Overcrowded hospitals and rural callouts push up ambulance response times

Ambulances are getting slower at responding to life-threatening emergencies despite an increase in paramedics, official figures show.

Response times in seven of the eight ambulance regions countrywide were worse for the first four months of this year compared to last year, according to Health Service Executive (HSE) records.

Trade union Siptu, which represents ambulance drivers and paramedics, blamed the deterioration on a high number of callouts in hard-to-reach rural areas and the "obstruction" of ambulances from leaving filled to capacity emergency departments.

The HSE’s own target for responding to highest priority 999 calls – where a life is a risk – is to be with the patient in less than 19 minutes.

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Figures obtained by Catherine Murphy TD show that in the west between January and April this year only half of all these highest priority calls were reached in less than the targeted time. It was the only region to improve, up from none over the whole of last year.

In the southeast, 53 per cent of life-threatening callouts were reached in time this year to April, down from 58 per cent last year.

The midlands and northeast were down to 57 per cent from 59 per cent and 60 per cent respectively.

A lot of ambulances just get stuck there and can't get back out

The northwest recorded the steepest drop in prompt ambulance response times – just 60 per cent of life-threatened patients were reached within 19 minutes compared to 67 per cent last year.

The southwest was down to 64 per cent from 68 per cent, while the mid-West also deteriorated, down to 67 per cent from 72 per cent.

The mostly urban east has the best response times, but they also declined from 77 per cent within 19 minutes last year to 76 per cent in the first few months of this year.

Performance standard

An independent review commissioned by the HSE three years ago found the National Ambulance Service needed an additional 548 staff to “reach the best achievable performance standard”.

Paul Bell, Siptu's health division organiser, accepted that the recruitment of more than 200 staff since then has made no improvement on the emergency response times.

“While it may be disappointing, we are not surprised,” he said. “Our members believe the response times are indicative [of performance], but the geography of the country, the nature of callouts and the obstruction in some cases of ambulances being able to get from emergency departments are all impacting on these figures.”

In relation to crowded emergency departments, he said: “A lot of ambulances just get stuck there and can’t get back out”.

Mr Bell also said the high proportion of rural callouts in Ireland meant ambulance response times could never significantly improve on the current figures. Some 12 per cent of ambulance callouts in the UK are rural, compared to 40 per cent in Ireland.

“If somebody says that somewhere along the line response times will adjust to 75 per cent or 80 per cent, I don’t think that is going to happen in Ireland. Not because of an unwillingness from our members, and probably not because of an unwillingness of the HSE – it is just the way it is.”

Patient outcome

The Siptu organiser said the less than 19 minutes key performance indicator should be replaced with “patient outcome” as a measurement of paramedic success. Furthermore, more community-based paramedics and first responder services were needed as a “geographic response to Ireland”.

The HSE said although ambulance response times “are helpful for performance measurement” they did not give “a comprehensive picture of modern ambulance service performance”.

“Response time performance is being globally reviewed in terms of whether it is the only appropriate measure of patient care,” a spokeswoman said.

“While rapid deployment and timely arrival are accepted, patient outcome indicators are being viewed as a more appropriate measure of patient care and experience.”

The spokeswoman added it was working to set up more community first-responder schemes in rural areas around the country.