Staff capacity constraints with the Air Corps and regulatory requirements on the Irish Coast Guard have meant that Priority 1 transfers have not been available between the hours of 7pm and 7.30am since 6 November 2017.
Since 2012, the Air Corps or Irish Coast Guard (IRCG) have completed all Priority 1 transfers with the exception of one.
Priority 1 transfer involves the transport by air from Ireland to another country within eight hours of a patient requiring emergent medical or surgical treatment, without which the patient’s life or health is significantly endangered.
The majority of these patients have to date been children requiring transfer to the UK to undergo heart or liver transplant surgery.
In light of these restraints, alternative options for the treatment and transport of Priority 1 transfer patients have been published by HIQA in their health technology assessment (HTA), intended to advise the Minister for Health and the Health Service Executive.
HIQA’s Director of Health Technology Assessment and Deputy Chief Executive Dr Máirín Ryan explained that the HTA highlights options for the treatment and transfer of paediatric heart and liver transplant patients, providing advice on immediate, short-term and long-term options for patients.
The optimal option for the immediate term will be to engage a private provider to deliver a dedicated night-time service.
The best short-term, which will be implemented within the next six months, solution may be to negotiate changes to the existing IRCG contract to allow for 12-hour rosters at one or more bases and to enable the IRCG to undertake night-time Priority 1 transfers.
The HTA advised that the cost of this option should be weighed against the cost of the ongoing use of a commercial provider or of having a dedicated IRCG crew on standby at the Dublin base.
Further short-term recommendations included the use of an air ambulance service supported by philanthropy and examining whether the IRCG can fly patients to the UK under a 24-hour shift, following changes to the regulatory framework.
The preferred long-term alternatives would be those provided by the Irish Coast Guard or the Air Corps.
The next contract to provide coastguard services in 2022 could provide for an additional aircraft and aircrew to provide air ambulance services.
Air Corps options include the provision of an air ambulance service on an “as available” basis or through a model similar to the Garda Air Support Unit, where aircraft would be provided by the HSE and dedicated aircrew would be provided by the Air Corps. However, this is contingent on restoration of sufficient air crew capacity.
Dr Ryan stated: “While we have presented immediate, short-term and long-term options for Priority 1 transfer patients, ideally, Priority 1 transfers should be considered as part of the wider patient transport services.
“The long-term development of an integrated aeromedical service for Ireland could provide a more sustainable approach and allow for more efficient use of resources than can be achieved by a service designed only for Priority 1 transfers.
“We realise the deep concern that the families of children awaiting heart and liver transplants must feel about how their loved ones can travel to the UK for a transplant, and we believe that the advice we have provided to the Minister and the HSE offers the best possible solutions in both the immediate future and in the longer term”, she concluded.