How long until the ambulance gets here? Getting answers is difficult. The National Ambulance Service (NAS) does not report response times on a per-ambulance-station basis, so we cannot report which stations are responding fast and where there are longer delays. Furthermore, it does not provide data on a county-by-county basis related to outcomes if there are delays.
There are some statistics, however, that shed some light on the situation. Figures released via a Dáil question in April revealed that last year, 890 people had died by the time the ambulance reached the scene.
A Freedom of Information request from the radio station Newstalk in February also highlighted some overall slow response times. It found that just 69% of life-threatening 999 calls were responded to within the HSE target of 19 minutes. That’s 31% of people that had a longer wait.
On almost 6,200 occasions in 2022, it took over an hour for an ambulance to respond. Twenty-one responses took over five hours and 233 took over three hours. This is out of a total of 390,000 emergency ambulance calls from the public in 2022 — a 6% rise on 2021, the NAS points out.
The average ambulance response time across the country stood at 26 minutes last April.
Cold and flu season is here. \iStock
Now that we are into winter again, with flu and Covid season in full swing to add to illness possibilities, ambulance delays are more of a worry.
So what’s the story behind the delays? Why do they happen and what’s being done to improve response times?
The NAS did not put forward a spokesperson to Irish Country Living but they did provide some answers related to the fleet, the challenges currently being faced and what is being done to ease the pressure on the system.
Fleet
This is what they had to say: “Every day, the National Ambulance Service deploys approximately 160-180 emergency ambulances, an average of 22 rapid response vehicles and in excess of 50 officer-response vehicles operating from over 100 locations around the country. NAS supplies services from 102 locations throughout Ireland.
“We operate a wide range of fleet including emergency ambulances, intermediate care vehicles, rapid response vehicles and a range of specialised support vehicles. Over the last number of years, we have invested significantly in new vehicles and a fleet-maintenance programme.”
Geographical areas
So how does it all work? The NAS operates on a national basis and mobilises responses to calls for assistance based on patient needs.
Ambulances may travel to, and be dispatched from, various locations, irrespective of their base, as they are not confined to work in geographical areas. This means that an ambulance based in Killarney may be dispatched to a call in Cork if it has just handed over a patient in Cork University Hospital and it is the nearest available ambulance.
The deployment model is designed around international best practice. It has eliminated previous practices that meant, due to legacy boundaries, the nearest ambulance was not always dispatched.
At times of very high demand for 112/999 services for patients with immediately life-threatening injuries and illnesses, this current deployment model can mean that some patients have longer waits.
Classification of emergencies: triaged
Not all 112/999 calls for ambulances are classed as critical emergencies. Response times targets set out in the HSE’s National Service Plan apply only to PURPLE (life threatening cardiac or respiratory arrest) or RED (life threatening illness or injury, other than cardiac arrest) calls.
While non-life-threatening calls can be distressing for patients and their families, they are not in the highest priority category and therefore, response times may be slower depending on demand at the
time.
As demand can exceed available resources, 112/999 calls are clinically triaged and prioritised to ensure that those patients with life-threatening injuries or conditions receive the fastest response possible.
Target times
National Service Plan 2023 targets call for 75% of 999 PURPLE calls to be reached within 19 minutes and 45% of 999 RED calls to be reached within 19 minutes.
Current figures (January to September 2023) show that ambulances reached 72% of PURPLE calls in 19 minutes and 46% of RED calls in 19 minutes.
NAS response times are broadly in line with last year which represents an improvement when considering year-on-year rising demand, the NAS said.
Challenges
Winter can be a particularly challenging period for our entire healthcare system, both in acute hospitals and across primary and social care services.
Last winter, attendances and admissions at emergency departments (EDs) across the country were higher than ever before.
All health and social care professionals across the healthcare system are trained to respond to this kind of sustained pressure and will take actions to mitigate the impact on patients and service users.
In order to deal with exceptional winter pressures, the NAS has the ability to engage private capacity and voluntary ambulance services to support hospital discharges.
