2026-01-14

I thank the Cathaoirleach Gníomhach and the Ceann Comhairle for the opportunity to raise this important issue. During the Christmas period, a young person in my constituency had an asthma attack. The rapid response vehicle, RRV, arrived and the advanced paramedic on the RRV saved his life, and of that there is no doubt. I say that because we have had a continuing issue in County Roscommon. I think this is my seventh time to raise it in the House. The rapid response vehicle promised to the people of Roscommon on the closure of the accident and emergency department back in 2011 and had been in place perfectly since then is being quietly downgraded. The RRV is now no longer available 24-7 as was promised. That is the first issue. It is being parked up on Mondays from 8 p.m. to 8 a.m. I presume this is saving the National Ambulance Service, NAS, a few euro every week. However, it is also putting the lives of people of County Roscommon in grave danger. I do not say that lightly. There is a significant difference between what a paramedic can do in an emergency and what an advanced paramedic can do in an emergency. I will take an asthma attack as an example. The advanced paramedic can administer intravenous, IV, steroids, magnesium sulfate, paracetamol and antibiotics. A paramedic cannot administer any of those intravenously. In a sepsis case, which are sadly increasing, the advanced paramedic can give the IV antibiotics and the IV fluids, whereas a paramedic cannot. Another example, which again, sadly, is common, is cardiac arrest. In such cases, the advanced paramedic can administer the drug that is needed quickly, insert the advanced airway incubation and administer IV fluids. A paramedic cannot do any of that. We have two issues in Roscommon. One is that the NAS is trying to save money by parking up the rapid response vehicle every Monday night. The family of the young man in question have told me that if he had had an asthma attack on a Monday night, he would not be alive today. That is not acceptable for my community and county in any way, shape or form. The other issue we have, one I have raised with the Taoiseach and repeatedly with the director of the National Ambulance Service, is that a paramedic is being used on the rapid response vehicle far too often. Paramedics are filling the role of an advanced paramedic because the National Ambulance Service has failed to have a full roster of advanced paramedics. I do not believe the NAS has made enough effort to fill that line. For example, we have had cases of cardiac arrest and heart attack where a paramedic rather than an advanced paramedic is on the rapid response vehicle instead and cannot do what is needed to save the person's life. We recently had two cases involving a heart attack and cardiac arrest. Frankly, I am getting sick and tired of raising this issue. I am not someone who comes into the Chamber and shouts and roars, but this issue is of the utmost importance. People's lives are being put at risk. I am really concerned that this continues. We need the rapid response vehicle on a 24-7 basis. I know the NAS issued an action card for the rapid response vehicle in Ennis and in Nenagh hospitals to ensure the vehicle is protected. That is not in place in Roscommon. I do not know why that is the case given that Roscommon hospital, like Ennis and Nenagh, lost its accident and emergency department. I want that same protection put in place for County Roscommon. The other point to make is that we are training community paramedics who are finding themselves doing the role of advanced paramedics when they are not available. This is a waste of time. We need the rapid response vehicle on a 24-7 basis in County Roscommon to ensure we can keep people alive.

