Action Plan to address recommendations

The HSE has developed an action plan to address the 17 recommendations in the National Ambulance Service of Ireland, Emergency Services Baseline and Capacity Review. The recommendations are:

  • NAS should undertake further investigation into why emergency calls per head are so low in Ireland compared to England, so that future patterns of growth in Ireland can be better understood and accommodated.
  • NAS should work with partners in the Irish health system to establish an agreed basis for handling routine activity (inter-hospital transfers of patients) with improved utilisation of ICVs.
  • NAS should build on the HIQA National Standards for Safer Better Healthcare and develop a suite of appropriate clinical outcome and patient experience measures.
  • NAS should consult with HIQA on a review of response time targets, in the light of the conclusions of this report about their achievability.
  • NAS should invest in technology to support a more systematic approach to performance management and continuous improvement to enable full staff engagement.
  • NAS should review its vehicle allocation processes with the aim of reducing the time from call determinant (identification of patient complaint) to vehicle allocation from 100 seconds to 45 seconds (although full achievement of this target will be dependent on the completion of the investment in new technology and the control rooms).
  • NAS should introduce a process for earlier identification of, and dispatch of a vehicle to, Echo (immediately life threatening) calls.
  • NAS should review its vehicle mobilisation processes with the aim of reducing the time from allocation to vehicle mobile from 80 seconds to 45 seconds (although full achievement of this target will be dependent on the completion of the investment in new technology and the control rooms).
  • NAS should undertake a review of all vehicle deployment points in both major and minor urban areas to reduce drive times, aiming for an average drive time of 4 minutes in major urban areas. (See Appendix E for proposed major urban deployment points).
  • NAS should work in partnership with identified hospitals to reduce the time spent by ambulances at hospital and ensure safe handover of patients.
  • NAS should consider extending the use of Rapid Response Vehicles (RRVs) in both the major urban and minor urban areas.
  • NAS should consider developing the scope of their network of Community First Responder response to include Delta calls (recognising this will require a major retraining programme), as well as increasing the number of schemes to cover many more areas, thereby improving patient care, clinical outcomes and response times in rural areas.
  • NAS should introduce a relief ratio of 34% as outlined in the framework in this report.
  • NAS should give consideration to a programme of work which includes further sensitivity modelling as to the options for providing an Advanced Paramedic to those patients who require it within appropriate timeframes.
  • NAS should review the number and structure of the dispatch desks, operating processes and the control room staffing arrangements.
  • NAS should consider setting up a clinical support desk in the control room to offer a Hear and Treat service to appropriate patients.
  • NAS, in partnership with the wider health system, should review its policy of taking all patients to A&E and consider developing a See and Treat approach.