National Ambulance Service NAS Martin Dunne Director NAS

National Ambulance Service (NAS) Martin Dunne Director NAS

NAS • 2000 Staff • 1 National Emergency Operations Centre (NEOC) across 2 sites (Tallaght and Ballyshannon) • 102 Locations • 500 Vehicles • Financial Envelope is circa € 200 m North Leinster • Population: 4, 809, 419 • 320, 000 Ambulance Calls per • Area: 68, 890 sq. Km (26, 592 square miles) annum • The primary & secondary road network in Ireland • Average 1000 calls per day is some 5, 306 km long and is made up of motorways, • 22 m km Per annum by Road dual carriageways & single lane roads

NAS Service Evolution 2006 to 2017 Ambulance Service 2006 Patient Intervention Basic Life Support Service 11 Individual Control Centres People Competency Emergency Medical Technician- 5 drugs Patient Care Equipment Limited medications Limited equipment National Ambulance Service 2017 Basic and Advanced Life Support; Community Paramedicine Single National Emergency Operations Centre across 2 sites • Emergency Medical Technician -13 meds • Paramedic - 24 meds • Advanced Paramedic - 48 meds • Community Paramedic - 48 plus • Expanded range of patient monitoring devices • Expanded range of patient management devices • Expanded range of medications • Equipment List for each vehicle type

NAS Service Evolution 2006 to 2017 Operations Fleet Estate Technology • Emergency Ambulance Service • Patient Transport Service • Aged Profile varied • Varied Specifications • No replacement plans • Overcrowded due to increased staffing • Requires significant development • Limited ICT • Limited connectivity to control • Varied Specifications • Emergency Ambulance Service • Intermediate Care Service • Rapid Response Vehicle, Motorbike Response Units, • Aero Medical Service • Critical Care Retrieval Service • Best Practice Procurement & Replacement Policy • Standard Specification • Modern Fleet – Use of Green Technology • Major estate upgrade commenced • New Ambulance bases • Deployment Points been developed in line with New Primary Care Centre Builds • Modern integrated CAS system • Modern Digital Communications System

Where We Are Now Live Performance Management (SFN)

The future……………

Emergency Medical Service (EMS) to Mobile Medical Service (MMS) Our new clinical model will introduce new ways in which callers to 112 / 999 are triaged to ensure they receive the most appropriate care and response to suit their needs. The changes will clearly identify those patients who require an immediate lifesaving response – ‘Emergency Care’ (these patients will receive the highest priority response in the fastest time), and those ‘Urgent Care’ patients who can be managed more appropriately in a care setting other than an Emergency Department. 8

Future Model of Care

Ø CLINICAL HUB – HEAR AND TREAT Telephone Triage - providing advice on self care, discharge or referral to other appropriate local treatment pathway (GP and primary care, local based urgent care service, specialist services – such as mental health service, social care services, dental services) Ø ALTERNATIVE DESTINATIONS Aim to ensure patients are treated in the right place first time and in doing so reduce the number of patients unnecessarily taken to an ED. - Local injuries unit or an appropriately resourced Primary Care Centre - Specialist Centre – PCI; Stroke; Fracture; Trauma Ø COMMUNITY PARAMEDIC Paramedics will function outside their customary emergency response and transport roles, in ways that facilitate more appropriate use of emergency care resources and enhance access for patients in rural and minor urban areas – take advantage of locally developing collaborations 10

Ø DYNAMIC DEPLOYMENT Where Emergency Response Resources will be strategically positioned at various predetermined locations, in order to provide a more rapid response to patient needs. Ø SEE AND TREAT Focused clinical assessment by paramedics at the patient’s location, followed by appropriate immediate treatment, discharge and/or referral to other services - more appropriate to needs Ø COMMUNITY FIRST RESPONDERS Groups of volunteers who, within the community in which they live or work, are tasked by the NAS to respond to emergencies appropriate to their skill set Three Community Engagement Officers appointed for each area. 11

Key Benefits of a New Model of Care Key Benefits Non – Conveyance Hear and Treat See and Treat / Refer / Transfer Resolution of calls using telephone triage without the need to dispatch crews Resolution of incident at scene without need to convey to another provider Ambulance Service • Reduction in dispatches • Incidents dealt with more promptly • Reduction in call cycle as no journey undertaken • More effective use of crew clinical skills Wider Health Service • Most appropriate pathway chosen • System capacity better utilised • Reduction in ED attendances • Reduction in hospital admissions • Appropriate and immediate resolution • Care closer to home • Immediate access to clinical treatment • Directed to most appropriate setting • Care closer to home The Patient

28% 2014

We need a Plan