Arainn has its flying priest now, but for years it has had its flying doctor. Dr Marion Broderick may not have the private pilot's licence, or the Cessna recently acquired by an tAthair Liam O Raghallaigh to serve his island flock; but even if she wanted the qualification, she has never had the time to train.
When the Shannon-based Sikorsky search and rescue (SAR) helicopter crosses Galway Bay and roars over the Irish Times roof with a serious medical case, Dr Broderick is invariably travelling with it. Like many of her rural colleagues, the hard-pressed Aran Island GP would put junior house-persons to shame.
Dr Broderick knows most of the helicopter crew with the Irish Marine Emergency Service (IMES) by first name. She is also honorary medical officer with the RNLI Aran Islands lifeboat. A good percentage of her work on the three western islands depends on emergency transport by air or sea.
Having campaigned to improve that service over the years, latterly as a member of the voluntary West Coast Search and Rescue Committee set up in 1988 by Joan McGinley of Donegal, she cannot speak highly enough about the emergency units under the IMES wing. These range from the voluntary lifeboat and coast and cliff rescue crews to the Air Corps, Naval Service and Shannon Sikorsky teams. Her main concern now is the lack of appreciation of that expertise - and the effect on patient care.
To put it bluntly, the IMES helicopter crew at Shannon can do better than "scoop and run" in her view. Several members of the flying staff are qualified paramedics, two having completed advanced cardiac life-support courses. They are prohibited by legislation, however, from using that training to the full extent.
Last year, in response to a Government review of IMES performance in marine search and rescue, Dr Broderick made that point. She submitted that several members of the Shannon SAR team were able to diagnose and treat patients in an emergency pre-hospital critical care situation.
These crew members are also trained in the administration of drugs, and establishment of intravenous access lines to give intravenous fluids to patients, she said. They would perform such duties as a matter of routine in Britain or the US; here they are prohibited from performing more than basic first aid. Not only is it a waste of expertise but it puts the crews in an impossible situation, she said. "As things stand, they are supposed to stand by, give no drugs or intravenous fluids, wait for the inevitable deterioration of the patient, and then intervene and attempt resuscitation. Such deterioration may involve cardiac arrest, which might well be avoided if the helicopter crew could give the appropriate drugs and fluids to the patient."
Even if there is a reluctance to upgrade such crews here to paramedic level, she believes that medical training for SAR crews needs to be formalised and that protocols should be agreed to allow those who have these skills to use them. As reported recently in this newspaper, the PricewaterhouseCooper consultancy review of IMES found that the agency, under the Department of the Marine and Natural Resources, had provided an "excellent" service since it was established in 1991. It found that in terms of accessibility, response times, coverage, effectiveness of response and results achieved, it was performing to "the highest standards" and compared favourably with international norms.
The review ruled out a proposal that IMES should assume the additional responsibility of a nationwide helicopter emergency medical service (HEMS). This service, which has been established in many other European countries, could meet the needs of serious road accident victims and could also provide a formalised inter-hospital transport service for seriously ill patients and organs for transplants.
The doctors in the HEMS campaign believe it would have to be established as a separate entity to the marine search and rescue service but that it could run under the IMES wing. Currently, the Shannon Sikorsky is occasionally used to transfer patients with neuro-surgical trauma to Dublin or Cork, and there is also an arrangement under which the Department of Health and the health boards can request the assistance of the Air Corps, based at Baldonnel, Finner in Co Donegal or Waterford, at no cost.
If the same service is requested from Shannon it has to be paid for - which means that treatment for seriously ill patients with neuro-surgical trauma and brain haemorrhage in Galway can be delayed by the "system". Another issue that worries Dr Broderick is that many major coastal hospitals do not have 24hour helipads - a case, perhaps, of health administrators yielding to objections from residents' associations.
