PHEM (Pre-hospial Emergency Medicine) - Ireland



Background

Ireland is one of the few countries in the world to boast a National Ambulance Service with a single national regulator, the Prehospital Care Council (PHECC). The National Ambulance Service (NAS) was established at the same time as the HSE. CUH enjoys a very close working relationship with NAS, and 2 senior Emergency Medicine staff sit on PHECC Council. We also uniquely hold joint appointments in Emergency and Retrieval Medicine. Trainees working in CUH are offered PHEM and telemedicine training.


Pioneers

Dr James (Jim) Doran

Dr James (Jim) Doran was born in Cork in 1925, and after WWII he graduated in Medicine from UCC. After working as a GP in Nelson, Lancashire, England, Dr Doran returned to his native Cork to work in General Practice in Carrigtwohill, East Cork.

In that time, he developed an abiding interest in and life-long commitment to Emergency Medicine, which culminated in running his own Ambulance Service from his practice in Carrigtwohill. He is credited with Irelands very first prehospital defibrillation. His son, Dr Hugh Doran, has continued the strong family connection to Prehospital Emergency Medicine work in the Practice he took over on the death of Dr Jim Doran in 1995.

Prof Stephen Cusack

The first chair of Emergency Medicine in Ireland was held by Prof Stephen Cusack. Recently retired, he brought a significant wealth of PHEM knowledge from working in services such as MEDIC 1 in Edinburgh to Ireland. Having held the acting Dean of UCC School of Medicine, he went on to establish the Faculty of Defense and Security Medicine, together with UCCs first Paramedical Science Programs.


Medico Cork

Cork University Hospital Emergency Department manages the Irish Health Service Executives (HSE) National 24 hour Emergency Telemedical Support Unit.

MEDICO Cork guarantees direct access to specialist medical advice from an Emergency Medicine Registrar ± Consultant through various Service Level Agreements (SLAs) with a range of State Emergency Service and military assets.

More on Medico Cork.


CUH Emergency Department Response Car

CUH ED has been engaged in the delivery of Primary Critical Care Support to the people of Munster since 1990, and remains one of the few centres in Ireland to have consistently deployed emergency medical teams to the scenes of accidents at the request of the National Ambulance Service, under the care of Emergency Medicine Consultants.

In 2000, CUH ED developed a more structured approach by rostering a Registrar in Emergency Medicine or Anaesthetics to an ambulance service rapid response vehicle on average for one shift per week. This service was acknowledged as an important contributor in pre-hospital care in the South of Ireland when a dedicated rapid response vehicle was purchased in 2008 with funds provided by the then HSE South Network Manager, Mr. Gerry O’ Dwyer. Since then, this vehicle has been staffed by a team of Emergency Medicine Physicians from CUH ED, on an ad-hoc basis.

Reconfiguration of acute services in Cork and Kerry has recommended the formalisation of this resource as an essential tool in delivering time-critical emergency care to the people of this region. The essence of this service is to provide a physician resource as an extension to the CUH Emergency Medicine and Regional Advanced Paramedic Services, with the primary goals of reducing morbidity, and relieving suffering of those with serious illness or injury in the southern region.


Prehospital Physician Responders

In 2017, the National Ambulance Service (NAS) formalised a Clinical Governance Framework with individual Prehospital Physician Responders across Ireland. It is a voluntarily framework facilitating a respond to high acuity ambulance calls, providing a level of medical care that complements that provided by prehospital practitioners (Emergency Medical Technicians, Paramedics and Advanced Paramedics). This care contributes greatly to patient outcomes and is highly valued by NAS. Prehospital Physician Responders, are named doctors that have a formal relationship with NAS and are tasked by NAS National Emergency Operations Centre (NEOC) to emergency calls received via the 999 system to provide specialist prehospital medical care.

In Cork, all Prehospital Physician Responders are additionally employees of HSE South/South West Hospital Group, ensuring seamless integration with receiving Emergency Departments and allied HSE resources. This close relationship between prehospital and hospital medicine has recently seen Dr. Eoin Fogerty accredited with Ireland's first prehospital blood transfusion.


West and East Cork Rapid Response

East Cork Rapid Response (ECRR) and West Cork Rapid Response (WCRR) are two stand-alone charities, supporting Prehospital Physician Responders, Dr. Hugh Doran (ECRR) and Dr. Jason van der Velde (WCRR) to provide voluntary Critical Care Support to the National Ambulance Service in Cork County.

Established in 2009, both charities fund rapid response vehicles, equipment and medications to provide prehospital Critical Care Support and Advanced Life Support, as per the rigorous standards laid down by both the Association of Anaesthetists of Great Britain and Ireland, The Royal College of Emergency Medicine and the Prehospital Emergency Care Council.

In addition, both charities support a range of existing prehospital emergency service personnel employed in Ambulance, Fire, Gardaí and Irish Coast Guard, with equipment, logistics and training to provide a voluntary Community First Response Network across the County.


Alterative Prehospital Pathway Team

Emergency ambulance demand has seen a steep increase in recent times. Prior to this project, all NAS emergency responses mandated patient transfer to hospital unless there was a 'refusal of transport' decision taken by the patient. An initiative (Cusack, O'Donnell, Ryan, Deasy 2002-2006) whereby an SpR in Emergency Medicine was placed one day per week prehospital in the Cork area achieved non-conveyance rates of 31%, with no detrimental outcome. Ir Med J.2008 Feb;101(2):44-6.

A collaborative project between NAS and CUH was established towards the end of 2019, with the focus on delivering patient centred, safe and efficient care and best use of finite emergency resources. Currently in pilot phase, this project is iteratively exploring alternative prehospital pathways to Emergency Ambulance conveyance for lower acuity calls. It is currently achieving 70% non-conveyance rates through collaborations with Community, Inclusion Health, General Practice and Acute Hospital Partners.



References

Ir Med J.2008 Feb;101(2):44-6.


Content By Dr Jason van der Velde, Íomhar O' Sullivan 22/05/2020. Last review Dr ÍOS 1/06/21.