NAS has also put in place Hospital Liaison Personnel to expedite turnarounds and coordinate care handovers.
During winter there may be a time when demand exceeds capacity and NAS needs to escalate its surge response and seek support from external service providers.
In addition, the Community First Responder Schemes are in position to respond to elderly patients and carry out welfare checks on patients waiting for emergency ambulances.
Their role is to help stabilise the patient and provide the appropriate care, including CPR and defibrillation, until the more highly skilled ambulance crew arrives on scene to take over the treatment. There are 252 CFR schemes in the country.
Their members are alerted after a 112/999 call is made relating to particular types of emergencies in their locality. A text is sent with the location, gender and age of the patient including a code indicating the nature of the incident.
CFRs are sent to reports of cardiac arrest, chest pains with risk of heart attack, choking and suspected stroke. They are not asked to attend trauma incidents such as road traffic accidents or any known violent or dangerous situation. The goal is to ensure that every patient who needs treatment across Ireland gets access to a community response.
Richard and his wife Lilian.
Retired farmer Richard (75) from Co Wexford, on holiday at his daughter’s home in Kildare, had to wait 65 minutes for an ambulance to reach him from Naas Hospital when he experienced a stroke.
posterior stroke
Putting a ladder away after cleaning out a gutter, he experienced what felt like an electric shock in the back of his neck and then described ‘seeing stars’. His daughter, a nurse, immediately rang 999. She also rang a neighbour to get the defibrillator from the village. Richard had suffered what’s called a posterior stroke.
"As he was drifting in and out of consciousness and vomiting at intervals, his daughter made the clinical decision not to use the defibrillator. Another neighbour stood out on the road to guide the ambulance when it arrived. Richard’s wife, Lilian, described the wait for the ambulance as, “a very anxious time”.
“We didn’t know if he’d make it,” says Lilian. “It was terrible. Richard was coming and going. We couldn’t understand why it would take so long for an ambulance to travel 14 km.”
All three have nothing but positive words, however, for the paramedics and their care when they did arrive.
“I couldn’t praise them enough, they were brilliant,” Lilian says. “I went in the ambulance with him and the care in Naas Hospital was 10/10.”
Richard doesn’t remember anything about it and is back to good health now, thankfully, although he won’t be
climbing ladders any time soon, he says.
What is Pathfinder?
Pathfinder reduces unnecessary Emergency Department attendance for older people, the NAS says.
It safely keeps older people who phone 112/999 in their own home rather than taking them to a hospital emergency department.
It is provided by NAS staff working with colleagues from the acute hospitals.
During the first eight months of 2023, Pathfinder attended to 2,874 callouts with 1,207 patients able to stay at home, where they availed of alternative pathways of care.
The service was first introduced in Beaumont in Dublin and is now also being provided in Cork, Kerry, Waterford, Kilkenny, Tallaght, Letterkenny, Galway and Limerick.
On average, two thirds of patients seen by Pathfinder following a 999 call have remained at home rather than being brought to the emergency department, the NAS says.
Other winter challenges facing ambulance shortages
Surges in influenza, Covid-19 and RSV illnesses.
Longer ambulance turnaround times at hospitals due to lack of beds at times. The HSE’s target time is less than 30 minutes. The HSE says that, in 2022, 85% of ambulances were cleared from hospital in less than an hour.
Staff absence due to illness
Recruitment difficulties due to pay and conditions
Severe weather events
What the Government says:
€200m was invested by the Government as part of Budget 2022.
More staff are to be employed in 2023 to increase the levels from the current figure of 2,125 whole time equivalent posts.
Staffing levels are up 10% since 2019.
The NAS set up a new Tactical Management Unit operating 24/7 to support staff and proactively manage pressures and escalations within the service, working with acute hospitals to reduce the impact of delayed turnaround time.
