HSE National Ambulance Service

National Ambulance Service

Formation	2005
Legal status	Active
Headquarters	Millennium Park, Naas, County Kildare^[1]
Region served	Ireland
Leadership	Martin Dunne (Director)
Website	hse.ie
Remarks	Appointment: Minister for Health

The National Ambulance Service (Irish: Serbhís Náisiúnta Otharchairr) 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

Logo of the former Eastern Health Board

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 (HSE) 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.^[2] 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 EMT, navy for Paramedic & yellow for Advanced Paramedic. The dress uniform is navy blue with a white shirt and peaked cap. All front line ambulances operated by the service are CEN compliant. They are yellow in colour with green and yellow battenburg markings along the vehicle. They are fitted with emergency lighting, scene lighting and array of antennas for radios 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 (NASC) (Irish: Coláiste Náisiúinta tSeirbhís Otharcarr) was first established in 1986 as the National Ambulance Training School and is based at St. Mary's Hospital in the Phoenix Park, Dublin with a second campus based in Ballinasloe, County Galway. The college is due to relocate to a purpose-built new campus within the proposed new command and control building in Tallaght. 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 provides most of its courses in conjunction with the Pre-Hospital Emergency Care Council (PHECC). Paramedic and advanced paramedic programmes are conducted in conjunction with both PHECC and University College Dublin.

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 current regional control centre system is being phased out to make way for the proposed new national control centre in Tallaght, Dublin. This proposed centre will be responsible for the deployment of ambulances at national level and will incorporate a national computer-aided dispatch (CAD) system as well as an integrated national terrestrial trunked radio (TETRA) 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.

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 Fire Brigade. 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 (HIQA). 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 Dublin Fire Brigade ambulance service is being ran in comparison to the NAS. Matters to be reviewed include the way ambulances are dispatched, service provision and value for money.^[3] As of 2014, Dublin City Council receives a payment of almost €10 million per annum from the National Ambulance Service budget to fund the Dublin Fire Brigade 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.^[4]

Motorcycle Response Unit

The Motorcycle Response Unit (MRU) currently operates in Dublin. The fleet of high-powered touring motorcycles are available when required to respond to various trauma/medical incidents. Riders are paramedics or advanced paramedics recruited from within the service. The MRU is currently based in Ballyfermot, Dublin with a view of relocating to Dublin City Centre where heavy traffic congestion and narrow streets would be easily overcome by the agile nature of the motorcycle.

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 (ICV). 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 available for emergencies. The ICV's are capable of being utilised as first responders/additional vehicles for life-threatening emergencies. The new vehicles will be crewed by two Pre Hospital Emergency Care Council (PHECC) registered Emergency Medical Technicians called Intermediate Care Operatives (ICOs).

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 (IRT) is available to deploy and operate the decontamination service. The Marine Ambulance Response Team (MART) 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 Care emergency 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. In 2012, the National Ambulance Service began the selection process for the National Aeromedical Service in conjunction with the Irish Air Corps. The AgustaWestland AW139 is piloted by air corps personnel and crewed with NAS paramedics and advanced paramedics. Based in Athlone, the helicopter can be deployed nationwide to seriously ill and injured patients. The National Aeromedical Service began operation in summer 2012 and has since proven to be an invaluable resource to the service and the public.

HSE Ambulance Call Response Classifications
AS1/Code 1	999 emergency call – immediate response
AS2/Code 2	Call transferred from GP – urgent response
AS3/Code 3	Inter-hospital transfer of patients to specialist facilities
PTS	Community transfer service for patients requiring scheduled in-hospital care