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  • Originally posted by danno View Post
    Must be a vast amount of unused capacity in the system.
    There is danno, currently the EAS is being used as much as possible to prove that a service is needed. The crews are dedicated, there is no question of that. My fear is they are being tasked to every available incident even when other services are in a position to respond quicker in an effort to beef the stats. The call volume is there, it's just not good enough to leave patients lying waiting for an a/c when the could be en route to hospital.
    There is more at stake than a tit for tat argument here about who should be doing what and its a mute point, the patients needs are paramount, put that at the top of the agenda and base all decisions on what's best for them.

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    • Originally posted by Jack Booted Man View Post
      An interesting article , http://www.imj.ie//ViewArticleDetail...rticleID=10206 , particularly the qualifications and experience of the IRCG winchmen, could this be an issue... the level of qualification of the medics on board , the HSE have vastly experienced APs on board 112 who deal with a myriad of medical issues across the entire spectrum. The IRCG are generally paramedics who due to the nature of the business aren't medically qualified or experienced like a HSE AP .... Are Dublin Fire Brigade facing similar issues with the qualifications of their crews , P and EMT v APs ( again the HSE driving for primacy over DFB assets). The IRCG have skilled winchmen who are medically qualified and experienced to a certain level , the HSE have highly skilled and experienced APs in the back of an IAC heli who's job is to to sit there and do medical stuff, nothing else. Could that be the real issue on the tasking of IRCG assets , should they not up skill to AP ( is that possible) or look at basing HSE APs in an IRCG base(s). The nearest asset is not always the best.... Depends on the qualifications and kit of the crew . Opinions ?
      Your post is interesting to say the least! Looking back about 10 yrs the clinical level of care on CG a/c was first responder, hard to believe. Presently all bar a couple of SAR crew are PHECC registered Paramedics. Due to the recruitment drives over the last few years there has been an influx of ex HSE and DFB Paramedics. All these are very experienced operators. There is no doubt that experienced Paramedics make better Paramedics and at times some CG crews may go through a quiet period for treating patients much like some rural ambulance stations (not saying rural bases are quiet, just they might not get a serious trauma /medical call every shift).
      The only way to keep skills sharp is to train, and to train realistically. Each CG SAR base has a medical trainer that co ordinates regular training across the range of topics Paramedics face. In the last few years the standard of medical equipment and resources have improved dramatically to the envy of some land crews that SAR crews regularly meet!
      This year alone all CG SAR Paramedics completed training to the most up to date PHECC guidelines, CPG 3 v2 to also include CPG 2012. I stand to be corrected but I believe this is the first service to have all Paramedics complete this training, and to be fair because its a small group, it is easier to introduce updates in a shorter time frame.
      The issue of up skilling to a higher level is a hot topic right now. The AP programme is gold standard of Pre Hospital care in Ireland. It is a fantastic programme but takes a serious time commitment to complete.
      In the UK CG and Mil SAR crews undergo a modular training syllabus which is designed around their working roster with a lot of distance learning. It used to be carried out by Cosarm but now I think orms training provide it. The crews get trained to UK level Paramedic in stages, utilising Hospital and Ambulance placements.

      Back to the post above, is the clinical level of the crews a deciding factor? I don't think so, and the EAS call out criteria does not seem to weigh heavily on who's in the back. As I posted here before, an AP is sent to all echo and delta calls, and when an A/C gets there the AP has been first medical contact.
      Also wort noting, the EAS criteria states that EAS Is activated by a HSE P or AP, but it states CG SAR A/C can be sent straight away. So in short when a CG heli arrives at a HSE initiated call there is almost always an AP in attendance.

      Finally, working in an A/C for a Paramedic is not the easiest of working enviroments. Communication is difficult off intercom with a patient. Checking breath sounds is impossible, counting respiration rates is more difficult. Crews rely on other tools like end tidal CO2 monitoring. This is not a Paramedic skill but special authorisation has been given by the medical director (this is the same individual that is behind the EAS and the national ambulance service) to CG crews to use this technology. In short it takes a long time to be a good Paramedic and it takes a long time to adapt to working in an a/c. The excellent medical crews on EAS only rotate onto the a/c for a few months then they are replaced, IMO they should leave the AP's attached to the unit as over time they will become more adept at working in this environment.
      Last edited by Meatbomb; 27 June 2013, 10:09.

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      • Certainly seems to be a need for a dedicated service alright. IRCG helicopters can contribute but despite all "yes we can " they're not dedicated and regular HEMS type taskings mean they'd be diverted from their primary task which is quick response SAR within their region. Easy enough for the CG to retask another IRCG heli to the likes of an offshore Medevac but not so easy if its an inshore job that requires a quick response and the primary sar a/c is away on a HSE job - recent Waterford tragedy a potential case in point.

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        • "Yes we can" isn't quite right - "yes we are contracted to"

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          • I agree with some of your post PH but I still think that the nearest available resource should be sent as there is a persons life at risk. As I stated before you can't not use a resource just because you might need to use it. What happens if there is a call in Moate and the EAS is in Donegal town (yesterday)? Not saying leave it sitting in Athlone, just saying you have to park the what if's at some stage.

            There is one other thing that I find strange, and if you can explain it I'd be glad to hear it, why did the HSE get involved in picking the medical equipment for the CG 92's? I think (personal opinion) that they have a plan to use them regularly. I guess time will tell.
            I say keep both services and send the closest available asset everytime not the current HSE SOP of sending EAS first everytime no matter where the patient is.

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            • Originally posted by DeV View Post
              "Yes we can" isn't quite right - "yes we are contracted to"
              Hems is included in the contract

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              • Yeah maybe but I'd say send the dedicated service provider and if it's not available by all means send the nearest IRCG asset. Judging by the EAS usage that would be pretty frequent anyway. This covers the IRCG - otherwise they're potentially exposed and probably why they're reluctant to release a/c.

