A LACK of co-ordination between those trying to find air transport for Maedhbh McGivern on Saturday night contributed to her missing an opportunity to have a long-awaited liver transplant, her mother said last night.
Assumpta McGivern said it also appeared “maybe there were too many people involved” in trying to find transport for her 14-year-old daughter to take her from Ballinamore, Co Leitrim, to King’s College Hospital in London when a donor organ became available.
She welcomed the inquiry announced by Minister for Health James Reilly into what he termed “the traumatic events that have led to this lost opportunity”. It will be carried out by the Health Information and Quality Authority.
“We are glad that there is an inquiry set up. We are glad that it’s going to be sorted. We are happy that the proper protocols will be put in place to ensure nothing like this happens again. I suppose that is the most important thing for us,” she said.
Last August, Maedhbh was placed on a priority list for a liver transplant by doctors at King’s College Hospital and about a month ago she was upgraded to highest priority. She has been mostly housebound since Christmas.
“A lack of co-ordination was definitely a problem and from what we are hearing maybe there were too many people involved. But we will leave it to the Hiqa inquiry,” Ms McGivern said.
The first call the family got about the transplant on Saturday evening came from King’s College Hospital at 7.20pm, she said. They were sitting with bags packed and ready to go at 7.30pm.
Mark Murphy, of the Irish Kidney Association, said what happened was very unfortunate and he questioned if the Northern Ireland authorities should have been asked for assistance in taking the teenager to London.
He said while a kidney can be outside a body awaiting transplant for up to 24 hours, the time is much shorter in the case of the heart, lungs and liver. It is less than 10 hours, he said.
In this case the donated liver was coming from “a non-beating donor” which meant the timeframe was even shorter, probably between four and eight hours. It appears at least some of those trying to arrange transport for Maedhbh, including the Coast Guard, were unaware of this.
Mr Murphy said it would have made more sense if the family had been instructed to travel to Baldonnel, Dublin, so they could be transported to London on the Government jet when it became available at 10.30pm, rather than leaving them “in limbo” in Leitrim for at least two hours.
Conflicting timelines issued by the Department of Transport and the HSE on attempts to get transport for Maedhbh was because coast guards internationally work on Greenwich mean time, an hour behind local time.
All Irish children needing liver transplants go to King’s College Hospital which runs one of the largest transplantation programmes in Europe, carrying out more than 200 procedures a year.
HSE statement how events unfolded
EMERGENCY MEDICAL Support Services (EMSS) is a private company which co-ordinates air transfer arrangements. In this instance, EMSS was working on behalf of Crumlin Children's Hospital to put transport in place for this patient.
When it became known that there was a liver available at King's College Hospital, London,
EMSS was tasked with putting the necessary transport arrangements in place.
In these circumstances, the HSE Ambulance Service acts as a conduit to the statutory agencies to request support from the statutory services (Air Corps or Coast Guard) in transferring the patient.
7.48pm HSE ambulance command and control centre received a call from EMSS requesting an aircraft from a statutory provider.
7.50pm HSE command and control put the request to the Irish Air Corps on a priority level 1 call.
7.55pm The Irish Air Corps confirmed there was no craft available as the on-duty craft was dealing with a transfer of a spinal injury case.
8.08pm HSE command and control contacted the Coast Guard command and control centre to request a Coast Guard aircraft on a priority level 1 call. The Coast Guard advised it had no aircraft available.
HSE Ambulance Service then contacted EMSS and Crumlin Children's Hospital to advise that no statutory providers were
available and that alternative arrangements would need to be put in place. At about 10pm, the Coast Guard advised that it would have a craft available in Sligo and that the patient should be brought to Sligo airport.
When the family arrived in Sligo, they were advised by the Coast Guard crew that the flight time would be up to four hours. This information was relayed to EMSS and the receiving hospital in London advised that this would be outside of the time window available to carry out the surgery.
As such, the transfer arrangements were stood down.
Emergency medical support services log of company calls
Emergency Medical Support Services is a call management service provider to liaise with King’s College Hospital London and the HSE ambulance control centre when a patient is called for transplant. If the State services cannot provide air transport , it then tries to arrange private air transport. If it secures private air transport, this has to be approved by Our Lady’s Children’s Hospital Crumlin before the company can proceed further.
