Ambulance workers vote in favour of industrial action

boomer_ie

http://www.breakingnews.ie/ireland/mhojauojidau/
From Breaking news

Around 1,200 ambulance workers have today voted in favour of taking industrial action regarding a dispute with the HSE.

SIPTU, which represents the employees, is to hold a meeting in two week's time to discuss what form the strike action will take.

The row centres on a decision by the HSE during the Christmas period to privatise a number of ambulance services.

SIPTU says paramedics are angry and concerned that the HSE is planning to privatise the sector completely.

Traumadoc

You can be sure they plan to privatise the whole thing. You will soon see tax breaks to set up a private system. They need a large ambulance service as they want to close all the smaller hospitals such as Kilkenny, Mallow etc. so to cover the lack of acute services they will need a large ambulance service.

Fyr.Fytr

In the event this goes ahead, who will provide cover, lead baloon situation if the privates themselfs are brough it

Army Medical Corps are the next option, then the vols I presume yea??

Trojan911

Fyr.Fytr wrote: »

In the event this goes ahead, who will provide cover, lead baloon situation if the privates themselfs are brough it

Army Medical Corps are the next option, then the vols I presume yea??

I heard on the news today, think it was a spokesperson for their Union, that all Emergency cases will be dealt with by the ambulance workers. Non emergency will not.

Elessar

I can't see anything wrong with privatisation. One one hand they are generally unhappy with HSE management and their decision making process, who isnt. They are looking out for their own jobs and pensions, it's understandable.

But on the other hand, they are not happy with privatisation which could be very good indeed for patients as it paves the way for more ambulances at less expense and thus more service to the people. It also eliminates the closed shop approach to employment that every government run institution has.

I really can't see anything wrong with it.

Traumadoc

Privatisation does not mean a better service, It may be fine in urban areas but there will be problems in rural areas, with the closure of Acute hospitals the distances needed to travel will be greater, this will cost lives ( a recent report in the UK showed there was a 1% increase in mortality for every10km travelled.)


http://emj.bmj.com/cgi/content/abstract/24/9/665

Elessar

Traumadoc wrote: »

Privatisation does not mean a better service

Why not?

It may be fine in urban areas but there will be problems in rural areas, with the closure of Acute hospitals the distances needed to travel will be greater, this will cost lives ( a recent report in the UK showed there was a 1% increase in mortality for every10km travelled.)


http://emj.bmj.com/cgi/content/abstract/24/9/665

I agree closing hospitals isn't a good thing at all. But this is a separate issue and would affect any ambulance service.

Traumadoc

Do private hospitals provide a better service for emergencies??
My experience of private healthcare is that it is fine for the profitable areas of Medicine ( such as transferring patients to and from private hospitals) but it is less satisfactory where advanced skills are needed. Most of the private ambulances I have come across have been staffed by people who do not have the advanced skills of the EMTs and advanced paramedics. If you were running an ambulance service for profit why would you employ an advanced paramedic when a driver with a first aid course will seem to do the job at half the price.
Remember these services will be obliged to provide the maximum return to the shareholders.

Eru

Private companies may not be working on a profit making basis under privatisation however in Ireland the idea is on that basis such as bin collecting, management companies.

It means they will be concerned with profit and will try to cherrypick and fight over the most profitable things.

Also, at present we pay for ambulances and A&E so would privatisation result in higher and staggered fees? IE getting a nasty shock in the post and having to weigh up Ambulance service A against B?

Elessar

Traumadoc wrote: »

Do private hospitals provide a better service for emergencies??
My experience of private healthcare is that it is fine for the profitable areas of Medicine ( such as transferring patients to and from private hospitals) but it is less satisfactory where advanced skills are needed. Most of the private ambulances I have come across have been staffed by people who do not have the advanced skills of the EMTs and advanced paramedics. If you were running an ambulance service for profit why would you employ an advanced paramedic when a driver with a first aid course will seem to do the job at half the price.
Remember these services will be obliged to provide the maximum return to the shareholders.

