance, then transferred to a larger regional hospital, loss of blood to the internal bleeding in the ruptured spleen could cause oxygen deprivation. This in turn could lead to brain damage and/or kidney damage. At the least, instead of being well and able to work, and support a family, the patient has to be on expensive kidney dialysis for the rest of his or her life. Brain damage could make the whole family dependent on the State for years to come.
At the end of May, the steering committee argued its case before the joint standing committee of the Departments of Health and Defence. They stressed that, impressive as it may sound, the service is not a high tech medical frill but an essential medical service. "HEMS is no longer a luxury, Dr Healy says. The Irish citizen is demanding proper emergency medical service and should be challenging the Government to provide it now while EU structural funding is available for it."
Another member of the committee, Beverly Cooper Flynn, financial adviser at National Irish Bank and a resident of Co Mayo says EU funding could pay for 75 per cent of the programme. Greece, as a disadvantaged and peripheral area, was recently able to fund 75 per cent of its HEMS programme through EU structural funding. It now has two medical helicopters in operation and six more on order.
Cooper Hypn, whose father is EU Commissioner Padraig Flynn, believes Ireland would also qualify for an EU backed helicopter programme on this basis, but that we need to get our application in soon.
The idea may seem an impossible dream, but the fact is that without such a service sick premature babies, heart attack victims and people with head and spinal injuries are not getting the best chance at life and a full recovery.
We have national centres for the treatment of head injuries (Beaumont Hospital, Dublin) and spinal trauma (the Mater) yet neither of these places has helicopter landing pads. St Vincent's has, but it is not equipped with lighting so helicopters can land only in the daytime.
This means helicopters bringing critically injured people to these hospitals must first land at the Phoenix Park, from where the patient is transferred to hospital by ambulance.
But international research has proven that the least number of "transfers" a patient has, the better the outcome. Without HEMS, a patient could have five such transfers between the scene of the accident, the ambulance, the county hospital, the Air Corps helicopter, another ambulance and a major hospital.
Some may balk at the cost, but Dr Tiny Healy and Dr Cowley ask, What is the value of a human life?"
Other countries have come with novel ways of paying for the service. In the state of Maryland, in the US, $10 is added on to the cost of a new licence plate. In France, which has 38 dedicated helicopters and Germany, which has 76, car and health insurance companies contribute a percentage of each premium to HEMS.
One great irony of this issue is that if you are on holidays in a remote part of Ireland this summer and have an accident or heart attack, you couldn't do better than to have it on the Aran Islands. Why? Aran residents now have at their disposal a "medevac" helicopter run by Shannon Air and Rescue.
Dr Marion Broderick, a GP on the islands comments "I don't see why the mainland should not have as good a medevac service as the Aran islands." Or, indeed, as good a service as in France, Germany, Spain or Greece.