I thank the Deputy for raising this important issue in relation to having a rapid response vehicle on a 24-7 basis in County Roscommon. I acknowledge that the Deputy has been continuously raising this issue and advocating in relation to advanced paramedics. By way of background, as the Deputy well knows, the National Ambulance Service serves County Roscommon out of three bases located in Roscommon, Boyle and Loughglinn, which all operate on a 24-7 basis. All three bases are staffed by a highly skilled workforce of pre-hospital emergency care practitioners, including paramedics, advanced paramedics and emergency medical technicians. In addition, the National Ambulance Service operates a modern fleet of emergency ambulances, intermediate care vehicles and rapid response vehicles from these bases. Turning to the specific issue, I am aware that this topic has been raised by the Deputy, as I said, on a number of occasions. The National Ambulance Service operates two rosters at its Roscommon ambulance bases, one for the operation of a rapid response vehicle and the other for emergency ambulances. The RRV roster has four paramedic posts and there have been two vacancies on this roster. The National Ambulance Service made repeated attempts to fill these vacancies in 2025 through its national transfer process. I am informed these attempts have been unsuccessful and the National Ambulance Service will continue efforts in 2026 to fill these vacancies. This is not about trying to save a few euro or trying to save money. The NAS is actively trying to recruit into this role and will continue to do so. I am also informed by the National Ambulance Service that the rapid response vehicle in Roscommon is currently rostered on a 24-hour basis, six days per week and on a 12-hour basis on Thursday nights. I understand that the daytime shift on Thursday is covered by available emergency resources in the region and the rapid response vehicle from surrounding areas. Roscommon also benefits from the emergency aeromedical service operated by the National Ambulance Service in conjunction with the Irish Air Corps, as well as additional aeromedical support provided by the Irish Coast Guard in the region on an as available basis for its bases in Sligo and Shannon. I can also update that the HSE is progressing plans to establish a new National Ambulance Service helicopter air ambulance service this year, which will predominantly serve the west and north west. This service will be particularly beneficial in providing additional emergency coverage to patients in County Roscommon. As well as front-line urgent and emergency care, the National Ambulance Service is a vital partner in the development and expansion of a range of clinically appropriate alternative care pathways to improve patient flow and reduce pressure on emergency departments. However, I take on board the point the Deputy made in sharing the story about a young man who had an asthma attack. I thank her for sharing that and his family for allowing her to do so. It points to the fact that if that service had not been available, the outcome may not have been what we would have wanted it to be. I am taking this question on behalf of the Minister, Deputy Jennifer Carroll MacNeill, and I will certainly feed back to the Minister the Deputy's concerns, especially the point she made about paramedics filling in for advanced paramedics. For the record, I asked for a breakdown on NAS clinical staffing in County Roscommon. The total number of paramedics, including six advanced paramedics, is 21. There are two paramedic supervisors and six emergency medical technicians. That amounts to 29 staff currently in place. I will speak to the Minister about the 12-hour period and the issue of paramedics filling in for advanced paramedics.

I want to be clear on the issue of the rapid response vehicle being parked up. This was done on Thursdays but I now understand it is done on Monday nights for 12 hours. The RRV is not being parked up because efforts to get an advanced paramedic have not been successful, whatever those efforts may be. That is not the reason because a paramedic is provided on the RRV every other day and night of the week. I believe it is being parked up as a cost-saving measure. If not, I do not know what the reason is. It is not because an advanced paramedic is not available because every other day of the week the service provides a paramedic quite happily. This should not be happening. In relation to the efforts being made to fill the four places on the advanced paramedic roster, which is the nub of the issue here, if an action card was issued - action cards are in place for Nenagh and Ennis hospitals - it would give a guarantee to anyone who is willing to go on the roster as an advanced paramedic. The reason people are not willing to carry out that role is that they afraid they are going to be pulled onto the air ambulance or moved elsewhere, as has happened. I do not know why County Roscommon does not have the action card to protect the rapid response vehicle. If we had an action card, it would give some comfort to an advanced paramedic to then decide to make the leap and take this role. I reinforce that point in relation to the action card. There is no reason the people of County Roscommon should not have the same protection as other places that are without an accident and emergency department. Of course, we are further from an accident and emergency department. That is why the rapid response vehicle is so important. I reiterate that lives are being put at risk in cases of cardiac arrest, heart attack, asthma attack and sepsis. This is happening in Roscommon, as I know from the coalface. I cannot and will not stand over a situation where people in my home county of Roscommon have their lives put at risk. I want this issue dealt with once and for all. I want the action card issued, the rapid response vehicle protected and the advanced paramedic and RRV provided on a 24-7 basis, as Fine Gael, the Government and the HSE promised the people of Roscommon in 2011.

I thank the Deputy for articulating the current situation in County Roscommon. The Deputy referred to people being put at risk. When anybody makes a 999 call looking for an ambulance, the call is triaged in relation to how serious the situation is, for example, whether it is a cardiac case, stroke, a broken limb, a fall or whatever else. The first response from the National Ambulance Service is always to triage and respond to the most critical incident first. It is important that anybody tuning in to this debate hears that. The Deputy said lives are being put at risk because the service is not available for 12 hours during the week. It is important to say, however, that all calls are triaged appropriately. Almost 30,000 patients were treated in the first six months of last year alone through a National Ambulance Service alternative care pathway, which is also important, with 40% of these patients not requiring subsequent conveyance. The Deputy is speaking about the emergencies that arise and the challenge that arises for patients and their families. I reiterate two points. In relation to the action card, which the Deputy said has been issued in two other counties but not in Roscommon, I will bring that point back. I reiterate also that I have been advised that the National Ambulance Service will continue efforts in 2026 to address the vacancies identified in Roscommon. I thank the Deputy again for raising this extremely important matter.