That is the case now.

Private services would do just as well, if not better (ala more vehicles/staff), that current services.

Private services are already staffed by EMTs. The reason they don't have Paramedics and EMT-A's is two-fold: They don't need them as all they currently do is patient transfer work and second of all the National Ambulance Training school has essentially been booked out by the HSE for their paramedic+ courses.

An entire privatisation would obviously come with stipulations that to fully cover emergency work then paramedics and a certain number of advanced are required (or just use existing staff). So there is really no reason that a private firm, under contract, could not provide the same level of service.

Remember that under the Health Act 1970, the government has no legal obligations to provide a national ambulance service at all.

Traumadoc

I am not against private ambulances for certain services such as transfer from rural areas to outpatients and non-emergency transport. But i feel that if the emergency service is put out to private companies there may be a fall in standards, as often is the case costings are the prime motives. Already private ambulances are used for emergency call outs and the staff are essentially first aiders.

Elessar

Traumadoc wrote: »

Already private ambulances are used for emergency call outs and the staff are essentially first aiders.

Please back this up with proof. PHECC guidelines have stated for a while now that at minimum an EMT is required on an ambulance to transport a patient.

What I am saying is nothing that NAS does cannot be done by private firms, once there are clear guidelines and stipulations, as I mentioned above.

Both state-run services and private services have their downsides, but essentially the government can legally privatise the service if they wish.

sunnyjim

PHECC guidelines have stated for a while now that at minimum an EMT is required on an ambulance to transport a patient.

Problem is, Ellessar, that people are not reading the PHECC documents right.

People with the former 1 week EMFR are calling themselves EMTs etc.

It's something that bothers the hell out of me. I had 2 girls convince me that they were now EMTs, they had patches to 'prove' it, but relented to tell me that they hadn't done any conversion course after asking! I told them it was ok, I'll take a taxi to hospital instead :rolleyes:

Fyr.Fytr

Trojan911 wrote: »

I heard on the news today, think it was a spokesperson for their Union, that all Emergency cases will be dealt with by the ambulance workers. Non emergency will not.

Ah grand so

Elessar wrote: »

Please back this up with proof. PHECC guidelines have stated for a while now that at minimum an EMT is required on an ambulance to transport a patient.

What I am saying is nothing that NAS does cannot be done by private firms, once there are clear guidelines and stipulations, as I mentioned above.

Both state-run services and private services have their downsides, but essentially the government can legally privatise the service if they wish.

One of the privates were and i think still are doing 999 work in Galway, can put you in touch with colleagues of ours who in fact crewed the ambulances


The basis of the dispute is, for patient transfers there is a 3 step agreement
1) Get hse ambulance crew to do it
2) If they are not available, off duty staff are to be contacted and asked to work over time at over time rates
3) If both dont work then contact the privates

HSE staff are engaging in this dispute because management are skipping step 2 and going to 3

Thus causing them to loose out on overtime and management breaching agreements

TheNog

Fyr.Fytr wrote: »

The basis of the dispute is, for patient transfers there is a 3 step agreement
1) Get hse ambulance crew to do it
2) If they are not available, off duty staff are to be contacted and asked to work over time at over time rates
3) If both dont work then contact the privates

HSE staff are engaging in this dispute because management are skipping step 2 and going to 3

Thus causing them to loose out on overtime and management breaching agreements

I am not fully up to speed with this dispute but would it not be better for privitisation for non emergency transfers only presuming the HSE could save some money on OT and then put the savings back into the ambulance service to improve service, equipment etc to a standard prior approved standard agreed by but the union and the HSE?

Fyr.Fytr

Yea it would its just the fact its a national and local agreement and hse mgmt signed an agreement to abide by such agreements and theyre in breach of the agreements now


Sure if they do stick you can drive Nog, you've done it before lol

timmywex

the cost of getting a private to do a run would be more than paying some hse staff overtime, the ambulance service overtime, is nothing (it can be less than the standard after tax is taken), the private services charge alot, for renting out vehicles and things alos, which the hse would have at their disposal anyway!

