The National Ambulance Service is the statutory public ambulance service in Ireland. The service is operated by the National Hospitals Office of the Health Service Executive, the Irish national healthcare authority.
History
The Health Board Act 1970 allowed for the provision of an ambulance service by each of the eight boards for their respective area. The health board ambulance services operated independently of each other, being funded from their board budget. In 1986, the National Ambulance Training School was established to provide training to ambulance staff on a national level, catering for the progression of pre-hospital care and the development of skills in the ambulance service as a whole. This was the first step towards nationalisation of the service, however it was not until 2005 with the establishment of the Health Service Executive that the new National Ambulance Service was established. With the new service being established, and with the new training standards implemented by the Pre-Hospital Emergency Care Council, the service acquired a national insignia, standardised uniforms, vehicles and equipment as well as a national recruitment process for staff. The National Ambulance Training School was renamed the National Ambulance Service College to reflect the new organisational structure.
Uniform, Vehicles and Equipment
The operational uniform consists of green cargo trousers with a white open-neck shirt bearing the ambulance service crest as well as high-visibility outerwear for night time and poor visibility conditions. Clinical grade is depicted by use of coloured shoulder sliders; green for emergency medical technician, navy for paramedic, yellow for advanced paramedic & red for control operations staff. The dress uniform is navy blue with a white shirt and peaked cap. All front line ambulances operated by the service are CEN compliant. Almost identical toUK ambulances, they are yellow in colour with green and yellow battenburg markings along the vehicle. They are fitted with emergency lighting, digital radios, touchscreen data terminals, satellite navigation and tracking systems. The ambulance saloon is fully insulated with environmental control. Equipment includes a CEN stretcher, cardiac monitor/defibrillator, suction unit, diagnostic equipment, trauma kits, resuscitation kits, medications and oxygen. Ambulances are also capable of securely holding an incubator in place of a stretcher.
National Ambulance Service College
The National Ambulance Service College was first established in 1986 as the National Ambulance Training School and is based at the organisation's new HQ named the River Building in Tallaght, which also houses the National Emergency Operations Centre. 999/112 emergency calls are processed here also, as well as a second base in Ballyshannon, Donegal. Up until then, St. Mary's Hospital in the Phoenix Park, Dublin was the training location in Dublin. There is also a second campus based in Ballinasloe, County Galway, which trains paramedics and Intermediate Care Operatives. The college provides training to NAS staff, hospital staff, the Garda Síochána, Defence Forces personnel and fire service personnel. It is operated by the National Ambulance Service and most of its courses are approved by the Pre-Hospital Emergency Care Council. Paramedic and advanced paramedic programmes are conducted in conjunction with an affiliate University.
Command and Control
Calls from the public to 999/112 are processed using the advanced medical priority dispatch system. Controllers ask the caller a series of structured questions and assign a determinant code to the call based on that information. This information is then passed on to the paramedics to determine a blue light or non-blue light response to the call. The National Emergency Operations Center is located in Tallaght, Dublin. This centre is responsible for the deployment of ambulances at national level and will incorporate a national computer-aided dispatch system as well as an integrated national terrestrial trunked radio system in line with An Garda Síochána. In 2014, the rollout of the TETRA system was completed and all ambulances are now fitted with TETRA terminals and all paramedics issued with hand-portable TETRA radios. These systems allow controllers to dispatch the closest available NAS ambulance to the scene. Dublin Fire Brigade also have a control centre located in their headquarters in Tara Street and currently handle 999 ambulance calls for three of Dublin’s four county boroughs, in lieu of the agreed amalgamation of emergency operations and clinical governance of all Dublin ambulances under NEOC.
Emergency Ambulance Service
The National Ambulance Service directly provides all 999 emergency ambulance services in Ireland. The exception is Dublin, where in addition to the National Ambulance Service, Dublin City Council operates under service-level agreement to the Health Service Executive to provide an ambulance service through the Dublin Local Authorities Fire and Emergency Service. This service currently operates under its own command and control and with the exception of Health Service Executive funding, is entirely independent of the National Ambulance Service. In 2013, a draft proposal by the HSE addressed concerns with the system of ambulance provision in the Dublin area. The concerns were related to the lack of integration between the two services from a command and control perspective and the fact that Dublin City Council does not fall under the remit of the healthcare watchdog Health Information and Quality Authority. In 2014, a joint review of the ambulance service in Dublin was announced by Dublin City Council, the HSE and HIQA to address concerns raised about how the DLAFES ambulance service is being run in comparison to the NAS. Matters to be reviewed include the way ambulances are dispatched, service provision and value for money. As of 2014, Dublin City Council receives a payment of almost €10 million per annum from the National Ambulance Service budget to fund the DLAFES ambulance service. The HSE stated that the National Ambulance Service could provide the entire Dublin ambulance service directly for around €3 million per annum less. In 2016 an independent national capacity review of the ambulance service was carried out by UK company Lightfoot Solutions with consultation from the NHSAssociation of Ambulance Chief Executives which indicated that an additional 200 staff were needed in order for the NAS to take over the DLAFES ambulance provision which currently consists of 14 ambulances operated through its 900 staff.
Motorcycle Response Unit
The Motorcycle Response Unit currently operates in Dublin and Cork City. The fleet of high-powered touring motorcycles are available when required to respond to various trauma/medical incidents. Riders are paramedics recruited from within the service. The MRU is based in Dublin South Centralambulance station in Drimnagh, close to Dublin City Centre where heavy traffic congestion and narrow streets are more easily overcome by the agile nature of the motorcycle. In October 2018, a Motorcycle Response Unit was added to Cork City. The bikes used are BMW R1200 RT.
The Emergency Aeromedical Service is an air ambulance based at Custume Barracks in Athlone, jointly operated by airmen from No 3 Operations Wing of the Air Corps and advanced paramedics from NAS. It principally responds to remote areas which would be otherwise difficult to access by road.
Intermediate Care
In addition to frontline emergency ambulance services, the HSE National Ambulance Service provides a routine and non-routine inter-facility transfer service 24 hours a day. In 2012, the NAS introduced the Intermediate Care Vehicle. This specially designed vehicle is equipped and crewed for the purpose of providing an inter-facility transfer service and responding to low acuity 999 calls, which in turn will make more frontline vehicles, crewed by higher skilled paramedics and advanced paramedics, available for emergencies. The ICV's are capable of being utilised as first responders/additional vehicles for emergencies. The vehicles are crewed by two Pre Hospital Emergency Care Council registered Emergency Medical Technicians called Intermediate Care Operatives.
Specialist Services
The NAS is also responsible for providing decontamination services in the event of a chemical, biological or nuclear incident. A special-purpose Incident Response Team is available to deploy and operate the decontamination service. The Marine Ambulance Response Team was established primarily in response to concerns of the risk of mass casualty/mass patient incidents on board the many Irish Sea ferry services travelling between Ireland and Great Britain. This service is provided in conjunction with the Irish Coast Guard. The NAS also provides a Neonatal Intensive Careemergency ambulance service and a Mobile Intensive Care Unit which are available 24-hours a day nationwide to transport their respective patients and medical teams to specialised facilities.
