On the night of August 7, Michael Collins saw what looked like “something out of a war zone”.
As he waited to pass on the narrow road at about 11.15pm, he saw a fire crew and gardaí tending to three people lying on the ground around the mangled wreck of a car just outside Schull, West Cork.
There were bits of debris everywhere, he later recalled.
The sight was alarming enough, but what later struck the Cork South-West TD was the amount of time the injured were waiting for an ambulance.
“They were waiting for more than two hours, possibly more, for an ambulance,” he said.
“They were waiting so long, a lady who lives nearby came out and gave them blankets to keep them warm as they lay there on the ground.”
Emergency staff, both in ambulances and in hospitals are warning that a "perfect storm" awaits in the health service this winter, and what happened in Schull is a just a taster.
One leading GP says services in Cork have already hit crisis point.
Dr Denis McCauley, chairman of the GP Committee of the Irish Medical Organisation, said the events of late July, when the HSE told people in West Cork to consider other care options when the Acute Medical Assessment Unit of Bantry General Hospital closed, are an example of what is going to happen on a wider scale.
About a week after people were asked not to go to Bantry, management at an overcrowded CUH told people not to go there and instead to consider "other care options".
“On one hand, you had a key local acute facility being closed temporarily, which then led to a cohort of people who would not normally have gone to Bantry going to CUH," Dr McCauley said.
“Then that leads to questions about where they go if CUH can no longer handle them.
“So, we're going to see more perfect storms.
“Cork got it this time because services that were normally available at Bantry weren't available and – surprise, surprise – problems then emerged in CUH.
“But these kind of perfect storms are going to hit other areas too.”
Emergency medicine consultant Dr Peadar Gilligan said we are heading towards "very dangerously overcrowded" emergency departments into the winter months.
“And, again, with the number of cases of Covid that are happening, there's an ongoing need to screen patients, but that will become more challenging in the context of major overcrowding.
“So it's going to be very, very challenging this winter."
He appealed for people to think twice before calling for an ambulance.
“I would certainly appeal to the population not to call an ambulance where it isn't absolutely necessary,” he said.
“I suppose for every ambulance callout it means that others are delayed in receiving treatments of patients who, for example, suffer major trauma, heart attacks, strokes, and those who are seriously unwell with infection.
“The ability of the ambulance service to deliver timely care to those patients is compromised."
Emergency Department Nurse Moira Wynne, who works in Beaumont Hospital in Dublin and is an Irish Nurses and Midwives Organisation rep, agrees with Dr Gilligan.
But she says there also needs to be a countrywide debate around how the ambulance service operates in Ireland.
“A certain section of the Irish population think it is almost like a taxi service," she said.
“Things are crazy now, and then we're heading into winter, which is always another brand of crazy, and I don't know how emergency departments nationally are going to cope with that," she said.
“I think we've really at the start of a perfect storm.
“And that storm is only going to get bigger and stronger as we come into the winter.”
For its part, the National Ambulance Service (NAS) said: “Life-threatening calls receive an immediate and appropriate response, while lower acuity calls may have to wait until a resource becomes available.
“All 999 calls are clinically triaged based on the patient’s condition and the nature and location of other 999 calls in the area are understandably not apparent to callers when they call 999.
“In recent weeks, the NAS [continues] to experience a surge in demand for services at a time when staff are also working hard to support Covid-related swabbing and vaccinations."
A paramedic, who spoke on condition of anonymity, said the country is now at a stage where we will increasingly see more people waiting at the side of the road for an ambulance.
Asked if what TD Michael Collins saw in Schull recently is likely to become more commonplace, Ms Wynne didn’t hesitate in her reply.
“I don't think it is an exaggeration because at the end of the day there are finite resources,” she said.
“And it's not as if there is a whole back-up crew waiting in the wings, and therefore people are going to be waiting that bit longer.”