The HSE National Ambulance Service (NAS) provides emergency pre-hospital care and emergency patient transport. When a 999 ambulance call is received, the caller is connected with the ambulance command and control centre for that region. The details of the call are recorded on a Computer Aided Dispatch System (CAD), with the Advanced Medical Priority Dispatch System (AMPDS).
AMPDS is designed to triage a call, so that the most appropriate resource is dispatched to the patient. The system allows an ambulance to be dispatched while the caller is still providing details of the patient’s condition. The controller can also provide pre-arrival instructions to the caller, to allow initial medical assistance to be available and administered to the patient without delay.
In all cases, in line with the Pre-Hospital Emergency Care Council Emergency Priority Dispatch Standard, the nearest available ambulance is tasked to the highest priority incident. The highest priority incidents are ECHO 1 (life-threatening cardiac and respiratory emergency) and DELTA 1 (life-threatening other emergency).
The number of calls responded to the National Ambulance Service (NAS) are as follows:
|
Year
|
Number
|
|
2008
|
459,121
|
|
2009
|
362,612
|
|
2010
|
354,354
|
|
2011
|
323,320
|
|
2012 (YT Aug)
|
194,932
|
* This data includes Dublin Fire Brigade call volumes. The HSE has been continuously refining the data collection process, including definitions, which accounts for the reduction in volumes from 2008 onwards.
In 2009, the NAS redefined “ambulance calls” as being those actually responded to by NAS, resulting in a reduction in the recorded number of responses. In 2011, the HSE implemented a national policy for non-ambulance patient transport services, resulting in a further refinement as the NAS was no longer responsible for this service.
“Ambulance calls” relate to calls actually responded to by various resources including emergency ambulances, intermediate care vehicles, rapid response vehicles and motorcycle response units. “Ambulance calls” are further sub-categorised into:
AS1 999 Emergency
AS2 GP Urgent
AS3 Inter-Facility Patient Transfer (Non-Ambulant)
AS1 999 Emergency Calls are categorised into 6 levels of clinical acuity. Further detailed resources are available at:
http://www.phecit.ie/Documents/PHECC%20Standards/EMS%20Priority%20Dispatch%20Standard-V3.pdf
AS3 Inter-Facility Patient Transfer Calls are categorised into 5 levels of clinical acuity. Further detailed resources are available at:
http://www.phecit.ie/Documents/PHECC%20Standards/Inter%20Facility%20Patient%20Transfer%20Standard-V2.pdf
In relation to the average length of time to deliver a patient to hospital, journeys can take anywhere from minutes to a 12 hour round trip, depending on the type of request that the NAS is responding to. Given the variety of journeys undertaken, from routine patient transfers to emergency life-threatening calls, it would be difficult to quantify and would not be illustrative of service levels.
The NAS has just under 500 vehicles in its fleet, made up of 283 emergency ambulances, 124 response vehicles (cars, motorcycles, 4x4s), 28 intermediate care vehicles and some special purpose vehicles. The NAS is a national service and its fleet is deployed on a national basis as required. Vehicles are rotated through locations on a daily basis to meet capacity demands, as well as to ensure appropriate vehicle rotation to maximise the life span of the vehicles.
The NAS has invested in replacement emergency ambulances in recent years, as follows.
2008 - 67 vehicles
2010/2011 - 50 vehicles (remount programme)
2012 - 12 vehicles (remount programme)
Additional expenditure on vehicles in 2012 was focused on the purchase of an additional 9 intermediate care vehicles and 12 additional rapid response vehicles.