TheNog

Fyr.Fytr wrote: »

Sure if they do stick you can drive Nog, you've done it before lol

I can be available at short notice. I can take the shortest route to a destination or indeed a scenic route if desired. Only request I have is to have the blues and twos on!!!

:cool:

Eru

TheNog wrote: »

I am not fully up to speed with this dispute but would it not be better for privitisation for non emergency transfers only presuming the HSE could save some money on OT and then put the savings back into the ambulance service to improve service, equipment etc to a standard prior approved standard agreed by but the union and the HSE?

Well perhaps Metman can shed some insight into privatisation seeing as its been done a fair bit in the UK including prison escorts which one would presume is similar in terms of costs (OT, vehicles, staff, etc).

Tango Alpha 51

Elessar wrote: »

Private services are already staffed by EMTs.

Remember that under the Health Act 1970, the government has no legal obligations to provide a national ambulance service at all.

First of all not all private ambulance companies are staffed by emt's. I have met crews from one company (won't mention names publicly as last time this company was mentioned on a forum, they tried to take the owner to the high court) who turns out consisted of a driver with a first aid cert & a first responder. The area I work in has two companies subcontracted for work & the vehicles are marked identical to our own with emergency ambulance on it but again the crews would be first responder level of training with the odd offduty HSE/DFB Paramedic on board. I can proove this but have no intention of leaving myself open to be dragged through the courts.

In relation to your comment re the 1970 Health Act, the act clearly states that it is one of the functions of the old HB's to provide an ambulance service. Now since the HSE came about because of amalgamation of the old HB's then the government are obligied to provide a national ambulance service.

One of the biggest problems we face in the service is that we are grossly underfunded & understaffed. Yet the general public don't see that. Ye don't see how much we have to fight for equipment, training, vehicles, staff etc. If it wasn't for the ordinary paramedic on the ground working well in excess of most people's normal working week, there wouldn't be ambulances out there. The government like senior ambulance service management don't care & to think that people think that privatising the service would lead to better pt care etc are wrong. Most of us are trying to do the best we can for the pt with the very little resources & I do mean little available to us.

Final thought for the day, bear in mind that if ye need us & call us, we do come & it's free. No matter how much abuse etc is thrown at us. If a private company takes over, then fees etc will be charged. That is fact people. It already happens in the states where one of the routine questions asked is have you got insurance. 300 US$ per ambulance call is alot of money to pay before you even get to the hospital.

scott22

The new EMT's will have a PHECC pin number. There isnt a conversion course from EMFR to EMT, it involves 5 weeks in the NASC and a week of placements. For anyone to refer to us as first aiders is totally disrespectful.

maglite

Scott where are you getting your info

there will be a cpnvertion course, i have met EMFR's with a Phecc number, in teh form of Letter, Digit,Digit,Digit,

it wont take 5 weeks as they already have a large skill set, and its looking like 3 day placement

boomer_ie

maglite wrote: »

Scott where are you getting your info

there will be a cpnvertion course, i have met EMFR's with a Phecc number, in teh form of Letter, Digit,Digit,Digit,

it wont take 5 weeks as they already have a large skill set, and its looking like 3 day placement

Those "PHECC" numbers are organisation specific numbers and are only allowed to be used by the individual while working with that company or voluntary organisation. They do NOT place the individual on any of the PHECC registers. I cannot see PHECC being happy with a 3 day placement conversion considering the requirements for driving, placements, and the list of additional drugs over and above that carried out by the old EMFR course which was 1 week long (not 4 weeks and 2 days that you seem to think)!

maglite

i am using placement to describe, hospital rotation. that will be 3 days , heard from almost everyone i have spoken to.

can we get a split on this thread so we keep the hse stuff clear?

Lemming

I'm surprised that nobody has raised the issue of privatisation and non-profitable areas (read rural and/or deprived social areas). Private companies first and foremost place importance on earning profit for shareholders. Everything else is secondary, whatever the field of business.

