Adjournment Debate. - Cork-Kerry Cardiac Ambulance Service.

Deputy Bernard Allen gave me notice of his intention to raise on the Adjournment the subject matter the absence of a cardiac ambulance service in the Cork-Kerry region. The Deputy has ten minutes.

Ten minutes from now?

With your permission I will give some of my time to Deputy McGinley.

Is that satisfactory? Agreed.

I raise this issue because of the very unsatisfactory nature of the ambulance service in the Cork-Kerry region. It has been unsatisfactory for quite some time and in recent days the position has deteriorated because the emergency back-up ambulance service provided by Cork Corporation has been withdrawn because of the condition of the ambulance.

Allied to the unsatisfactory service, there is no maximum standard response time in existence in this country. In cities like Belfast 90 per cent of the emergency calls are answered within six minutes. A standard response time of this type I believe is necessary along with proper cardiac equipment and crew training for each ambulance. A properly equipped ambulance and proper crew training would increase the survival rate of heart attack patients in the region. Most deaths from sudden heart attacks come within the first hours and it is highly important that, in the event of emergency calls involving heart attacks, there be a ready response from a properly equipped ambulance. Most calls in the event of sudden heart attacks come over the 999 emergency system, and in most cases such calls are not pre-announced as cardiac calls, they are described as collapses. The first attention the victim gets is from the ambulance crew, so it is vital that there be a fully equipped ambulance and a fully trained crew.

Most of the ambulances in the Dublin area responding to 999 calls — in an area of high density population and low areas to cover — are adequately equipped with cardiac monitors and cardiac defibrillators and the crews are properly trained to work this equipment. In contrast, in the Southern Health Board area none of the health board ambulances are equipped with cardiac monitors or cardiac defibrillators. There is no doubt whatsoever that the provision of cardiac equipment and cardiac training does reduce mortality rates in cardiac emergencies especially with the new semiautomatic monitor defibrillators.

There is a number of sudden deaths in Cork city alone every week, many of which are caused by heart attack. In fact 50 per cent of all sudden deaths nationally are caused by heart attacks or at least by cardio-vascular disease, and two thirds of those who die from coronary arterial disease die outside of hospital, and 90 per cent of people who suffer sudden cardiac arrest develop ventricular fibrillation, a condition which can often be corrected if a defibrillator is available quickly.

Fifty per cent of people who die from sudden heart attack present no evidence of disease on the face of it. What I am saying is that a properly equipped ambulance service is essential for the saving of lives. I am not being over dramatic when I say that people are dying on the streets of Cork city and in the towns of Counties Cork and Kerry who need not die. The Southern Health Board in fact recognise this fact and have asked for adequate funding to upgrade the ambulances. The ambulances in Dublin have this equipment since the late seventies. Mr. Seán Hurley who is the manager of the Cork Regional Hospital said that £200,000 would be sufficient to equip the ambulances. I would ask the Minister what is the price of life?

In a so-called Christian country £17.6 million is being spent on a Taoiseach's office block while the Department of the Taoiseach are spending £20 million on an extension to the National Museum. If we can spend money like this, it is a crime against the people of this country that we cannot spend £200,000 to equip heart ambulances. Despite the feeling of complacency around at present about the health services, they are still deteriorating. In the Southern Health Board region we are being forced to close a hospital because of financial starvation. Waiting lists for surgical procedures are being lengthened because the Minister will not make decisions regarding the appointment of consultants.

A paltry £200,000 would be sufficient to give us a properly equipped ambulance service and I am asking the Minister tonight to make an early decision to rectify the appalling and tragic situation that is taking place every week of the year in the streets of Cork city and in counties Cork and Kerry.

At this stage I would like to hand over to Deputy McGinley.

I wish to thank my colleague, Deputy Allen, for giving me the remaining few minutes of his time. Everything he has said about properly equipped ambulances to deal with cardiac arrest can be applied to any rural area in the County of Kerry and along the entire western seaboard. It is unbelievable that this service has been available to the capital city here for over ten years where most people are living within ten or 15 minutes of a major hospital whereas in rural areas such as Deputy Allen and I represent, it takes an hour or two to get to a hospital.

I believe the equipment needed in ambulances for this purpose is relatively inexpensive. For about £10,000 or £12,000 any ambulance can be equipped with a defibrillator, a stabiliser and a resuscitator. I have no doubt that if they were available to ambulances in rural areas, countless lives would have been saved.

It is no joy to me to have to relate that in my own parish I know of two people who passed away on their way to hospital during the summer, young men in their forties who had 20 or 30 years life expectancy. I am firmly convinced that if the service had been available it would have prevented that loss of life.

I understand that in Scotland where there is terrain and rural population similar to the situation here there is an excellent service. It would be worthwhile for the Department of Health and the Government to find out how they can do it so that we might take steps to provide an adequate service.

