[Article] Girl's transplant hopes dashed

Vorsprung

A 14-year-old Leitrim girl missed a liver transplant at the weekend because of a failure by State agencies to arrange for her to be airlifted to a London hospital on time.

The Health Service Executive and the Department of Transport gave different accounts last night of when the Coast Guard was first informed that an airlift was needed.

Maedhbh McGivern from Ballinamore was about to board a Coast Guard helicopter at Strandhill airport in Co Sligo on Saturday night when she and her parents, Joe and Assumpta, were informed they would not make it to King’s College Hospital London before the 2am deadline yesterday morning.

The family had been informed by the hospital that the transplant would need to take place quickly because the donation liver belonged to a “non-breathing” donor.

In a statement last night the HSE said that it contacted the Coast Guard at “20.08hrs” on Saturday to request an aircraft “on a priority level 1 call. The Coast Guard advised that they had no aircraft available,” it said.

At “approximately 10pm” the Coast Guard contacted them to say an aircraft was available in Sligo and the patient should be brought there. The HSE statement continued that when the McGivern family arrived in Sligo “they were advised by the Coast Guard crew that the flight time would be up to 4 hours”. This was relayed to the London hospital, which “advised that this would be outside of the time window available to carry out the surgery”.

However, a statement from the Department of Transport last night said the Coast Guard received the request from HSE Ambulance Control at the later time of “20:50pm” on Saturday. This was 42 minutes later than the HSE said it first contacted them.

The department said it “tasked the Sligo-based Coast Guard helicopter to carry out the mission . . . Journey time from Sligo airport to Heathrow is approximately 3.5 hours”. At “22:49pm” the Coast Guard was told the airlift had been cancelled “as the shelf-life of the donor liver was exceeded, taking into account the travel time”.

Coast Guard crew at Sligo airport told the McGivern family they had been available all evening, and that no one had contacted them.

Linky

Pretty tragic turn of events for this young girl, hopefully another suitable liver will come along soon.

The priority here has to be to make sure it doesn't happen again, but there needs to be accountability. Something has obviously seriously gone wrong here and from the 2 different versions of the story, both parties think they're right, or someone knows they're wrong and have seriously messed up. If that's the case, heads should roll. Being Ireland, I wonder whether this will happen.

Does anyone know what the usual procedure is for such cases? Is there a clear protocol for organising such flights?

MagicSean

It will be interesting to see the result of any enquiry if it is made public. In my opinion it highlights a crazy situation within the public sector where we have too many managers yet never seem to have anyone to take responsability for a situation. Things tend to fall on the lower level workers to sort out. The only contact the patient received was from the London transplant coordinator. I think the father has every right to be angry.

Klunk001

Judging by the distance and the short time frame available, a fast fixed wing asset would have been the better option.

Trotter

Given the failsafe system the coast guard helicopter centres use, I have no doubt that they would have had the girl in the air quickly after receiving the tasking.. even if that meant the Shannon helicopter had to take the task. If the Sligo heli was under minor maintenance for a few hours, it would be covered by Shannon anyway I imagine.

Lapin

Klunk001 wrote: »

Judging by the distance and the short time frame available, a fast fixed wing asset would have been the better option.

I would have thought so too.

Are there no such aircraft available on standby in Baldonnel for such an occurance ? If not why not ?

Its somewhat ironic that it was Sligo Airport that Mary Harney flew into some years ago in an Air Corps Casa aircraft from Baldonnel to open an off licence in the north west.

punchdrunk

the way I see it here is as follows,the air corps jet was in Monaco with the President at the royal wedding,(this is currently the primary asset used to fly patients to the UK) our other government jet is older and has reliability issues-i.e it wasn't prepped and ready to be used for air ambulance work
so there was one air corps asset (a helicopter) left on-call to cover the country
and by chance this was responding to another patient transfer when the call came.

