‘Fit to sit’ patients used to ease ambulance backlogs at Letterkenny hospital ED

The National Ambulance Service says its paramedics work closely with emergency department staff at Letterkenny University Hospital to hand over patients in as short a time as is safely possible in order to get their ambulances back on the road and responding to 999 calls.

Patients brought to the hospital by ambulance are generally accompanied by NAS paramedics until they are fully admitted to the emergency department (ED). However, when the Letterkenny emergency department is busy - as it often is - and ambulances get backed up, a different approach needs to be taken.

In response to a question from Cllr Gerry McMonagle at the regional health forum meeting this week, which asked what happens when multiple ambulances are backed up at Letterkenny hospital, Brendan McGovern, the general manager of the National Ambulance Service (NAS) in this region, said paramedics will, with hospital staff, jointly screen and assess less seriously ill patients who may be ‘fit to sit’ in the emergency department awaiting treatment, and ‘cohort’ more than one ambulance patient under the clinical care of an existing crew already awaiting handover at the ED.

However, when multiple ambulances are backed up at emergency departments, Mr McGovern said NAS management teams escalate the problem to successive levels of senior management at the hospital site and beyond to “develop a situation specific plan to relieve pressure and release [ambulance] resources” to respond to the next patient in need in the community.

He added that the NAS will also employ ambulance liaison staff at the Letterkenny ED and dedicated managers to assist with patient flow and clinical supervision at times of peak demand.

Read more: 14 backed up ambulances a sign of the misery endured by patients seeking admission to LUH

Cllr McMonagle was also provided with a breakdown of the number of calls made to the Ambulance Service in the West and North West region (which includes Donegal and the five counties of Connacht) over the past four months. Breakdowns by county are not maintained, he was told.

It shows a small but steady increase in calls, from 5,972 in October to 6,380 in January. In all, there were 24,712 ambulance call-outs across the region over the four months – an average of 203 per day.

The NAS data categorises more than 11,000 of those calls as being in response to life-threatening situations, and reveals that the 19-minute target response time is often being missed.

The target regarding life-threatening cardiac or respiratory arrests is for 75% of all calls to be responded to within 19 minutes. That was only met or exceeded once, in October, when 77 such calls were logged and 78% were responded to within the 19-minute target.

As the number of calls increased in subsequent months, the proportion which met the target fell: for 111 calls in November, 66% were dealt with within the targetted time; falling to 63% for 97 calls in December and just 61% from 105 calls in January.

The target for the much broader range of life-threatening situations other than cardiac or respiratory arrest is for 45% of 999 calls to be responded to within 19-minutes.

That target was exceeded in both October and November, with 47% of just over 2,500 such calls received each month responded to within the 19-minute timeframe. However, that fell to 39% hitting the target in December and 37% in January when around 2,800 calls were received each month.