And to use an apt example in Dublin Bus - the private buses that operate cherry picked the most profitable routes, leaving Dublin Bus to carry the cost of providing transport for non-profitable routes. I see privatisation of the ambulance services going the same way.

Some public services should never be privatised simply due to their essential nature. Do we really want to end up like the US medical market (and we're already half-way there through willful incompetence and mismanagement) ?. The HSE is already under heavy attack politically by counsellors, many of whom also sit on HSE sub-forums and have already quit or are threatening to walk out according to yesterday's Evening Herald.

Elessar

maglite wrote: »

i am using placement to describe, hospital rotation. that will be 3 days , heard from almost everyone i have spoken to.

can we get a split on this thread so we keep the hse stuff clear?

Scott is right. I think new EFRs have to undergo 2-3 days placements and they are kept on their organisation's register. EMTs I believe have to do the course from scratch, regardless of EFR qualification.

boomer_ie

Elessar wrote: »

Scott is right. I think new EFRs have to undergo 2-3 days placements and they are kept on their organisation's register. EMTs I believe have to do the course from scratch, regardless of EFR qualification.

EFRs are not required to do any placements to be on the EFR register (which does not as yet exist) so I dont know where this "3 day placements" for EFRs is coming from. EMT level and above are required to do placements.

If you dont believe me check the PHECC website.

remmurts

Lemming wrote: »

...should never be privatised simply due to their essential nature. Do we really want to end up like the US medical market (and we're already half-way there through willful incompetence and mismanagement) ?...

I think I'd rather get any type of emergency medical interventions in the US than in Ireland. You've been reading too much Socialist Worker if you really believe that ireland has a better medical system than the US.

Although the US system is not without its problems (most caused by government interference), you can only hope that Ireland's system "ends up like the US medical market."

sunnyjim

Really? Tomorrow morning, if I was to be hit by a car on Amien Street, I'd be picked up by 2 A+ EMTs courtesy of Dublin City Corporation. And I wouldn't have to pay!

In America, some of the Fire and Ambulance services are funded by the County/State/Government (I don't know), but we are also hearing of people paying for ambluances. Is it only the private ones that have to be paid for?

Elessar

sunnyjim wrote: »

Really? Tomorrow morning, if I was to be hit by a car on Amien Street, I'd be picked up by 2 A+ EMTs courtesy of Dublin City Corporation. And I wouldn't have to pay!

No, you would be picked up by two either EMTs or Paramedics and maybe an EMT-A if one is available. And you may, in fact, be charged.

sunnyjim

Que?

How so?

scott22

maglite wrote: »

Scott where are you getting your info

there will be a cpnvertion course, i have met EMFR's with a Phecc number, in teh form of Letter, Digit,Digit,Digit,

it wont take 5 weeks as they already have a large skill set, and its looking like 3 day placement

MY info.

Certainly no conversion course as the EMT course has to be done from scratch. I was in the first EMT class to go into the NASC last October and completed my PHECC exams last month. We had 5 weeks in the school, ICU, CCU and A&E hospital placements, 2 days placements on an emergency ambulance(min required 5 AS1 calls and record details on a PCR ) 2 days on an non-emergency ambulance(again 5 calls to be logged) PHECC do not give pin numbers to anybody under the grade of EMT, details of same can be found on the PHECC wed site

Tango Alpha 51

scott22 wrote: »

The new EMT's will have a PHECC pin number. There isnt a conversion course from EMFR to EMT, it involves 5 weeks in the NASC and a week of placements. For anyone to refer to us as first aiders is totally disrespectful.

Who refered to the new emt's as firstaiders????.


Mods,
Can we get this thread back on track. Oh just for the record, no-one has said we're going on strike. The vote was for industrial action which could be in the form of anything.

maglite

Elessar wrote: »

Scott is right. I think new EFRs have to undergo 2-3 days placements and they are kept on their organisation's register. EMTs I believe have to do the course from scratch, regardless of EFR qualification.

we are on about EMT's

Lemming

remmurts wrote: »

I think I'd rather get any type of emergency medical interventions in the US than in Ireland. You've been reading too much Socialist Worker if you really believe that ireland has a better medical system than the US.