the coastguard are our primary emergency response asset,the role of Air-Ambulance is secondary to this role and is only possible when they are tasked to carry out the job by the HSE.if the HSE don't request MRCC (the Marine Rescue Co-ordination Centre) to do the job then it can't be done as it's the Coastguards decision to take a base like Sligo off-line while the chopper is away,not the crews decision

helicopters (from either organisation) are not ideal for flights to the UK as they are far slower than the Lear Jet,but the crews of either Heli would have responded if tasked and able;I'm 100% sure of this.

somebody in the HSE took far to long to realise that the Air Corps didn't have the assets available to do the job and should have

A: either reacted quickly and tasked the coastguard to do it so they would have had adequate time to prepare(I imagine they would have had to remove resuce kit from the chopper to lighten it as Sligo to London would be stretching the range of the S-61),or

B: gotten a private air ambulance company with a Jet to do it

simply put the Air Corps are too over stretched to do this job
if the Government aren't willing to give them the assets to do the job properly then it's time to out source Air Ambulance to the private sector
if we only currently have one serviceable Jet then it can't double job as State Taxi and Air-ambulance-it's simply not feasible
if the back-up wasn't there then Mary should have flown on a charter plane

I'll say it again,if either organisation's Helicopter Captain had taken the call and been in a position to do the job (i.e not already on another task) then they would have had blades turning within the hour.there's no doubt in my mind of that fact

on the facts available so far,it would seem the government have been caught with their pants down again-being too cheap to maintain a proper level of service and tying the hands of the people who have to try to do the job by giving them no contingency at all
"plan for the worst-hope for the best"
yet again we see that a token service is not up to the job,and relying on another department's assets to dig them out of a hole doesn't always work
either give the role to CHC (and pay them for it) or equip the Air Corp to do the job to a level the public deserve

it also seems to me that unfortunately somebody in the HSE ambulance control has ****ed up in realising what assets they did or didn't have,and then took too long in making the right call

Buffman

The minister has appologised and HIQA is investigating.

http://www.rte.ie/news/2011/0704/health.html

This transfer was apparently supposed to be co-ordinated by a private company on contract to the HSE, so for me the main question is what was their role in this.

The air transfer was co-ordinated by a private company, Emergency Medical Support Services, contracted by Our Lady's Children's Hospital in Crumlin.
EMSS said it could not comment on the case because of patient confidentiality and the hospital was not available for comment.

Also, the Air Corp offered a Gulfstream jet from 10.30pm. This offer was declined, so we don't know if this jet would have been able to refuel, collect the patient at any available Western airport, and get to London by 02.00.

The Air Corps says it offered the use of a G4 fixed-wing air ambulance, due to land in Baldonnel at 10.30pm, but this offer was declined.

There is also a private Air Ambulance available out of Weston, though I don't know if they have any arrangements with the HSE.

In fairness to the Coastguard, they always help when the can, and very recently did a similar transfer, but they are not an Air Ambulance and I don't think it's fair they should be used as one. IMO the Sikorsky's are not the most suitable aircraft for doing long range patient transfers and we lose one of our few Search and Rescue assets while it's out of the country.

dixiefly

Govt jet unavailable because it was ferrying Mary mcAleese back from the important duty of attending Prince Albert of Monaco's wedding!

stevie06

According to RTE, it appears that the Aer Corp had a Fixed wing asset available at 1030pm, but it was declined by the HSE, prob due to the fact that the family were in Sligo at the time.

its a shame that this girl couldn't get to London in time!

punchdrunk

if somebody had coordinated a HSE ambulance to get her to sligo (or even the father to drve to sligo airport),the sligo chopper then to fly her to Baldonel they could have had the Gulfstream ready to go and gotten airborn in time

such a shame :mad:

Absurdum

It was unfortunate and it may be insensitive to say this, but remaining in the middle of nowhere (rural Leitrim) when you know that you may get a call at anytime to get over to London ASAP was not a good idea, the family could have been assisted in temporarily relocating to either Dublin or London when she was placed on the priority list.

dixiefly

Absurdum wrote: »

It was unfortunate and it may be insensitive to say this, but remaining in the middle of nowhere (rural Leitrim) when you know that you may get a call at anytime to get over to London ASAP was not a good idea, the family could have been assisted in temporarily relocating to either Dublin or London when she was placed on the priority list.