Read more
Welcome to the Irish Country Living Christmas Food Magazine
Meet The Maker: Ceramic artist Cora Cummins
How long until the ambulance gets here? Getting answers is difficult. The National Ambulance Service (NAS) does not report response times on a per-ambulance-station basis, so we cannot report which stations are responding fast and where there are longer delays. Furthermore, it does not provide data on a county-by-county basis related to outcomes if there are delays.
There are some statistics, however, that shed some light on the situation. Figures released via a Dáil question in April revealed that last year, 890 people had died by the time the ambulance reached the scene.
A Freedom of Information request from the radio station Newstalk in February also highlighted some overall slow response times. It found that just 69% of life-threatening 999 calls were responded to within the HSE target of 19 minutes. That’s 31% of people that had a longer wait.
On almost 6,200 occasions in 2022, it took over an hour for an ambulance to respond. Twenty-one responses took over five hours and 233 took over three hours. This is out of a total of 390,000 emergency ambulance calls from the public in 2022 — a 6% rise on 2021, the NAS points out.
The average ambulance response time across the country stood at 26 minutes last April.
Cold and flu season is here. \iStock
Now that we are into winter again, with flu and Covid season in full swing to add to illness possibilities, ambulance delays are more of a worry.
So what’s the story behind the delays? Why do they happen and what’s being done to improve response times?
The NAS did not put forward a spokesperson to Irish Country Living but they did provide some answers related to the fleet, the challenges currently being faced and what is being done to ease the pressure on the system.
Fleet
This is what they had to say: “Every day, the National Ambulance Service deploys approximately 160-180 emergency ambulances, an average of 22 rapid response vehicles and in excess of 50 officer-response vehicles operating from over 100 locations around the country. NAS supplies services from 102 locations throughout Ireland.
“We operate a wide range of fleet including emergency ambulances, intermediate care vehicles, rapid response vehicles and a range of specialised support vehicles. Over the last number of years, we have invested significantly in new vehicles and a fleet-maintenance programme.”
Geographical areas
So how does it all work? The NAS operates on a national basis and mobilises responses to calls for assistance based on patient needs.
Ambulances may travel to, and be dispatched from, various locations, irrespective of their base, as they are not confined to work in geographical areas. This means that an ambulance based in Killarney may be dispatched to a call in Cork if it has just handed over a patient in Cork University Hospital and it is the nearest available ambulance.
The deployment model is designed around international best practice. It has eliminated previous practices that meant, due to legacy boundaries, the nearest ambulance was not always dispatched.
At times of very high demand for 112/999 services for patients with immediately life-threatening injuries and illnesses, this current deployment model can mean that some patients have longer waits.
Classification of emergencies: triaged
Not all 112/999 calls for ambulances are classed as critical emergencies. Response times targets set out in the HSE’s National Service Plan apply only to PURPLE (life threatening cardiac or respiratory arrest) or RED (life threatening illness or injury, other than cardiac arrest) calls.
While non-life-threatening calls can be distressing for patients and their families, they are not in the highest priority category and therefore, response times may be slower depending on demand at the
time.
As demand can exceed available resources, 112/999 calls are clinically triaged and prioritised to ensure that those patients with life-threatening injuries or conditions receive the fastest response possible.
Target times
National Service Plan 2023 targets call for 75% of 999 PURPLE calls to be reached within 19 minutes and 45% of 999 RED calls to be reached within 19 minutes.
Current figures (January to September 2023) show that ambulances reached 72% of PURPLE calls in 19 minutes and 46% of RED calls in 19 minutes.
NAS response times are broadly in line with last year which represents an improvement when considering year-on-year rising demand, the NAS said.
Challenges
Winter can be a particularly challenging period for our entire healthcare system, both in acute hospitals and across primary and social care services.
Last winter, attendances and admissions at emergency departments (EDs) across the country were higher than ever before.
All health and social care professionals across the healthcare system are trained to respond to this kind of sustained pressure and will take actions to mitigate the impact on patients and service users.
In order to deal with exceptional winter pressures, the NAS has the ability to engage private capacity and voluntary ambulance services to support hospital discharges.
