Why red tape could be costing lives

Ambulance staff are barred from all but the simplest procedures. They wantthe rules to change, reports Bette McDevitt.

Ambulance staff are barred from all but the simplest procedures. They wantthe rules to change, reports Bette McDevitt.

Dave Kiernan from Drogheda, in Co Louth, and Robert Day from Dublin keep up with any news from Ireland about changes in the medical services. Although they are far from home, it is a subject close to their hearts. Both men have made personal sacrifices to advance their knowledge of pre-hospital care. The emergency medical technicians are taking a nine-month course at the Center for Emergency Medicine in Pittsburgh to become certified paramedics.

A paramedic, by US standards, is a highly trained emergency technician who can dispense medication, give life-saving fluids and carry out medical procedures outside the hospital. They can also use two-way radios to consult emergency-room physicians.

Kiernan and Day are in diverse company, with students from Qatar, Korea, Iceland and across the United States. They are the only ones not sponsored by their government. Both men, and others from Ireland who preceded them, have paid about €23,000 for tuition, board and lodgings and transportation. They saved for a year and a half.

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"Yes, it's a personal choice to do this training, but I've been driven here through frustration at the lack of these essential services in Ireland," says Kiernan, who has five years' experience.

Their days, and the nights that follow, can be hectic. Along with classes and labs, the technicians are on duty with Pittsburgh paramedics, answering ambulance calls around the city and helping in emergency helicopters. They also work in the emergency rooms of the many Pittsburgh hospitals.

"After only two months here I can see 100 per cent of the benefits of the advanced training. If the public only knew the potential for life-saving that exists, they would be up in arms. If they only knew that people were dying for lack of skills used in pre-hospital care," says Kiernan. "We are one of the few countries in Europe that doesn't have a helicopter emergency service."

In the Republic, they say, emergency medical technicians are limited to basic life-support skills, administering oxygen, giving basic medication such as aspirin and putting the patient on a stretcher for transport.

"Even something so simple as gaining access to the veins for drugs, if your patient is crashing and the system has gone down, would be helpful," says Day. "You still have that one way to get drugs into them to give them a better chance." Kiernan adds: "It's cost-effective, too, because your patient has a better start toward recovery."

The men have the support of their superiors and colleagues at home in the effort to raise standards. "As much as our bosses would dearly love to put a paramedic on every ambulance in Dublin - and there are enough of them with the trained personnel available - they can't do it. They might as well put a kindergarten teacher on the ambulance, because no one could use their skills."

Kiernan adds: "Hopefully, when we do return home, the Department of Health will have implemented the long-awaited advanced EMT programme [see right\]. Maybe, with our training, we can make a positive contribution to the programme, using the skills obtained in the paramedic programme."

The road ahead:

Although foreign training has qualified some emergency medical technicians (EMTs) to connect a patient to a drip, insert a tube into an airway or administer heart drugs, they are prohibited from carrying out the procedures here, writes Breda Heffernan.

Micheál Martin, the Minister for Health and Children, has approved in principle the introduction of an advanced EMT programme, which would involve training ambulance personnel to administer medication and use certain equipment. He has yet to announce funding and give the scheme the green light, however.

Tom Searson of the Association of Ambulance Personnel says he hopes the Department will move quickly. "The syllabus is already there and ready to go. It would only cost a few million euro but would save so much in the long term by reducing time spent in hospitals and freeing up beds."