Although the US system is not without its problems (most caused by government interference), you can only hope that Ireland's system "ends up like the US medical market."

We can only hope? Ehhhh heh ..... when the health-care system in the US is beginning to cripple even fortune 500 companies due to the costs of providing employees with cover since they would struggle to afford it other wise, it's time to reassess the state of play.

I don't read the socialist worker. I do however keep an eye on several different news sources ranging from the tongue-in-cheek-whilst-making-valid-points to the completely humorless across both Europe and N.America, and elsewhere occasionally too. The US system is rapidly appearing to become unsustainable, and indeed I recall one poignant article (to make a point) written mid-last year by a BBC journalist about a friend of his who had medical cover for years and when he needed it due to developing a serious and debilitating condition .... he had to fight tooth and nail to get the support he paid for for years. Indeed every year the medical insurance folks would ask him if he wasn't sure he'd like to terminate his policy knowing full well it'd be the end of him (literally) ...

You are also putting words into my mouth by claiming that I said Ireland had a better health-care system. We don't. We have an equally f*cked up health-care system, albeit from a different perspective. Both the US & Irish health-care systems have one thing in common; if you have an abundance of money you *should* be fine.

No, we have a shameful sytem; I speak from personal experience watching loved ones get f*cked over by the system they paid into for years in medical insurance, and from professional dealings with the HSE.

Traumadoc

The GDP cost for healthcare in the US is twice the Irish cost, while the yearly cost for a family of 4 in New York would be about $10,000.
I agree the quality of healthcare in the US is superb , but it comes at a price. Many people rely on company subsidies and could not afford it otherwise.

Elessar

buzzman wrote: »

In relation to your comment re the 1970 Health Act, the act clearly states that it is one of the functions of the old HB's to provide an ambulance service. Now since the HSE came about because of amalgamation of the old HB's then the government are obligied to provide a national ambulance service.

There is no absolutely legal obligation on the government to provide an ambulance service. Read the Health Act again and see the link below for more confirmation. They do not have to provide a National Ambulance Service, and may privatise if they wish.

sunnyjim wrote: »

Que?

How so?

http://www.citizensinformation.ie/categories/health/emergency-health-services/ambulance_and_transport_services

People seem to think that healthcare is free in Ireland. But you are/can be charged for everything, without insurance.

Anyway back on topic, having heard the arguments I still think the country would be better off with a privatised service. The current NAS is a closed system and even the DFB haven't got enough ambulances - they both do a great job, though if the government wanted to bring more privatisation in I would be in support of it.

Paulzx

Elessar wrote: »

No, you would be picked up by two either EMTs or Paramedics and maybe an EMT-A if one is available. And you may, in fact, be charged.

You will never be charged when picked up by a dfb ambulance. The a+e will charge you 60 euro for attendance which has nothing to do with coming in by ambo.

Where you got your info that "you may, in fact be charged" is beyond me. It is complete rubbish and factually incorrect

Elessar

Paulzx wrote: »

You will never be charged when picked up by a dfb ambulance. The a+e will charge you 60 euro for attendance which has nothing to do with coming in by ambo.

Where you got your info that "you may, in fact be charged" is beyond me. It is complete rubbish and factually incorrect

Read the citizens information link I posted above.

"Unless you have a medical card, you may be charged for ambulance services"

Backup your statements with proof before you go off on a rant.

I think we all need to get back on topic.