NAS has also put in place Hospital Liaison Personnel to expedite turnarounds and coordinate care handovers.
During winter there may be a time when demand exceeds capacity and NAS needs to escalate its surge response and seek support from external service providers.
In addition, the Community First Responder Schemes are in position to respond to elderly patients and carry out welfare checks on patients waiting for emergency ambulances.
Their role is to help stabilise the patient and provide the appropriate care, including CPR and defibrillation, until the more highly skilled ambulance crew arrives on scene to take over the treatment. There are 252 CFR schemes in the country.
Their members are alerted after a 112/999 call is made relating to particular types of emergencies in their locality. A text is sent with the location, gender and age of the patient including a code indicating the nature of the incident.
CFRs are sent to reports of cardiac arrest, chest pains with risk of heart attack, choking and suspected stroke. They are not asked to attend trauma incidents such as road traffic accidents or any known violent or dangerous situation. The goal is to ensure that every patient who needs treatment across Ireland gets access to a community response.
Richard and his wife Lilian.
Retired farmer Richard (75) from Co Wexford, on holiday at his daughter’s home in Kildare, had to wait 65 minutes for an ambulance to reach him from Naas Hospital when he experienced a stroke.
posterior stroke
Putting a ladder away after cleaning out a gutter, he experienced what felt like an electric shock in the back of his neck and then described ‘seeing stars’. His daughter, a nurse, immediately rang 999. She also rang a neighbour to get the defibrillator from the village. Richard had suffered what’s called a posterior stroke.
"As he was drifting in and out of consciousness and vomiting at intervals, his daughter made the clinical decision not to use the defibrillator. Another neighbour stood out on the road to guide the ambulance when it arrived. Richard’s wife, Lilian, described the wait for the ambulance as, “a very anxious time”.
“We didn’t know if he’d make it,” says Lilian. “It was terrible. Richard was coming and going. We couldn’t understand why it would take so long for an ambulance to travel 14 km.”
All three have nothing but positive words, however, for the paramedics and their care when they did arrive.
“I couldn’t praise them enough, they were brilliant,” Lilian says. “I went in the ambulance with him and the care in Naas Hospital was 10/10.”
Richard doesn’t remember anything about it and is back to good health now, thankfully, although he won’t be
climbing ladders any time soon, he says.
What is Pathfinder?
Pathfinder reduces unnecessary Emergency Department attendance for older people, the NAS says.
It safely keeps older people who phone 112/999 in their own home rather than taking them to a hospital emergency department.
It is provided by NAS staff working with colleagues from the acute hospitals.
During the first eight months of 2023, Pathfinder attended to 2,874 callouts with 1,207 patients able to stay at home, where they availed of alternative pathways of care.
The service was first introduced in Beaumont in Dublin and is now also being provided in Cork, Kerry, Waterford, Kilkenny, Tallaght, Letterkenny, Galway and Limerick.
On average, two thirds of patients seen by Pathfinder following a 999 call have remained at home rather than being brought to the emergency department, the NAS says.
Other winter challenges facing ambulance shortages
Surges in influenza, Covid-19 and RSV illnesses.
Longer ambulance turnaround times at hospitals due to lack of beds at times. The HSE’s target time is less than 30 minutes. The HSE says that, in 2022, 85% of ambulances were cleared from hospital in less than an hour.
Staff absence due to illness
Recruitment difficulties due to pay and conditions
Severe weather events
What the Government says:
€200m was invested by the Government as part of Budget 2022.
More staff are to be employed in 2023 to increase the levels from the current figure of 2,125 whole time equivalent posts.
Staffing levels are up 10% since 2019.
The NAS set up a new Tactical Management Unit operating 24/7 to support staff and proactively manage pressures and escalations within the service, working with acute hospitals to reduce the impact of delayed turnaround time.
Read more
Welcome to the Irish Country Living Christmas Food Magazine
Meet The Maker: Ceramic artist Cora Cummins
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