Ambulance death shows need for cardiac services in southeast

The desperately sad death of Thomas Power while en route in an ambulance from Waterford to Cork has reignited the debate over cardiac services in the southeast.

"HSE has blood on their hands" was the headline in Tuesday's Waterford News and Star, a sentiment echoed by one local campaigner who accused Minister for Health Simon Harris of "killing" Thomas Power.

The fact that Power was a seemingly fit and active 39 year old who married only last year and whose wife is expecting their child understandably served to inflame opinions in Waterford, where a long-running campaign for improved cardiac services has largely been ignored in Dublin Government circles.

It was inevitable, perhaps, that a case like this would happen at some point in this controversy. Last September, this newspaper ran a report on a press conference held by doctors in Waterford under the now prophetic headline “Waterford cardiac consultants warn of patient deaths”.

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At this stage, however, it is impossible to say whether Power, who suffered a heart attack while in the ambulance, would have survived if these services were available nearer his home in Waterford.

Having self-presented at University Hospital Waterford complaining of chest pains on Sunday afternoon, Power was put in an ambulance for transfer to Cork University Hospital. This is because UHW’s cath lab, where patients with heart problems are treated, is closed at the weekend.

Cardiac treatment

There are six regional centres in the country for treating serious cardiac cases, but Waterford is the only one that does not operate 24/7. Out of hours, ambulances bring cases such as Thomas Power for treatment in Cork, 90 minutes away.

The hospital says he was not on any existing cardiac waiting list and there was no inkling at that stage of what was to unfold. Close to Dungarvan – still at least 45 minutes from Cork – he appears to have suffered a heart attack and died.

Had Thomas Power made it to Cork, he would most likely have had treatment to unblock his coronary arteries, known as angioplasty. A catheter would have been inserted through an artery, and a balloon passed through and inflated to push fatty tissue out of the way. A stent inside the catheter would allow the vessel to be enlarged and held in place.

This is complex work that can only be undertaken by a multidisciplinary team of doctors. Time is obviously of the essence. In this context, Waterford city is at the outer limit of acceptability in terms of ambulance journey times to Cork.

The hospital is unable to say at this stage why an air ambulance was not deployed to move Thomas Power to Cork. It may be that his condition while in UHW was not sufficiently serious, or regarded so. It could also be that the arrangements for ambulance cover out-of-hours are so convoluted that this method of transport would confer no advantage. Neither of the hospitals involved has an onsite helipad, so it would first have been necessary to take Thomas Power by ambulance to a local rugby club ground in Waterford to link up with the ambulance.

In Cork, another ambulance would be required to take him from the airport to the hospital. In any case, the helicopter would first have to get to Waterford, probably from Baldonnell near Dublin – if it was not already in use on a day when the likelihood of callouts was already elevated because of the good weather.

Catheterisation lab

In short, the air ambulance back-up seems decidedly patchy, not surprising given that Ireland is the only country in Europe without a dedicated national service of this kind. The campaign in Waterford has centred on the need for a second catheterisation lab, where heart patients are treated. And yet a second lab would have been of no benefit to Thomas Power if both labs were to remain closed at weekends.

Just 4 per cent of the work in the existing lab involves emergency treatment, while 96 per cent of cases are for scheduled procedures. This latter facet is being addressed through the outsourcing of patients on the waiting list in Waterford for treatment in public and private hospitals in Cork, and by the provision of a mobile cath lab, for three days a week, from September.

What Power’s case shows is the need for a fresh look at how emergency cases are handled. Almost 175,000 people in the southeast are living more than the crucial 90 minutes from a high-level cardiac centre, and so could potentially face the same fate as Thomas Power.

In the interests of equity, the forthcoming review of acute cardiac services nationally needed to look at this potential inequity, not just in the southeast but in other parts of the country.

Paul Cullen is Health Corespondent