Emergency aircraft alert system put in place
The system means the Air Corps and Coast Guard report to the service at 9am and 5pm seven days a week with details of what helicopters and planes are free for use if a transplant emergency arises and where they are based.
The NAS is also now the single, central co-ordinating point through which all requests for Air Corps or Coast Guard assistance with patient transport must be made. There are further recommendations that it establish a dedicated National Aeromedical Co-ordination Centre for this purpose.
The NAS is also responsible for sorting out ground transport for the patient to the location where they pick up their aircraft. If the patient needs ambulance support, the NAS provides it directly, but where the patient is well enough to travel without medical back-up, they can make their way to the pick-up point under their own steam or with a Garda escort where speed is important.
Where air transport is requested, the Air Corps and Coast Guard have committed to confirming their availability to the NAS within 15 minutes. If there are no state aircraft available within the required time scale, the NAS informs the patient’s hospital which then arranges private air transport.
The importance of determining and communicating the time scale involved and the likely travel time of available aircraft in each individual case is emphasised in the new system.
The failure of the various parties involved in the McGivern case to establish the tight deadline she was under and the resulting rejection of transport options that could have got her to London earlier played a major part in her missing out on her transplant.
Another major change under the new system is that Our Lady’s Hospital for Sick Children, Crumlin — of which Meadhbh is a patient — has developed an individual transport plan for every patient on the transplant list who is living at home so they and their families know which airport or pick-up location to go to as soon as they get a call that a donor organ is available.
One of the upsetting factors for the McGivern family is that they were repeatedly told to stay put and await instructions despite being ready to leave their home 10 minutes after they got the call from Kings College Hospital telling them a donor organ was available.
They could have been in any one of a number of airports and taken up a variety of different transport options by the time the decision was made — two-and-a-half hours later — that they should get on the road for Sligo.
Timeline of events on the night of Saturday, July 2.
* 7.20pm The McGiverns get a call from King’s College Hospital, London, to say a liver is available for Meadhbh and they should get ready to travel.
* 7.30pm Meadhbh and her parents, Joe and Assumpta, are ready to leave their house in Ballinamore with a Garda escort. They await instruction as to where to go.
* 7.30pm-7.45pm King’s College page Emergency Medical Support Services (EMSS) to arrange ‘Priority 1’ transport for the McGiverns. There is a delay in EMSS responding as the page fails to identify the hospital.
* 7.50pm EMSS call HSE National Ambulance Service requesting an Air Corps air ambulance. EMSS call Joe McGivern to say they are handling transport arrangements.
* 7.55pm-8.15pm HSE ask Air Corps to provide transport but Air Corps say on-call helicopter is unavailable due to a rescue, another helicopter and crew would take too long to assemble and the only jet in service is in use (at the Royal Wedding in Monaco) and will not be back until 10.30pm. HSE ask Irish Coast Guard to provide transport but Coast Guard say no helicopter is available until midnight as Dublin-based one is having repairs and Sligo-based one can not be taken off stand-by rescue duty until the Dublin crew have picked up a spare helicopter from Shannon.
* 8.15pm-8.30pm HSE informs EMSS no aircraft are available from the Air Corps or the Coast Guard. EMSS inform Our Lady’s Hospital, Crumlin, of the same but say they will try their British air ambulance broker. The British broker says it is having difficulties because aircraft are tied up with other transplant cases and with the Monaco wedding and Wimbledon tennis final. EMSS call King’s College for help.
* 8.30pm-8.45pm Our Lady’s Hospital contacts hospital’s air ambulance provider to ask for transport.
* 8.45pm-9pm Our Lady’s hears from own air ambulance provider that it has sourced a private jet but no crew. EMSS are told by the British broker that it will have no aircraft but if King’s College Hospital declare the case one of “life or death”, they can then call on the Royal Air Force (RAF) for help. EMSS call King’s College Hospital to request a “life or death” declaration which the hospital confirms. EMSS tells British broker it has go-ahead to request RAF help.
* 9pm-9.15pm RAF say they have no aircraft available. HSE contact Irish Coast Guard again and request use of the Sligo-based helicopter.
* 9.15pm Joe McGivern, at home and making his own inquiries while awaiting instructions, calls EMSS with contact details for a private helicopter provider in Galway. EMSS call the number but it is diverted.
* 9.30pm-9.45pm EMSS call the McGiverns to say the Coast Guard’s Sligo helicopter has been requested. Joe McGivern provides EMSS with GPS coordinates for Ballinamore so a landing spot for the helicopter can be identified. Our Lady’s contacts HSE to say their air ambulance provider has sourced a crew who can get a private plane to meet the McGiverns at Knock or Dublin, with an estimated departure time of 11.30pm and an estimated arrival time at Stansted Airport at 12.35am, followed by an hour-long ambulance transfer to King’s College.
* 9.45pm-10pm Coast Guard confirm availability of Sligo helicopter. Our Lady’s cancels the private plane.
* 10pm-10.15pm EMSS call the McGiverns to see how long it would take them to drive to Sligo Airport. On being advised it would take about 40 minutes, the decision is made not to bring the helicopter to Ballinamore but to let the McGiverns meet it in Sligo. The McGiverns get on the road.
* 10.15pm-10.30pm| EMSS contacts its British broker to arrange road transport for the McGiverns from Heathrow Airport to King’s College. Efforts are made by EMSS and the HSE to get an estimated arrival time in Heathrow but the Coast Guard are not yet able to provide one. HSE tells Our Lady’s the provisional departure time from Sligo is 11pm, with an hour and a half flying time to London. Our Lady’s tells King’s College this, and King’s College begin preparing for a 2am surgery.
* 10.30pm The state jet that was in Monaco returns to Baldonnel, ready for use, but has been discounted.
* 10.45pm-11pm The McGiverns arrive at Sligo and attempts are made by the HSE and EMSS to confirm departure and arrival times.
* 11pm-11.15pm The Coast Guard inform the McGiverns they will need two refuelling stop-offs en route to Heathrow, followed by a road transfer to King’s College, with an all-in travel time of four hours. The McGiverns call EMSS with this information.
* 11.15pm EMSS inform King’s College of the confirmed arrival time. King’s College requests McGiverns to await confirmation that the surgery still has the go-ahead.
* 11.30pm King’s College calls EMSS with the news that the donor liver can not be held beyond 2am and is going to be offered to another patient. EMSS contact the McGiverns to tell them Meadhbh’s transplant is being cancelled.
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