Life-saving air ambulance service could be grounded over crewing model row
The National Ambulance Service helicopter at the Cork University Hospital helipad in Wilton, Cork. Picture: Dan Linehan
The State’s life-saving air ambulance service could be grounded in a simmering row over its crewing model.
The has learned that the 10 highly skilled advanced paramedics who crew the HSE’s Helicopter Emergency Medical Service (Hems) from bases in Athlone and Cork have resigned from the service, and have requested a return to their original ground-based ambulance duties.
Their request comes amid fears the National Ambulance Service (Nas) wants to cut the number of paramedics on each aircraft from two to just one.
Farm safety minister Michael Healy-Rae has described any such move as “reckless”.
HSE and National Ambulance Service management have been warned that a solo paramedic crewing model poses a risk to patients, to the paramedics and pilots, and poses a flight safety risk.
They have been told that if the National Ambulance Service can’t provide two paramedics for each aircraft, then the air ambulance service should be stood down on those days.
A senior manager has warned that a single patient safety incident — such as a drug error, an in-flight patient emergency, or a crash — would bring the crewing issue “sharply into focus”.
There are also concerns that the National Ambulance Service is recruiting emergency medical technicians (EMTs) to replace the second paramedic on each aircraft.
Qualifying as an emergency medical technician takes just five weeks. Internal emails warn that an emergency medical technician will not be able to carry out any of the major “interventional skills” required to help critically ill patients such as intubation — the placing of a tube in a patient’s airway — and the IV administration of powerful painkillers.
While the HSE has denied there are any plans to change the crewing model, the has learned that a single clinical crew model was trialled after the State took over a charity-funded, Munster-based Helicopter Emergency Medical Service in 2023.
An unpublished internal report on the trial said the introduction of a solo advanced paramedic (AP) crewing model “had a detrimental impact on the primary role” of Helicopter Emergency Medical Services — that being to provide safe and effective care to patients.
It described the single crewing model as “unsustainable” and one which poses “safety concerns with a measurable increase in risk to both the patient and the practitioner”.
It found multiple incidents of increased risk to the patient, which were directly related to a solo practitioner trying to manage multiple aspects of complex trauma cases while also preparing patients for flight, coordinating all communications to the flight crew, and loading and unloading the patients onto the aircraft.
It also referenced a 2019 internal report which pointed out that the existing service — in place since 2012, and crewed by an advanced paramedic and an emergency medical technician — was already operating at “a lower clinical level” than “international norms”.
Among its recommendations were the scrapping of the advanced paramedic and emergency medical technician crew combination, and the maintenance of two advanced paramedics on the aircraft while the Helicopter Emergency Medical Service moves towards a doctor-led service.
The has also seen a raft of internal emails from clinical risk and clinical development experts warning senior managers about any potential move from a two-person advanced paramedic to a solo advanced paramedic crew.
Siptu, which represents the 10 advanced paramedics who are now working the air ambulance roster under protest, is liaising with the National Ambulance Service management on their concerns about the future crewing model.
However, industrial official Graham Macken accused management of frustrating the talks.
“Unless we see progress in the short term, we will formally refer this matter to the Workplace Relations Commission (WRC),” he said.
National Ambulance Service management has also been told in recent days that, as well as referring the matter to the WRC, the union will consider options to conduct a formal ballot for forms of industrial action.
The minister of state at the Department of Agriculture, Food, and the Marine, Michael Healy-Rae, said he was shocked and worried about any plan to cut the number of skilled advanced paramedics on the air ambulance aircraft.
“Certain people in the HSE are totally ignoring the safety aspect of this. They seem to think that these helicopters can work with minimal crews. Well, they can’t,” he said.
“You need highly skilled, highly trained expertise in these aircraft.
“They deal with the most high-risk and the most complex medical trauma cases. Anything can happen to a patient while they are being transferred by air.
“Having just one advanced paramedic on the helicopter is not safe for the patient, and it’s not safe for the crew of the helicopter either.
“I have been trying to get answers on this issue through parliamentary questions and, to be totally honest, I am totally dis-satisfied with the responses I’ve received. They show a complete disregard for the crew and for patients.
“I don’t accept the responses, and I would condemn any move to reduce the number of paramedics in the strongest possible way. I would go so far as to describe any such move as a reckless action.”
The HSE was asked a range of specific questions about its crewing model plans, with several directed specifically at National Ambulance Service director Robert Morton.
It declined to answer the specific questions, issuing a statement instead.
It said that, since its inception in June 2012, the HSE’s Helicopter Emergency Medical Service has operated a successful crewing model consisting of one specialist paramedic and one emergency medical technician.
“In September 2024, the HSE commenced a feasibility study to examine the need for physician-delivered Hems in Ireland,” it said.
“The initial results of the trial have not supported any such change, hence the trial period has been extended into 2025.
“Pending any outcome from that feasibility study, the HSE has no plans to change the Hems crewing model.”
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