That thought had crossed my mind but there is no indication as to when the liver could become available and , in fairness, this issue hasnt previously arisen so there was no prior indication that this could happen. They might rethink this now.

Paulzx

The girl could be waiting years for a transplant so temporarily moving to Dublin is not an option. Anyway, her geographic location had feck all to do with the clusterf&*k that has just occured.


A pertinant question for me is .........why has the HSE outsourced coordination of its patient movements to a private company, namely EMSS?

What is the reason for this? What benifet is there?

It seems rather simple to have a set protocol for incidents of this nature using Ambulance control as the coordinating body.

Call comes in

1.. Ring first body on our protocol list. Air Corps with either heli or fixed wing.
Inform them of time contstraints. Get answer. Yes or NO

2...Ring next body...ie MRCC. Inform of time constraints. Get answer. Yes or
No.


Make decision. If nothing available start on previous drawn up list of private air operators and/or RAF


Not exactly bloody rocket science. So why do we have another body i.e EMSS in the loop to complicate things?

Buffman

Paulzx wrote: »

A pertinant question for me is .........why has the HSE outsourced coordination of its patient movements to a private company, namely EMSS?

What is the reason for this? What benifet is there?

Ye, this is the main thing I'd be wondering too. Having looked at their website, it seems to suggest it's a one stop shop for patient transport.

E.M.S.S was established to provide Emergency Medical Team Transport within Ireland and to co-ordinate any transport services required outside the country especially in the U .K and Europe. Our primary role is in the transport of Transplant Teams for organ retrieval and also the return of the team and organ to the Transplant Unit.
When required unaccompanied Organ Transport is provided, for example, if the organ is being flown either in or out of the country and the handover point is one of the Airports, or indeed collection from the airport for delivery to the transplant teams hospital base.

To offer the service EMSS seem to be offering, they would require a fixed-wing air ambulance on standby somewhere in the British Isles, which could then reach most parts of the UK or Ireland and return within a reasonable time. Yet when push comes to shove it seems to fall back on the HSE to organise everything. So the question has to be, what is EMSS's role in the process?

xper

Paulzx wrote: »

It seems rather simple to have a set protocol for incidents of this nature using Ambulance control as the coordinating body.

Call comes in

1.. Ring first body on our protocol list. Air Corps with either heli or fixed wing.
Inform them of time contstraints. Get answer. Yes or NO

2...Ring next body...ie MRCC. Inform of time constraints. Get answer. Yes or
No.

The problem might have been that that was exactly the protocol rigidly adhered to and the answer to the question "Can you transfer a patient from Sligo to London in the next couple of hours?" from each agency individually was, correctly, "No" whereas it seems to have emerged that if the Coastguard had gotten her from Sligo to Baldonnel, the Air Corps Gulfstream would have been back and been available to get her to Heathrow before midnight.

Was it thus a failure to co-ordinate thinly spread assets rather than an absolute lack of assets? If you are not prepared/able to provide dedicated assets for this service then you've got to prioritise and utilise shared resources and ensure one of the pooled resources is availabe all the time. Is there an option 3, 4 and 5 on that protocol? And someone has to have the knowledge and authority to co-ordinate all this. Hopefully the enquiry to come will make a genuine effort to establish the problem and propose a fix.

I am sure everyone involved, the Sligo Coastguard crew, the staff at Baldonnel and the control centre staff feel pretty gutted today. Some of the shriller, largely ill-informed commentary I've heard on the radio throughout today from presenters and public won't have helped. And I can't even begin to imagine how the family involved feel.

savagecabbages

My take on things from reading & hearing bits and pieces in the media is that the EMSS aircraft encountered mechanical difficulties at the last minute.
The HSE probably did call upon number one on the list and got a yes. That only turned to a no once the mechanical difficulties were encountered. Maybe the other assets hadn't been initially alerted because EMSS were performing the mission.

