A confidential report into Ireland's ambulance service said that targets for response times can not be met.
According to a report carried by The Irish Times, the document claims Ireland is too rural to support a service that compares with its English counterpart.
Under HIQA's targets, 80% of potentially life-threatening calls are supposed to be dealt with by a first responder in under eight minutes.
Last year only 26.6% of callouts met that target - while in rural areas that dropped to 6.6%.
According to the study by Lightfoot Solutions, commissioned by the HSE, Ireland's "high rurality" means the cost of running the service is much higher than its English counterpart, while Irish people are less than half as likely to call an ambulance than people in England.
The report said improvements would only be made by hiring 290 extra staff - at a cost of €15m per year, and even then it may not provide enough of an improvement in clinical outcomes for patients who are not time critical.
David Hall, Managing Director of the Lifeline ambulance service, said there are longstanding problems in the service.
"It's 2015 … the ambulance service is in existence since 1972, not since 2014, which they'd like to lead people to believe - that these are first-world problems that have suddenly just arisen"
"The rural parts of Ireland have always been neglected."