The voice on the radio sounds chillingly detached. “The death will occur of your loved one. They will die tragically in a preventable car crash early next month,” prognosticates the Road Safety Authority’s latest campaign ad, called Time to Talk. The voice warns that you and all belonging to you will be devastated and forever left regretting that you never challenged the dearly departed ones about their dangerous driving habits. Their fatal road journey becomes your guilt trip. It’s a clever ad worth heeding.
By the eighth day of this month, 72 people had died on Irish roads since New Year’s Day. Many of them were young people who, until the moment of impact, were fit, healthy and strong. There are doctors who believe that, had they received specialist clinical or surgical interventions at the crash scene, some of those people would still be alive. That is a haunting thought for the bereaved but it is one this country needs to address.
Major trauma is the biggest cause of death among children and young adults in Ireland. On May 8th, when just a third of the year had elapsed, an 18-month-old child was killed by a car in Co Clare. With his death, Ireland reached the target of 72 road deaths that has been set for the whole of 2030 in its Vision Zero strategy. Only days earlier, a 15-year-old girl died in a crash in Co Wicklow. On February 1st, three friends aged 19, 21 and 25 died in a crash on a country road in Co Carlow. In a 48-hour period that same month, two young men aged 19 and 20 were killed in Limerick, a 21-year-old woman died in a collision in Co Waterford and a 33-year-old pedestrian lost his life in Co Mayo. The previous weekend, a 15-year-old girl was killed on a secondary road in Co Tipperary. In March, a mother and her two teenage daughters were killed in a road crash outside Swinford.
The tragic roll call has been concentrating the State’s minds. The Oireachtas passed the Road Traffic Bill last month, providing for lower speed limits and mandatory drug testing at crash scenes. The Garda Commissioner ordained that all uniformed members of the force must do 30 minutes of road policing during their shifts. This week, the Minister for Transport legalised the use of e-scooters. The Road Safety Authority has been imploring everyone to slow down. From July 6th, it will be mandatory that all vehicles being newly registered in the EU be fitted with Intelligent Speed Assistance technology that will make them beep, vibrate or automatically slow down to prevent accidents. Yet one eminently sensible and relatively inexpensive initiative to reduce the number of lives lost on Irish roads – as well as in our homes, on our farms and factories, on our mountains, in our seas, rivers and lakes – has failed to make it on to the to-do list.
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Ireland chooses to be an outlier in Europe by not operating a consultant-led helicopter emergency service that would bring life-saving expertise to the scene of a crash rather than waiting for the injured to arrive at a hospital. Specially-trained pre-hospital emergency consultants can conduct clinical procedures that paramedics and advanced paramedics are not qualified to do, such as open-heart surgery, anaesthesia to protect the brain, blood transfusions, and accessing major blood vessels in the chest to control haemorrhage. By whisking specialised critical-care doctors to the scene by helicopter, highly-skilled medical treatment can begin there and then, thus saving vital time.
A group of Helicopter Emergency Medical Service (HEMS) doctors from Ireland who are working abroad and some international experts have repeatedly called for a pre-hospital consultant-led service to be established in Ireland, even offering to provide training free of charge. The statistics they cite are persuasive. The UK has more than 21 specialist physician-staffed HEMS, each delivering 200 to 300 emergency anaesthetics and on-scene resuscitations, and treating between 3,000 and 4,000 patients a year. Research by the University of Dundee published in the Emergency Medicine Journal in 2020 found that physician-led pre-hospital care showed an increased chance of survival at 30 days compared with care provided by ambulance clinicians.
Wales, which is slightly more than a third the geographical size of the Irish Republic and, similarly, has extensive rural tracts, operates six doctor-led emergency helicopters round the clock all year and is said to save 300 lives annually. Northern Ireland has operated a physician-staffed helicopter emergency service since July 2017. Switching to a different model at the Border is a myopic strategy – as exemplified during the Covid lockdowns – and leaves residents in the Border region straddling two systems. Joining them together with a coherent all-Ireland service is something the Shared Island unit in the Department of the Taoiseach might explore.
The National Ambulance Service in Ireland is a celebrated lifesaver and should not feel jeopardised by the proposal to introduce helicopter-borne consultants. The idea is not to supplant paramedics or advanced paramedics but to augment them. Saving lives should be the priority, not job demarcation. Opponents of a physician-led system will also cite its expense as a reason for not adopting it but it need not be prohibitively costly. Helicopters already exist in the ambulance and coastguard services. The main initial outlay would be on training up emergency consultants and anaesthetists to qualify for the HEMS sub-speciality. What price do we place on a saved life, or 100 lives?
The cruel reality is that victims of catastrophic trauma injuries do not all die instantly. Some bleed to death. Some suffer cardiac arrest. It makes sense that if the bleeding can be staunched or resuscitation achieved at the roadside, the chances of survival and full recovery are improved.
The Road Safety Authority produces high-impact public service campaigns. Its current Time to Talk one is a powerful nudge to the communal conscience to stop ignoring dangerous habits. The authority might take its own advice and take the time to talk to the Government about the tragic consequences of ignoring a measure capable of preventing the loss of lives.