Meet the IRT - a team trained and ready to respond to major emergencies anywhere in Ireland. David Labanyi reports
As the world watched the unfolding horror of the September 11th attacks, one Dublin ambulance driver observed events with a professional eye.
What struck him was the scale of the response required by the emergency services - the panic, the confusion, the unprecedented number of casualties. And he noted how well these services performed.
While Ireland has been lucky to date in not having had a mass emergency like a plane crash or a major motorway pile-up, such an event could happen, thought Colm Megan.
So he talked to his boss, Pat McCreanor, chief ambulance officer of the Health Service Executive about training a rapid reaction team for a large scale emergency in Ireland.
The result is the Incident Response Team (IRT), an 18-strong team of specially trained paramedics which is now on call 24 hours a day.
"Basically, if there is a plane crash, a train crash or a chemical spill anywhere in the country our team can be there in an hour," says Shane Mooney, deputy leader of the IRT.
The team is trained to manage a major incident causing many casualties and where management is as important as treatment.
Management of the scene of a major accident was a major aspect of the training programme. "This involves medical management, the 'triage' of casualties at the accident site, how many ambulances do we need and which hospitals should they be directed to.
"If we are called in to assist, that is one of the first things our members do, assess the situation, assess the emergency service requirements and make sure we have the right resources."
These management skills are supplemented with specialist medical training involving the use, for example, of breathing apparatus. "This allows the team to treat and 'decontaminate' a patient affected by a chemical spill," he says.
"This restricted breathing apparatus course is the same as the fire services and it ensures we can treat patients while being protected ourselves."
This training was conducted with the Army at the Curragh.
Other aspects of the programme included advanced cardiac life support, pre-hospital trauma life support, integrated road rescue and steep access specialist training.
As the training progressed so did the scope of what the team was capable of. In mid-January a woman canoeist broke both her ankles in swollen rapids in the River Dargle Valley. "It's a very difficult place to access and it requires rope expertise that wouldn't be available to most ambulance crews," says Mooney. "That's the kind of stuff we can do - enhanced casualty care in inaccessible places."
The team has also practised techniques for getting to injured people across difficult terrain. "We can get there that bit faster [than standard emergency services], and when we get there, we're trained to give causality care while planning the best extraction route for that patient."
Originally, it was planned that the team would operate just in the eastern region where all the team members are based. But after a series of training exercises with the Air Corps in Baldonnel an agreement was reached giving the IRT immediate access to a helicopter or a fixed wing aircraft allowing the team to respond to calls all over Ireland.
"Our links with the Air Corps means that if we need to be deployed, we can get to anywhere in the country with our equipment and have an 18-strong, self-sufficient medical team on the ground within the hour," Mooney adds.
"Our training and skills are now certainly on a par with anyone in the UK," he says.
It was the promise of additional skills that attracted applications to the team rather than financial incentives as members do not receive extra wages for being on the team.
The members are all experienced ambulance officers with between five to 25 years service. They work as full-time ambulance drivers constantly on call for the IRT. When a call comes through, those team members not responding to an ambulance call respond. Based at St Mary's Hospital in the Phoenix Park, Dublin, the team was pulled together over the past year following a series of interviews.
"Although it's all voluntary and there's no extra cash or other incentives for the extra time, we got loads of applications. Maybe it's a lads thing, all the abseiling and cliff rescue training was appealing enough but we were surprised by the number of applications. So we held interviews and narrowed the group down," says Mooney.
Funding was found for a dedicated vehicle to transport all the specialist equipment required. Due to the on-call nature of the team, the vehicle is always at one of the ambulance bases from which a team member is working.
"The jeep will be at one of the team member's HQs. If the team is requested and that driver is out on another call, there are a number of lads who have keys so somebody can come and get the vehicle, rendezvous with the rest of the team and get to the scene. We also have access to ambulance service jeeps and quads for mountain rescues."
All the team members carry pagers and when a call from ambulance command comes through, they rush to a prearranged rendezvous. Since completing training the team has been activated, or put on call, a number of times, particularly for possible aircraft incidents in Dublin Airport. "So far, thankfully, we've not been needed but we were ready none the less."
With the team now operational, the plan is to continue developing the skills of the team while simultaneously widening its remit, says Mooney. In March the team plans to simulate a river exercise designed to develop techniques to rescue an injured climber or canoeist from a very steep valley.
Each team member will carry out additional training every month. "Our day job 40 hours a week is patient care. With this extra training we can now do that in more inhospitable places, places where an ambulance crew couldn't normally get to," says Mooney. "Basically we're the sort of service that you won't need until you really need us."