If the Government implements the Hanly Report as intended by its authors (as seems increasingly likely), the lives of hundreds of thousands of citizens will depend on Emergency Medical Technicians, otherwise known as EMTs. EMTs are often presented as mini-docs, even in Ireland, where their training lags far behind that of other countries. So, if medical training takes a minimum of seven years post-Leaving Cert. Education, how much training do EMTs get? What kind of exams do they have to pass? Which subjects do they study? How many ambulance drivers are qualified EMTs? Are there national standards, or are there different standards in different parts of the country? Who sets standards?
The answers to some of these questions can be found on the Internet, on the Web Sites of public bodies that have a direct connection with the north-east. Despite the rush to implement Hanly, emergency medical training in Ireland is in its infancy, it would appear. The rather grandly- titled Pre-Hospital Emergency Care Council, the body responsible for standards-setting (and maintenance) in this area of transport, does not specify any minimum educational requirements for EMT courses on its Web Site. (Neither does the American Government Web Site, on which this one seems to be closely modelled.) Ditto the National Ambulance Training Board, which is responsible for providing ‘pre-hospital emergency care training’ to members of health board ambulance services and other emergency services. Both the Pre-Hospital Emergency Care Council and the National Ambulance Training Board are under the chairmanship of North- Eastern Health Board CEO, Mr Paul Robinson. According to the National Ambulance Training Board, the Leaving Certificate is not a mandatory requirement for entry onto an Emergency Medical Technician course. This is non-reassuring, to use a medical term. After all, Quinnsworth used to require an Honours Leaving Cert from their checkout operators; manning a checkout desk in a supermarket is surely less demanding than dealing with a cardiac arrest or an airways blockage, resuscitating a dying person, or stemming a massive haemorrhage. Moreover, the National Ambulance Training Board, is not the only body in the country to run courses in ‘emergency pre-hospital care’ (to use a term that might have been invented by the Hanly team). The Dublin Fire Brigade runs its own courses in this area: despite the existence of the Pre-Hospital Emergency Care Council, and notwithstanding the gloss of its Web Site, national standards in EMT training do not exist in Ireland.
Altogether, EMT training takes only 32 weeks, with six weeks, or 195 hours devoted to theory, and the remainder to clinical placements, or ‘attachments’. This may sound like a lot of theory, but then, there is a lot of ground to cover. According to the Council’s Web Site, there are attachments in emergency medicine, obstetrics and paediatrics, in coronary care and in surgery. This is rather a lot of material to cover in six weeks. Nor is there any detail on how these attachments operate. If a trainee is the third man in the ambulance, and all the call-outs are asthmatic or coronary, how do EMTs get their training in obstetrics, for example? (Continued in next column..) |
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(Continued...) Come to think of it, with only six weeks tuition across all areas of emergency care, how do ambulancedrivers learns how to deliver a baby? This, after all, is not something that happens very often in an ambulance. Moreover, when you consider that helping mothers to give birth is something that takes midwives up to six years of university education to learn, you are forced to conclude that EMTs must, of necessity, know very little of midwifery. So much for emergency maternity care.
Without emergency services, under Hanly, 23-26 hospitals – depending on the scenario chosen – will become day centres, with ‘medical cover’ at night and weekends provided by nurses and general practitioners. What of that first ‘golden hour’ when proper care is critical to patient survival? Local communities, in the wake of the service cuts, will increasingly be forced to rely on ambulance drivers now invariably referred to as ‘emergency medical technicians’, to save lives. But even trained emergency medical technicians, while they can use technology such as defibrillators cannot (yet) administer the anticlotting and other drugs that may be needed to save a life.
Problems have been reported in the United States in the areas of cardio-pulmonary (heart and lung) resuscitation, where EMTs of unspecified educational attainment levels – are reported as having difficulty differentiating between lack of oxygen and obstruction of the airways. Yet in Ireland, where training is less developed and death rates from heart disease and strokes are high, EMTs are required to distinguish between medical and surgical cases after a training course (run by the National Ambulance Board) that consists of just 195 hours of instruction, followed by an in-service placement of an unspecified nature. While we know the pass rate in the last NQEMT (National Qualification Emergency Medical Technician) exam (September 2004, 90 per cent), no one knows just how many ambulance drivers in Ireland have passed this exam. No Web Site gives this crucial information. Meanwhile the Hanly effect on health continues. In the north-east, in a health board region widely regarded as being in the vanguard on health reform, the hellish vista of distressed families, forced to watch helplessly, as ambulances speed past the gates of their local hospital carrying their loved ones – who may be injured or ill, dying or giving birth – to huge hospitals up to two hours distant from their homes, goes on. And on.
Those with a vested interest in promoting, building, buying or working in these giant medical empires should now step forward from the shadows and explain just how emergency medical technicians can, in 32 weeks flat, acquire skills (with or without a Leaving Certificate) – having answered just one obligatory question about the management of heart attacks – to save the lives of citizens unlucky enough to live far from the golden trail of ‘centres of excellence’.
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