In my own constituency it takes an hour or two to get to a hospital and there are people on Island communities who have to cross the seas to the mainland to get to a hospital. It should be a top priority for every health board, particularly in the north west where we have some of the remotest areas in the country and unhabitated islands, to have this necessary equipment available. I can inform the Minister that in the north west at the moment — in west Donegal, Gweedore, the Rosses, etc. — a voluntary committee of concerned citizens have already been established and are in consultation with the health board. There is a major fund raising campaign going on. They can certainly make their contribution but they must have the backing of the health board, the Government and the Department. I understand also that it only takes weeks to train the personnel to manage this equipment. I understand there are three-week courses in the Phoenix Park here in Dublin which nurses and medical personnel can attend and thereafter be perfectly able to handle this equipment.

I hesitate to interrupt the Deputy. He might now bring his remarks to a close.

Thank you very much, a Cheann Comhairle, for giving me the opportunity to speak on this major issue. We are talking about the saving of life. I would ask the Minister to give the issue his immediate attention and to instruct the health boards to have this equipment available in all rural based ambulances.

I wish to thank Deputies Allen and McGinley for raising this matter on the adjournment. I welcome this opportunity to explain the current position in relation to ambulance services in general and cardiac ambulances in particular. The provision of ambulance services is a matter for each health board in the first instance. Health Boards may provide ambulance services under section 57 of the Health Act 1970. Ambulance services are also provided by a small number of voluntary agencies. Dublin Fire Brigade provide an accident and emergency ambulance service for the Dublin City area for the Eastern Health Board on a contractual basis. The eight health boards provide funding for their ambulance services from their own allocations.

Ambulance services in each health board area are based at a number of ambulance stations, which are usually located on hospital sites. The health boards provide a 24 hour, seven day week accident and emergency ambulance service as well as routine minibus transport of patients to out-patient appointments and clinics.

All ambulances are equipped with radio communications and are in constant contact with their station. They carry an extensive range of first-aid and medical equipment based on recommendations made by the Ambulance Services Council. Ambulance personnel are trained in first-aid and resuscitation techniques and other skills related to their job.

Defibrillators are the only piece of equipment which distinguishes cardiac ambulances. All ambulances carry various types of equipment but cardiac ambulances carry defibrillators. Normal ambulances are not equipped with this type of equipment.

Normally, the ambulance service is the first link between a member of the public involved in an accident or emergency and the health services. A rapid response by the ambulance service is especially important when the patient has suffered a heart attack. The ambulance service has always coped very well with these situations and I am sure it will continue to do so.

However, specialised cardiac ambulances have been introduced over the past number of years, especially in the USA, as an alternative approach when dealing with cardiac patients. A cardiac ambulance service is operated in the Dublin area by the Eastern Health Board and now responds to around 5,000 cardiac calls per year. This service has been assessed by the Eastern Health Board and I understand that the board intend to continue its use in the greater Dublin area.

In regard to the Southern Health Board, I understand that a private cardiac ambulance service already operates within the Southern Health Board region.

It does not respond to 999 calls.

The Deputy got his opportunity but I will respond to what he has said. In regard to the Southern Health Board's service I understand that the provision of pre-hospital cardiac care, including the introduction of a cardiac ambulance service is being actively considered by the board at present in the context of the development of cardiology services in general. Officials of my department are available at any time to discuss proposals with the board for the provision of such a service.

The Irish Heart Foundation also provides some cardiac assistance by way of cardiac cars and have made two cardiac cars available to two health boards in this country. I understand that an offer of a cardiac car was made to the Southern Health Board and that having considered the matter, they decided not to avail of the offer.

Deputy Allen made a statement at the weekend that was quoted in the press saying that there was a very poor ambulance service in the Southern Health Board area. The chief ambulance officer of the Southern Health Board has assured us that this is not true and that the service is up to the proper standard. Tonight Deputy Allen has said that the ambulance available to Cork Corporation has been withdrawn because of its condition. The Department of Health have not been notified of this nor have representations been made to us about the situation. I am quite confident that if that situation was made known to the Department and if consultation takes place between the corporation and the Southern Health Board who have responsibility and a statutory duty to provide ambulance service in the Southern Health Board region, in consultation with us, we can resolve the matter in a reasonable way as quickly as possible.

It is important to recognise that we have an excellent ambulance service in this country.

The Minister is evading the issue. I was referring to emergency services.

The time available to the Minister is almost exhausted. Let us hear him out for the two remaining minutes available.

There is no point in coming into this House scaremongering and frightening people by saying that we do not have a proper ambulance service at our disposal. There is a proper ambulance service in this country. At this time the Department of Health are examining the whole ambulance service.

You have been examining it for ten years.

The Deputy had a good hearing. He should afford the Minister the courtesy of the same facility. If Deputy Allen is finding it difficult to listen to what the Minister is saying there are ways out of this Chamber. I suggest he take one.

Before I was interrupted I was assuring the House that we are satisfied that we have an adequate ambulance service available in this country. I would further assure the House that the totality of the ambulance service available is under examination by experts in my Department and that if changes need to be made they will be made in due course.

The Dáil adjourned at 9.05 p.m. until 10.30 a.m. on Thursday, 25 October 1990.