Looks like they were cutting it fine once they got the ball rolling for the second time...
The report will clear it all up for us.

Delancey

Whats the bet that the report if/when it's published will be peppered throughout with phrases like '' systemic failure '' , '' communication breakdown '' , '' failure to grasp the seriousness of the situation , etc '' but will not name a single individual ?

This is Ireland - we don't 'do' accountability here :mad:

joegriffinjnr

Ok folks I admit I know feck all about the operation side of this but are you trying to tell me that We could not get a young girl living in Ballinamore at 20:10 to London by 02:00 for a life saving operation? If so what sort of **** hole of a country is this getting?? How many helicopters and planes are sitting around at that time of night. When a little girl needs a life saving operating EVERY thing that could be used should be used. Even a RYANAIR 737 FFS. Who cares how much it will cost , this is a young girls life were talking about here. Piss up and Brewery comes to mind. Stop playing with peoples lives and just get the bloody job done.

bob50

Ok folks firstly i dont know a whole lot about air assets But.. just to say the young girl lives in Ballinamore Co leitrim not too far from the border

I would have tought the coordinators might have an agreement with the RAF in the North they have Sea Kings reguarly in use coming over to our east coast from Holyhead and helping out in sea / mountain rescue missions etc and i would imagine they would have bases in the north

Hope she gets a liver transplant soon

punchdrunk

Joe there was plenty of aircraft available,but the problem doesn't rest with them,it's the structure put in place to tell them to go and do the job
Captains can't task themselves on a job-they have to be ordered to respond and it would seem that the command and control side of issuing the tasking failed miserably

unfortunately this looks more and more like a case of the HSE strikes again!
I agree it's simply not good enough in this day and age

punchdrunk

Bob strangely enough,the RAF withdrew it's wessex aircraft from Aldergrove about ten years ago,very often it's us now doing rescues off the northern coast

Paulzx

bob50 wrote: »

Ok folks firstly i dont know a whole lot about air assets But.. just to say the young girl lives in Ballinamore Co leitrim not too far from the border

I would have tought the coordinators might have an agreement with the RAF in the North they have Sea Kings reguarly in use coming over to our east coast from Holyhead and helping out in sea / mountain rescue missions etc and i would imagine they would have bases in the north

Hope she gets a liver transplant soon

There are no RAF or Royal Navy search and rescue assets based in Northern Ireland anymore. Ulster is covered by the assets in the Republic and from Scotland.



Ireland is actually pretty well covered in terms of SAR with the 4 bases in Dublin, Waterford, Sligo and Shannon.

It was unfortunate that the Air Corps were already on an air ambulance mission from Kerry.

The problem was not a lack of assets or unwillingness on the part of crews in the Air corps or Coastguard.
The problem was a lack of proper command and control of the situation with one office/agency controlling what was going on. Between the HSE, EMSS and possibly(we don't know yet) crossed communications to the MRCC on what exactly was required we have ended up with a disaster whilst perfectly servicable aircraft stayed on the ground.

God love the family involved.

bob50

punchdrunk wrote: »

Bob strangely enough,the RAF withdrew it's wessex aircraft from Aldergrove about ten years ago,very often it's us now doing rescues off the northern coast

Punchdrunk forgot yes you are correct we now carry out and assists with North rescues I think we also might assist the welsh coast if we have availabilty

ted1

Did they try aer lingus or ryanair. Why the need for an air ambulance?