Paulzx

Firstly, a two line reply to an incorrect post is not a rant. I am entitled to correct inaccurate info that you have posted in order for other readers to receive correct info

Have you actually read the info on your link correctly?. It states that non medical card holders may be charged for ambo in non emergency transport cases

" For non-emergencies, the use of an ambulance is usually a medical decision. In general, people who do not have medical cards may be charged for the service. The practice varies between the HSE and charges may be waived in certain cases (i.e., hardship), etc. "


The original post on this topic gave the example of a 999 ambo case in Amiens street and my reply is perfectly accurate in reference to this

I don't know whether you work in emergency services but i know of no situation were a patient has been billed for an ambualnce in a 999 situation

I would be very surprised if this was any different outside of the area i work

And by the way, this is not a rant but a statement of the situation as i see it

Tango Alpha 51

Elessar wrote: »

There is no absolutely legal obligation on the government to provide an ambulance service. Read the Health Act again and see the link below for more confirmation. They do not have to provide a National Ambulance Service, and may privatise if they wish.



http://www.citizensinformation.ie/categories/health/emergency-health-services/ambulance_and_transport_services

People seem to think that healthcare is free in Ireland. But you are/can be charged for everything, without insurance.

Anyway back on topic, having heard the arguments I still think the country would be better off with a privatised service. The current NAS is a closed system and even the DFB haven't got enough ambulances - they both do a great job, though if the government wanted to bring more privatisation in I would be in support of it.

Having looked at this link, it's clear that no where in this link does it back up your statement's either. I'm not getting into a tit for tat argument. Do you work for either the HSE NAS of DFB. I've clearly stated what I am. NAS is not a closed shop but the government don't deem us as a priorty when it comes to recruitment. Privatisation doesn't equate to a better service. I'm not saying we're perfect but us & the DFB do the best we can, using the limited resources available to us. I know that who I'd want coming to treat me & mine. And just for the record you don't get charged for an ambulance when you dial 999. As the OP stated you will get charged by the ED for attendance. However if privatisation comes in, then you will be charged everytime you call an ambulance.....

timmywex

put it this way, if the gardai were to be privatised, there would be public outcry, the ambulance service faces a similar situation, but people only seem to care about the ambulance service when they have to dial 999, if the people dont get behind this, they will soon realise that they get a big bill in the door for an ambulance if privatisation goes ahead

Traumadoc

Paulzx wrote: »

You will never be charged when picked up by a dfb ambulance. The a+e will charge you 60 euro for attendance which has nothing to do with coming in by ambo.

Where you got your info that "you may, in fact be charged" is beyond me. It is complete rubbish and factually incorrect

They already bill the insurance companies for transfer of emergency cases between hospitals- I know because I sign the insurance forms. Its no great step from that to charging for emergency pickup. Your statement "you will never be charged" is incorrect.

remmurts

Is the 999 ambulance service being abused by the public? Are they calling for non-emergencies? Is it being used as a taxi service to the A&E? Do they think they will be seen more quickly if they arrive by ambo?

Paulzx

Traumadoc wrote: »

They already bill the insurance companies for transfer of emergency cases between hospitals- I know because I sign the insurance forms. Its no great step from that to charging for emergency pickup. Your statement "you will never be charged" is incorrect.

When i say you will never be charged i am talking about the situation at present. Maybe my grammar was incorrect but i can state for a fact that dfb do not charge for 999 ambo cases. If you can find any different i'd love to know where the money is going

What happens in the future is way above my pay grade

Paulzx

remmurts wrote: »

Is the 999 ambulance service being abused by the public? Are they calling for non-emergencies? Is it being used as a taxi service to the A&E? Do they think they will be seen more quickly if they arrive by ambo?

Yes it is being abused

Yes it is being used as a taxi service.

Yes, people think they will be seen quicker. It is often said to us by the patient that they have rang an ambo in order to be seen quicker. They are quickly informed that this is a myth and normally end up straight out to the waiting room after handover if their condition is minor

Traumadoc

Paulzx wrote: »

When i say you will never be charged i am talking about the situation at present. Maybe my grammar was incorrect but i can state for a fact that dfb do not charge for 999 ambo cases. If you can find any different i'd love to know where the money is going

What happens in the future is way above my pay grade

Im sure they will go down the Australian route where you are billed for the call out - your insurance usually covers it, if you are too poor the government insurance scheme (medicare) pays it.