7.31pm: pager call received from King's College Hospital London (duration 1.22 min)
7.43pm: call returned and details obtained (2.30 min)
7.46pm: HSE ambulance control advised of call (1.42 min)
7.48pm: more details to HSE ambulance control (1.10 min)
7.50pm: call to patient's guardian re call and plans (6.32 min)
7.57pm: call to UK for private air ambulance (2.01 min)
8.00pm: advised by HSE ambulance control that no Irish Air Corp or Irish Coast Guard aircraft or helicopter were available for the transfer (1.36 min)
8.02pm: Crumlin children's hospital nursing administration advised (7.22 min)
8.09pm: further request for an aircraft from the UK – urgent (1.56 min)
8.20pm: updated transplant co-ordinator in King's College Hospital that no aircraft was available from Ireland in the time needed. Requested King's College Hospital to source their own aircraft (3.26 min)
8.37pm: advised by our UK air ambulance agent that no aircraft was available in the time required. We were also advised that if the transplant co-ordinator in King's College Hospital was to declare the transfer as "life or death" then the RAF in the UK could be requested to help (2.25 min)
8.40pm: transplant co-ordinator in King's College Hospital was advised of the option to declare the transfer as "life or death" and request the assistance of the RAF in the UK (3.35 min)
8.43pm: approval given by King's College Hospital to request assistance of the RAF (27 sec)
8.44pm: RAF assistance requested through UK air ambulance agent (1.32 min)
8.46pm: patient's guardian updated on the situation (4.18 min)
8.57pm: we requested the HSE ambulance control see if the Irish Coast Guard helicopter based in Sligo might be an option in this situation (2.03 min)
9.01pm: requesting update from UK air ambulance agent on RAF request – no update available (2.53 min)
9.04pm: Crumlin children's hospital nursing administration updated on situation re no Irish aircraft either State or private available to us. Also advised of RAF and Sligo Coast Guard option. We were advised by Crumlin nursing administration that they had sourced an aircraft but were waiting on funding approval for its use (4.51 min)
9.16pm: following on from a request by the patient's guardian we rang a helicopter operator in Galway. Call diverted (3.51 min)
9.20pm: re above (15 sec)
9.21pm: re above (2.47 min)
9.27pm: HSE ambulance control advised us that the Irish Coast Guard helicopter in Sligo was looking "hopeful" (1.43 min)
9.32pm: patient's guardian updated with this information and advised him to prepare to go to Sligo airport (2.02 min)
9.35pm: Crumlin nursing administration updated re changing situation (7.47 min)
9.58pm: requested from patient's guardian how long it would take them to get to Sligo airport (3.44 min)
10.02pm: HSE ambulance control advised that patient and companions should make their way to Sligo airport (37 sec)
10.03pm: patient's guardian advised to go to Sligo airport (39 sec)
10.04pm: Crumlin nursing administration updated that patient and companions were en route to Sligo airport for an Irish Coast Guard flight to London (1.14 min)
10:05pm: HSE ambulance control advised that patient and companions were en route to Sligo airport (1.04 min)
10.10pm: our UK air ambulance agent advised that the Irish Coast Guard were doing the flight and they could stand-down the request to the RAF. We also confirmed that a medical vehicle was available to collect the patient and companions when they arrived in London and drive them to Kings College Hospital (1 min)
10.17pm: travelling details of all travelling given to HSE ambulance control as per request (2.44 min)
10.21pm: transplant co-ordinator in Kings College Hospital advised that the patient was en route to London via a "Heli Lift" (1.37 min)
10.32pm: asked the patient's guardian how they were getting on time wise (39 sec)
10.37pm: as above (1.52min)
10.56pm: patient's guardian advised us that they had arrived at Sligo airport (1.06 min)
11.08pm: transplant co-ordinator in King's College Hospital advised that the estimated time of arrival in London Heathrow of the patient would be 3.30am. We were requested by the co-ordinator to ask the family to wait for confirmation that this timeframe was still okay before they could take off for London (1.16 min)
11.10pm: patient's guardian advised of above (1 min)
11.22pm: transplant co-ordinator in King's College Hospital advised us that the patient was not to travel as the timeframe meant the transplant would not go ahead (1.15 min)
11.24pm: patient's guardian advised of above (2.57 min)
11.30pm: Crumlin nursing administration advised of cancellation due to timeframe (5.51 min)
11.36pm: UK road medical transport stood-down (1.39 min)
11.40pm: HSE ambulance control advised of cancellation due to timeframe (12.01 min)