EXCLUSIVE: Code red for Tipp ambulance service

A Tipperary paramedic has come forward to raise concerns about conditions in the region’s ambulance service.

The whistleblower told TipperaryLive that they and their colleagues are travelling long distances, and patient care is being compromised.

The paramedic who has been working in the field for more than 20 years said the system is ‘broken’ and the staff are ‘frustrated.’

“Animals are getting better treatment than humans."

"I have never seen morale so low,” they said.

DISPATCH

The paramedic explained that ambulance dispatch is a two-step process.

Regardless of where the patient is, a call centre in Donegal takes the call and assesses the caller’s condition.

The call-taker has no medical training but uses keywords to assess a person’s condition and their position of priority.

Severity is coded in five categories, Alpha, Bravo, Charlie, Delta and Echo. Delta and Echo denote potentially life-threatening and life-threatening conditions, respectively.

The call taker uses shortness of breath as a keyword to determine priority.

So, if a patient says they are having trouble breathing, they are prioritised over other calls regardless of the reason.

The nearest ambulance is dispatched by another centre in Tallaght, Dublin, with an alert going to the ambulance directly.

That ambulance could be anywhere in the country.

GEOGRAPHY

According to the whistleblower, the nearest ambulance may not be in the same region as the caller. They say they can travel up to 700 km per shift.

And this is not an occasional occurrence.

“I can safely say that I have done more calls in Waterford city than Thurles town,” they said.

The source said that an ambulance in Thurles could be the closest to a caller in Waterford city.

At any point in that journey, the ambulance can be ‘stood down’ because a closer ambulance becomes available or a higher priority call comes in.

If a higher priority call comes in, the ambulance must reroute to that call.
According to the source, the caller is not notified but is left waiting for help that may not arrive on time.

They said it can take them hours to reach patients.

“It’s embarrassing to turn up four and five hours later,” they said.

The Tipperary Star was given examples, including patients left outside injured for hours and families woken up in the middle of the night having given up on help.

We were told of an instance of an ambulance being within view of a house, with a relative outside before being stood down.

Some callers were left with severe vomiting and pain because shortness of breath was detected in another caller.

CENTRES OF EXCELLENCE

The source told TipperaryLive that hospitals are holding ambulances to use as resources to supplement emergency departments.

“Hospitals are holding ambulances,” they said.

When the ambulance transports the patient, the hospital may not have space for them.

So the patient remains in the ambulance, and the paramedic cannot take another call.

In some cases, the patient does not need a hospital, but because of a lack of out-of-hours GP care in some areas, the patient must be taken to the hospital.

Once the call is made, the paramedic is obliged to take them to the nearest hospital.

“The amount of people who don’t need hospital is frightening. It happens too often,” said the paramedic.

WORKING TIME

Patients are not the only group suffering.

The source told TipperaryLive they and their colleagues are being refused their breaks.

They said they can be driving between nine and thirteen hours and are often not given time to eat or rest.

If they insist, they are being told the call is important and are sent out. If they do get a break, it is often interrupted for a call.

The source said the Organisation of Working Time Act is not protecting paramedics.

HIQA RESPONSIBLITY

HIQA are responsible for assessing paramedic performance.

They do this by using what they call Key Performance Indicators (KPI) The paramedic told the Tipperary Star the KPI measure paramedics are assessed on is a response time.

Response time is defined as, the ambulance responding to the call alert within 90 seconds.
The source says they and their colleagues are issued monthly progress reports where they fail if they do not respond in 90 seconds.

That 90 seconds, they said, could be their bathroom break.

The source also said HIQA measures do not take into account the time it takes to reach a patient.

HIQA recommends an ambulance be with the patient within 19 minutes.

“I guarantee you we don’t achieve this in 90% of cases,” said the source.

STAFF WANTED

All of this, the source says, has led to burnout amongst paramedics.

Paramedics are leaving the service, and there are not enough others being trained to take their place.

The paramedic we spoke to says there is a ‘real crisis of personnel.’

To add insult to injury, the source says seasoned paramedics are being taken off the road and put in a new supervisory role.

Director of the National Ambulance Service, Robert Morton spoke to Morning Ireland on RTE on August 16.

He told RTE that from September, two new training programmes are due to start, but those paramedics will take three years to train.

He was responding to an internal report which said the National Ambulance Service needs to increase its staff by 2,161 by 2027.

Mr Morton also said 68 new paramedics are due to graduate soon.
That report cited on Morning Ireland also said 70 members of the service have left in the first six months of this year.

However, our source says that this is not practical.

They said that a recent panel of 140 paramedics was created, and seven people took positions.
SIPTU
On the same Morning Ireland programme, SIPTU Sectoral Organiser Ted Kenny claimed overruns and travelling large distances (400-500 km) are contributing to burnout.

He also said paramedics were delayed getting breaks, and that turnaround times in hospitals can be around three or four hours.

In their submission to the Joint Oireachtas Committee on Health in December 2021, SIPTU raised concerns about morale and journey distances of paramedics from the National Ambulance Service.

They said: “SIPTU representatives have expressed deep concerns over the high level of pressure on the ambulance service, with paramedics frequently diverted from other parts of the country under a system which has been widely criticised by staff and has seen many members suffer from burnout.

“Staff recruitment and retention in the services has become a serious issue.”

Mr Morton told Morning Ireland that Covid-19 peaks, an ageing population and how the public ‘choose’ to access care is to blame.

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DEEPLY CONCERNING

The paramedic we spoke to said they feel the burnout and frustration themselves and so do their colleagues.

They added that as someone living in Tipperary, they are concerned for the safety of their friends and family.

“It concerns me that those calls could be my relatives,” adding that they believe the public should expect and be entitled to a service which is ‘up to scratch.’

The paramedic told TipperaryLive that when the health boards ran the service, ambulances worked in the locality.

“We have seen it done properly and we know how it should be,” they said adding that this was more efficient and better enabled paramedics to provide care to those who need it.

“If a businessman sat down with this, he would shut the doors,” they said.

Note: For operational reasons, we are protecting the identity of the local whistleblower.