                Dunno about the medical equipment. Maybe someone simply asked them?

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                • PH, I think you need to make up your mind.
                  One minute your bleating on at the cost of the CG service (because the IAC aren't involved) and the next minute you dont want the CG service used to the benefit of the majority of the countries taxpayers ( because it might impact on an IAC operation).
                  Run all 5 bases to the benefit of the patients and see where the dice falls. It will soon show if a midlands based asset is a benefit or not. If it is great, if it's not then it's no longer required.

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                  • Originally posted by Pure Hover View Post
                    Yeah maybe but I'd say send the dedicated service provider and if it's not available by all means send the nearest IRCG asset. Judging by the EAS usage that would be pretty frequent anyway. This covers the IRCG - otherwise they're potentially exposed and probably why they're reluctant to release a/c.

                    Dunno about the medical equipment. Maybe someone simply asked them?
                    Reluctant to release a/c? When? The reality seems to be quite different.

                    So the EAS being the dedicate resource was put on trial to see if it could reduce transit times for critically ill patients, to say send this resource to a patient an in doing so delays their arrival in hospital is totally reckless. Not reckless on behalf of the crew, but on HSE management for allowing such a terrible sop exist.

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                    • [QUOTE=Tadpole;397498]PH, I think you need to make up your mind.
                      One minute your bleating on at the cost of the CG service (because the IAC aren't involved) and the next minute you dont want the CG service used to the benefit of the majority of the countries taxpayers ( because it might impact on an IAC operation).
                      Run all 5 bases to the benefit of the patients and see where the dice falls. It will soon show if a midlands based asset is a benefit or not. If it is great, if it's not then it's no longer required.[/QUOTE


                      Thought I was clear but perhaps not. Not saying the IRCG should not be used to the benefit of taxpayers but should be used to back-up the EAS because they're not dedicated and don't have the required AP support. I think you said yourself that if patient care is the focus then all 5 bases should be used but I doubt if that's the primary focus for all parties. Jaysus don't get me going on the cost of that contract - Paul Williams might be watching! Extensive use of these a/c will lead to even greater costs for the state.
                      Last edited by Pure Hover; 27 June 2013, 22:51.

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                      • Firstly, it won't cost extra, it's already in the contract. Secondly if you are actually talking about using the best asset for patient care then you cannot have a dedicated asset, you have to use the closet asset to the casualty I think MB has already extensively dealt with the AP issue.

                        Finally, in case Paul Williams is reading why hasn't the true cost of the EAS been released to the public? After all the service was costed with a 135 but is now operating a 139 the difference in cost of which is being picked up by the DF budget while the HSE are still only paying for a 135. I can only presume that it's not an attempt to hide the actual cost from the tax payer.
                        Last edited by Tadpole; 27 June 2013, 22:55.

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                        • [QUOTE=Pure Hover;397500]
                          Originally posted by Tadpole View Post
                          PH, I think you need to make up your mind.
                          One minute your bleating on at the cost of the CG service (because the IAC aren't involved) and the next minute you dont want the CG service used to the benefit of the majority of the countries taxpayers ( because it might impact on an IAC operation).
                          Run all 5 bases to the benefit of the patients and see where the dice falls. It will soon show if a midlands based asset is a benefit or not. If it is great, if it's not then it's no longer required.[/QUOTE


                          Thought I was clear but perhaps not. Not saying the IRCG should not be used to the benefit of taxpayers but should be used to back-up the EAS because they're not dedicated and don't have the required AP support. I think you said yourself that if patient care is the focus then all 5 bases should be used but I doubt if that's the primary focus for all parties. Jaysus don't get me going on the cost of that contract - Paul Williams might be watching! Extensive use of these a/c will lead to even greater costs for the state.
                          The EAS a/c is it? The CG contract has a monthly allocation of hours. These hours are flown regardless, training, Sar or hems.

                          AP's are on scene for almost all CG hems missions I am aware of, and CG a/c don't need to wait for HSE staff to request an a/c, they can be tasked while the ambulance is on the way and in a few cases were on scene before the ambulance.

                          It sounds like people think EAS is a time machine and is the answer to all the calls out there then the CG picks up the slack. Then when EAS' duty period ends its CG a/c responding to all NACC taskings, seems to be good enough then.

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                          • Reluctant to release a/c? When? The reality seems to be .
                            Reluctant to release a/c in terms of making sure they're covered in terms of SAR. Won't be you answering Dail questions when joe civ drowns and the dedicated SAR helicopter wasn't available because it was on a HSE task that the dedicated helicopter could have covered. If the EAS is tasked then that's different.

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                            • When a NACC request comes in, an a/c is tasked straight away. Look at the uproar over the failed transplant because a catalogue of cross department errors lead to a screw up, of which the CG were one link in the chain. They won't make that mistake again.
                              It's a hems and Sar contract, if its carrying out a mission for what it's contracted for what case is there to answer.

                              We both know in years gone by that duty Sar a/c were taken out of finner for crew changes, thankfully nothing ever happened. If an a/c was not tasked and somebody dies as a result then someone will rightly have some tough questions to answer.

                              Ambulance crews are starting to ask for CG helicopters to be tasked because they know they are closer, same goes for EAS, if its closer they want it not CG. It's simply common sense.

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                              • And I won't like to be the one answering the questions when it's found out that a HSE protocol is sending an EAS asset because it's 'their train set' rather then the asset in the best position to provide the best patient outcome. After all that's what the EAS was supposed to be set up to do, wasn't it?

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