Moneygall

Sounds like a complete HSE cockup.
In fact from personal observation 3 small private jets sat on the apron of Enniskillen Airport over the weekend , only 25 miles from Ballinamore

stevie06

From RTE Today,

The private company, involved in making the unsuccessful arrangements for Meadhbh McGivern to travel to London for a liver transplant on Saturday night, has said it was never told the organ involved was a non-living donation and found this out through newspaper reports yesterday.
In a second statement, issued last night, Emergency Medical Support Services said the Coast Guard helicopter, which was unavailable, was one of four normally available around the country and after a specific question was put by the EMSS Duty Controller in relation to the Sligo-based helicopter, it took nearly one hour to get sanction from Coast Guard officials to use it.
However, the statement said that 'at no point was there a mention of the flying time of four hours to London Heathrow not to mention two refuelling stops.'
EMSS said that had those who knew that there was a non-living donor involved declared this sooner, the Coast Guard helicopter would not have even been an option as Our Lady's Children's Hospital Crumlin had themselves sourced a private aircraft form the UK to come into Dublin airport to collect the family.
This resource was stood down when the Coast Guard Helicopter was made available.
Meadhbh McGivern's father Joe has said the Coast Guard crew in Sligo told him they had been at their base all evening and were not contacted.
In response to this, EMSS said the Coast Guard did not offer the Sligo helicopter as an option at 8pm 'but had they offered one of the remaining three helicopters potentially available then perhaps we may have had a better outcome to this incident'.
In relation to suggestions that the Aer Corps aircraft on Presidential duty in Monaco could have returned to perform the transfer, EMSS said that it had absolutely no contact with the Aer Corps in relation to transport and all these communications are routed thorugh HSE Ambulance Control as per HSE protocol.

seems like nobody wants to step up and take the blame for this one!

surely common sense would dictate that a jet would be faster/more comfortable than a helo!
unless the person in EMSS grew up watching Airwolf!

god knows why they canceled a jet over the coastguard.......... the coastguard isn't an air ambulance, they are there for SAR cover, if they are off station then the SAR cover is limited until they are back.

very strange....................

Buffman

stevie06 wrote: »

seems like nobody wants to step up and take the blame for this one!

surely common sense would dictate that a jet would be faster/more comfortable than a helo!
unless the person in EMSS grew up watching Airwolf!

god knows why they canceled a jet over the coastguard.......... the coastguard isn't an air ambulance, they are there for SAR cover, if they are off station then the SAR cover is limited until they are back.

very strange....................

Ye, I saw that on RTE aswell and it wouldn't inspire my confidence in EMSS. I would have thought one of the first question's asked when they get the transplant call is 'what is time time limit?'

And as for cancelling the private aircfart when the Coast Guard Sikorsky was made available, the mind boggles. This Sikorsky should only be used as an emergency last resort IMO.

The more I hear about this the more I fail to see the need for EMSS to be involved in the process at all.

carveone

stevie06 wrote: »

From RTE Today,

surely common sense would dictate that a jet would be faster/more comfortable than a helo!
unless the person in EMSS grew up watching Airwolf!

Oh god, that's exactly what I was thinking this morning
A heli is comparatively so slow it isn't even funny. 130 knots or so. Compared to a Learjet at 400 knots (point to point distance from Sligo to Gatwick is roughly 400 miles). The considerable advantage a heli has is, of course, terrain. But they still asked the patient to drive to Sligo airport. None of that makes sense.

There are lots of aircraft around in Ireland, private and commercial including turbines. But you really need a Learjet in cases like this.

I don't wish to be the one with 20:20 hindsight but there is a Ryanair jet scheduled from SNN to STN at 21:40 on a Sunday. Arrives in Stansted at 23:00. Ryanair would have been only too happy to take her. I've made it from Brighton to North county dublin, on Aer Lingus standby, in less than 4 hours.

None of this is being really helpful, but there was no technical reason why this had to happen, it was people in the way.

Delancey

Elephant in the room question : Where was the Government jet ?

Paulzx

Delancey wrote: »

Elephant in the room question : Where was the Government jet ?

The government jet was offered

Klunk001

Government jets, there are two of them. One fitted for air ambulance, in this case I believe the patient could walk on and use a seat.
Also 2 Casa aircraft that are used from time to time for this type of thing.
Were they offered in time?