I welcome the Minister to the House on the first occasion since his appointment on which I congratulate him. I hope that, God and the Trinity College electorate willing, I will be back here to discuss other topics with him.
I was at a function in Wicklow recently at which another guest collapsed and there was a call to see if a doctor was present. I came forward to give medical assistance but in such circumstances, a doctor can do little more than anyone else with first aid experience so I sought an ambulance which came within 17 minutes from Arklow. That was an exceptional time, but it was even better that the two ambulance crew were very efficient and well equipped. The status of ambulance workers has changed considerably and they are now referred to as emergency medical technicians while the ambulances have very good equipment, particularly cardiac equipment.
Soon my short-term patient was taken to hospital where he recovered. It occurred to me that he may have required drugs and at present the legislation does not cover such emergency medical technicians giving drugs to patients even though they are highly trained. This is important for patients throughout the country but it is causing confusion in Border areas because in Northern Ireland medical technicians are allowed to give drugs. As the Minister of State is aware, we are trying to encourage co-operation in cross-Border activities, particularly emergency services. It is wasteful and hard on patients if personnel cannot respond to the nearest emergency. For example, Craigavon could cover parts of County Monaghan if that was better than waiting for an ambulance to arrive from Drogheda.
I contacted the Pre-Hospital Emergency Care Council to get its views on this matter. It stated there was a great will for team effort in caring for patients and that the medical profession did not require the person concerned to come to hospital before anything happened to him or her. It also stated everyone on the medical advisory board to the Pre-Hospital Emergency Care Council was in favour of increasing the role of emergency medical technicians, EMTs. They included emergency medical specialists and general practitioners. The council believed it was appropriate that drugs should be given by the people concerned under strict protocols.
The types of drugs about which I am talking are: glucagon for a person in a diabetic coma; glucose, intramuscularly or intravenously, if that is what is required; glyceryltrinitrate under the tongue for a person with angina; hydrocortisone which may be needed in many types of instances; morphine sulphate if a person has a very bad pain; salbutamol for a person with asthma which is given through a nebuliser; and possibly the most important currently, because of the emphasis put on trying to improve coronary care, the giving of thrombolytic drugs which break down clots intravenously as soon as possible to someone whom the technicians know has had a coronary because of what they can see on the electrocardiographs they are taking.
It is extremely important for patient care that this legislation should be brought forward. EMTs are not included in current legislation and regulations on the administration of medications. It is imperative to address this. This was highlighted in reports such as Building Healthier Hearts, 1999, and by Dr. Emer Shelley, the chief heart adviser from the Department of Health and Children who has spoken publicly about the need to change the legislation.
The construction of the Misuse of Drugs Regulations, 1998, would probably allow the administration of controlled substances, including narcotics such as morphine by EMTs, whereas the Medical Products (Prescription and Control of Supply) Regulations, 1996, cannot be interpreted to allow the administration of nitrous oxide gas used for pain relief or glyceryltrinitrate to be given under the tongue for angina. Thus, all public sector and many private sector EMTs in Ireland are currently in an uncertain position regarding the administration of medications.
The Pre-Hospital Emergency Care Council has developed within its medical advisory group and clinical care committees a collaborative practice framework that could be implemented by amendment with proposed clauses of exemption that would ratify current medical practice of EMTs; ratify practice of other pre-hositpal care personnel, for example, mountain rescue services; and ratify proposed additional authorisations required by EMTs.
The clauses of exemption may be as simple as the following. On page 5 of the Misuse of Drugs Regulations, 1998, under the heading "Admin istration" and in respect of Article 4 (1)(b), the following could be added: “The holder of a national qualification EMT certificate can administer to a patient in accordance with the directions of a registered medical practitioner or standard operational procedures and protocols approved by the Minister on the recommendation of the Pre-Hospital Emergency Care Council.” On page 15 of the Medicinal Products (Prescription and Control) Regulations, 1996, under section 2 which states “The provisions of articles 5 and 6 of these regulations shall not apply as respects” the following could be added: “(d) the supply of medicinal product to the holder of a national qualification EMT certificate for use in accordance with (i) the directions of a registered medical practitioner or (ii) standard operational procedures and protocols approved by the Minister on the recommendation of the Pre-Hospital Emergency Care Council.” The format and terminology of the draft clauses are entirely consistent with the existing regulations and Statutory Instrument No. 109 of 2000 establishing the Pre-Hospital Emergency Care Council. I suggest this legislation should be brought forward as soon as possible.