Tango Alpha 51

Traumadoc wrote: »

They already bill the insurance companies for transfer of emergency cases between hospitals- I know because I sign the insurance forms. Its no great step from that to charging for emergency pickup. Your statement "you will never be charged" is incorrect.

TraumaDoc,
Your right in when you say that people are charged for intra hospital transfers (private patient's). The thing is the HSE charge the pt not the National Ambulance Service. Medical card holders are not charged. Emergency callouts to the ambulance service be it HSE of DFB are not charged for anyone. Being charged for an ambulance after dialing 999 for the majority of calls would be wrong.

Remmurts,
Like Paulzx has already stated ( & he's coming from a DFB point of view inrelation to the ambulance service), the 999 system is most definitely being abused all be it by a minority of people. Yes it's being used as a taxi service. And people do think that by calling an ambo that they will leap frog everybody else in the ED but like Paul has said we to tell them that's it's only a myth & they soon learn the error of their ways.

Unfortunately you still get the same stupid calls from the regulars. At the end of the day, they are patients like everyone else but they do tie up the scarce number of ambulances that are on duty at any given time of the day.

The general public really have no idea what we & our colleagues in the DFB have to face every day. All people see is us flying around on blue lights & sirens & they think, that's a cool job to have.

Before I get totally off topic all together, a small point that the public aren't aware of. When we drive on blue lights & sirens we drive on our own private driving licences. If we crash for whatever reason & because of the nature of the job we have to drive through red lights/ cross over the white lines in the road etc, the Gardai could do us for careless/dangerous driving even if it wasn't our fault. We in turn get points on the licence resulting in our own private car insurance going up.

I love my career & wouldn't change it for anything but the public need to know all the pros & cons re the job.

Privatisation will result in a poorer level of care being afforded to the pt because every call will come down to getting the most profit out of it, it's as simple as that.

Mrs OBumble

You folks seem to have difficulty distinguishing between Ownership (govt vs private) and Funding Source (taxpayer vs individual patient).

Yup, that's right, it's "taxpayer" - the government, the DCC, the DFA, the HSE .. whover .. don't have any money of their own - all they have, they get from the taxpayers. Who ultimately are the patients. The only difference is whether the money is taken from patients on an individual level at the time they need the service vs taken from them in a small drip-fed way every payday. The latter is more efficient, the former discourages people from abusing the service and does tend to improve the standard of service (since staff aren't so quick to write off paying customers as they are members of the public).

You also need to distinguish between for-profit and private: there are many non-government-owned organisations that are not profit making, particularly in the heath sector. What's more, a non-govt-organisation isn't hamstrung by government employment conditions and inefficiencies, so can generally deliver far more service for the same money.

And finally, given the congested goat-tracks that pass for roads in much of this country, it's appalling that there's not an emergency helicopter service in place. Someone who's been in a major road accident really really does not want to spend an hour in an ambulance only end up in a general hosptial in Mallow or Drogheda or Kilkenny, where the emergency specialists might see only a few major trauma cases in a year. It will take a lot of capital to put a service like this in place, so private sector involvement is necessary. But if Ireland wants to be considered as a first-world country, it really needs to happen.

Traumadoc

My experience is that there are far more polytraumas coming into the rural general hospitals than into the big dublin hospitals. Naas general would see far more trauma than Tallaght for example. I have worked with a helicopter retrieval service overseas and it was rarely used for the roadside evacuation of trauma cases as it was generally quicker to transfer by ambulance. The same would be true for Ireland.

Paulzx

I agree with traumadoc on the helicopter issue. The huge costs invlved would be better off used to bring the existing ambo service especially in rural areas up to a decent standard.

As it stands the air corps is available for inter hospital transfers and has formal service level agreements with some hospitals.

As regards having helicopters on standby there are very few occasions when they would be of benefit. We do not live in a country with thousands of miles of area. At the moment if you were to have a serious accudent somewhere extremely rural on the western seaboard which was inaccesible by road i'm sure the coastguard will be quite happy to task one of their 4 helis if requested. This might not be the ideal situation but to me is a valid use of an existing state resource