‘Quick-assemble’ national Covid-19 response service promptly triumphs

Two weeks after winning big at the Irish Healthcare Awards 2020 for establishing Ireland’s first-ever national Covid-19 screening programme, the National Ambulance Service’s emergency crews responded to 999 calls from across the Border to assist colleagues overwhelmed by a second surge of the virus, Peter Doyle reports

In the grand scheme of things, it did not seem that unusual. Reports of the public showing their appreciation to healthcare workers during the pandemic are now commonplace, after all.

But when residents of a housing estate in Northern Ireland stood on their doorsteps to applaud an ambulance crew from the Republic, which was responding to a 999 call from one of their sick neighbours, it marked a new level of cooperation between the two jurisdictions of this island in the fight against Covid-19.

Recalling the incident, Martin Dunne, the Director of the National Ambulance Service (NAS), told Irish Medical Times that several ambulances crossed the Border last month after he received a plea from help from his counterpart in the North, Michael Bloomfield, the Chief Executive of the Northern Ireland Ambulance Service [NIAS].

Fresh surge
The urgent request for assistance, Dunne added, came after a fresh surge in Covid-19 cases north of the Border was recorded and NIAS emergency crews were forced to triage patients in hospital carparks because of a resultant lack of bed capacity.

“We work quite closely with our colleagues in Northern Ireland, we are on the one island after all,” Dunne said. “They were under serious pressure and he [Bloomfield] sent me a text, asking if we could help them out.”

“I asked them exactly what they needed, and the main requirement was front-line resourcing to maintain a level of service. We put out texts to the crews, asking if they were available, and the feedback was very good.”

The fact that the NAS is a truly national service, Dunne explained, meant it could respond quickly and effectively to the unfolding crisis its nearest neighbour was experiencing.

“We have no borders, no counties, no trusts,” he said. “We are a national service. What they are doing down in the Ring of Kerry, they are doing up in Inishowen.

Bridget Clarke, National Ambulance Service

The vehicles are exactly the same, the equipment is exactly the same, so when someone asks us for help, if it is a bad crash or a building fire, for example, we can send ambulances from all over the country.”

Superb response
Describing the positive response from the public and healthcare professionals in Northern Ireland to the sight of crews from the Republic responding to emergency calls as “superb”, Dunne said the NAS would continue to provide cross-border assistance when possible.

“It has been a great success. There were no issues with the hospitals and a lot of friendships were made. And we will continue to help them out, as would the NIAS would do likewise, if we needed the same assistance. But the first thing we have to do is cover our own rosters to ensure service in this country is maintained.”

Double success
Two weeks prior to the request from the NIAS, the NAS had celebrated a double success at the Irish Healthcare Awards. After lifting the ‘Best Covid-19 Response: Public Sector (Non-Hospital)’ award for its Covid-19 screening programme at the virtual ceremony on December 1, the NAS was named winners of the ‘An Duais Mhór’ category, which was sponsored by not-for-profit supply chain specialists, GS1 Ireland.

Initial screening
It was in March last year, a fortnight after the first case of Covid-19 was recorded on these shores, when the NAS agreed to provide initial screening in an early effort to control the spread of the deadly virus. The objectives of the NAS programme included the implementation of a safe and timely screening service for nursing home residents, prison inmates, people living in sheltered accommodation and Direct Provision centres, the homeless, and workers in meat processing plants.

Martin Dunne, National Ambulance Service

A clinical governance model for receiving referrals from general practitioners (GPs) and hospitals to screen people who were too unwell to visit a designated Health Service Executive (HSE) testing centre was subsequently developed, while at the same time NAS staff were given extra training to enable them to provide a screening service which was compliant with World Health Organization standards.

The plan also included provision to undertake the mass testing of all residential care staff across Ireland in May/June 2020, as per the National Public Health Emergency Team recommendation, and the screening of all patients and staff affected by “clusters” in residential care settings.

By August last year, when entries for the Irish Healthcare Awards closed, the NAS had carried out 128,752 Covid-19 tests. By January 12, 2021, the NAS has completed a total of 274,888 including 107,301 completed since April 2020 in nursing homes and other residential care facilities. A remarkable record, considering that all this activity took place while the NAS – with a staff count of circa 2,000 – responded to day-to-day emergency calls from the public.

Around 93,000 of the tests were carried out by NAS personnel in residential care facilities, which equated to approximately 15 per cent of all Covid-19
tests performed nationally. All this activity took place while the NAS, with a staff count of circa 2,000, responded to day-to-day emergency calls from the public. Commenting on the awards, Dunne said front-line services such as the NAS have had to adjust and adapt to increasing demands placed on their services as a result of the ongoing pandemic.

“The first thing we had to do was maintain a normal level of service because people were still getting sick, were still involved in car crashes, were having heart attacks, delivering babies etc,” he observed.

“In parallel, we were asked by the HSE to go out and initiate with immediate effect the required testing of patients across the country, on a national basis. Because we are a national service, we could mobilise that very quickly.”

A lot of behind-the-scenes work, such as sourcing personal protective equipment and swabbing materials, making sure the ambulances were appropriately equipped and ready for action, and establishing links with local GPs, Dunne said, was coordinated by the Covid-19 control centre, which was being run by his NAS colleague, Bridget Clarke.

A mammoth task
It was a mammoth task, and with alarming reports emerging from countries like Italy and Iran, where intensive care units were being swamped with Covid-19 patients, the clock was ticking.

“There was a huge amount of work that went on in less than a week,” Dunne continued.

“So, it is nice for everyone that was involved to get a level of recognition; and it is good for people to know that people have recognised their work and it is being taken seriously.

“Because we are still doing the same thing; we are at 250,000 face-to-face swabs at this stage countrywide, plus 1,000 ambulance calls a day across the country.”

The best people
Clarke, who is based at the NAS headquarters in Tallaght, Co Dublin, said it was a case of all hands-on deck, with Defence Forces personnel, emergency crews, health professionals, and retired healthcare workers working together when steps to set up Ireland’s first-ever Covid-19 screening service were initiated.

“My first task was to establish who were going to be the best people in this room to be able to work together,” she said. “We had brought in a real mix of staff into a setting where staff usually concentrate on emergency services.”

The NAS also had to recruit extra clerical staff to log the surge in calls and monitor the email referral system. “We were having hundreds of phone referrals, so the likes of myself manned the phones to speak to public health if they wanted to prioritise screening, and to GPs who were telling us about sick patients, while at the same time we had to establish what was the work? Who were the best people to do it? And to find them?”

By some miracle, she said, the “best people” were in the room within 24 hours.

“Bringing that team together was the most extraordinary challenge and privilege because people were so willing to work together, and most of us had never met beforehand,” Clarke continued.

“Nobody ever said ‘that’s not my job’. In my 35 years in the health service, it was honestly the best integrated care model I have been involved with, and it happened overnight.”

All photos courtesy of the National Ambulance Service.

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