On the Adjournment With the Oireachtas, and Drapier, on holidays this column is being handed over to backbenchers. This week Independent TD Dr Jerry Cowley argues the need for an emergency helicopter ambulance service.
Having been a busy full-time general practitioner, and a rural one at that, gave me a splendid opportunity to see life as it is, dealing with people, and sharing in their joys and their grief. Such is the walk of life, all of us labouring under the yoke of Adam and Eve.
Witnessing the brevity of life puts important matters into context.
Having moved to west Mayo as a young doctor, I was first struck by the natural beauty , the poor quality of the roads, both national and regional, and the warmth of the people. Everyone takes a friendly interest in everyone else's business - it would be common to hear what you were about to do before you even thought about doing it yourself.
Twenty-three years later, the roads are much the same, and my cervical and thoracic spine "shock absorbers" are a true record of the trauma of travelling here day and night. The roads are all very fine if you're strolling along on your holidays with no particular place to go, but when your life depends on it, or your fractured spine or bleeding brain need no more rocking to avoid a life of disability, then sin scéal eile.
Just last Saturday on a protest march for the reopening of the Western Rail Corridor in Charlestown, I met a man in a wheelchair leading the protest.
John Mahon is a well-known community activist who campaigned alongside Msgr Horan for Knock Airport.
In June 1997 he lay in a field waiting for a service which never arrived, despite the best efforts of his own GP. On a summer's evening this 60-year-old man had been feeding cows in his field when he slipped on the ground. He was unable to get up. He waited for two hours and ten minutes for help to arrive.
When his GP, a very able and experienced practitioner, arrived he knew things were not well and tried to make arrangements for a helicopter rescue.
He was told that this was not possible as no such service was available. As a result Mr Mahon had to travel by ambulance to Mayo General Hospital, and from there, over the rocky road to Merlin Park Hospital, Galway, from where he was airlifted the next morning by helicopter to the Mater Hospital in Dublin.
Both Mr Mahon and his GP now ask the same question - why could he not have been airlifted from the field at the time of the accident the previous day?
Indeed. Especially as the GP said that the last time he saw Mr Mahon move his legs was when he was in the field.
Something happened between the time he left the field and his arrival in the hospital in Dublin, because he has not used his legs since.
Unfortunately the story is not unique and makes the delay in instituting an all-Ireland HEMS (Helicopter Emergency Medical Service) deeply frustrating. It is inexcusable that we are the only country in the EU without this service - and since Northern Ireland shares with us that dubious distinction I have always felt that HEMS would make a worthy cross-Border project.
The campaign for HEMS goes back to Mr Barry Desmond's time and has involved delegations with Mr Pat Hanafin of the Association of Ambulance Personnel to meet the Cross-Border Emergency Care Committee set up under the Good Friday agreement, and separately meeting Minister Bairbre De Brún, in Stormont, and Mr Micheál Martin TD, Minister for Health and Children.
After seven years and a number of studies, both governments appointed consultants Booz Allen Hamilton to do a study on a dedicated all-Ireland HEMS. The report was to be completed in August 2002 but is still awaited!
HEMS would complement the Irish Ambulance Service in the excellent job it does already - it is very good but simply cannot fly.
All those at the coalface, including local consultants and GPs, see the urgent need for HEMS. Suitable cases include bad head and spinal injuries, bad burns, bad cardiac patients, people impaled in machinery and desperately ill children with meningitis, or born in peripheral hospitals needing urgent surgery.
A UK research paper showed that dedicated helicopter transfer resulted in a 50 per cent survival rate in patients with a sickness score (a commonly used measure of the severity of an injury) over 18, a group found not to survive after land transfer, and there are unfortunately no shortage of terrible fatalities from accidents on our roads, farms, and in our factories
How can we justify the continued use of the Air Corps to do air ambulance work when original research from the National Neurosurgery Centre in Dublin proves the young lives lost through delay - 12.5 hours average delay whilst awaiting the arrival of the Air Corps helicopter?
This is not the fault of the Air Corps. Unlike HEMS, the Air Corps is not a dedicated service. It is well documented that the equipment it carries is inappropriate and insufficient, reflecting its multi-purpose role. Nor can the Search and Rescue service provide a HEMS service for the same reason.
Of course we are particularly badly affected in the west. The research suggests that the further you have to travel (the at-risk time) to the National Neurosurgical Unit in Dublin the greater chance of dying or being disabled for life.
An Irish HEMS would, I suggest, be mainly an inter-hospital or secondary transfers system with a secondary responder role as appropriate for primary transfers.
We have the option of choosing the system that best suits our needs.
People say HEMS is expensive. I believe HEMS can save money. International research shows that the time spent in intensive care units can be reduced by one third without altering hospital care by using HEMS for inter-hospital transfer.
This results in considerable savings, as the specific charges for the critically ill patient are considerable.
Savings extend beyond the health service. The National Roads Authority puts the average cost of a life lost on the roads at €1.27 million. At Beaumont Hospital alone, it is estimated that four lives are lost every year, with 12 to 16 people permanently disabled, because of the lack of a HEMS service. Thus the saving of life and disability could amount to €20-25 million - enough to set up HEMS for all of Ireland.
A HEMS would be part of the existing ground ambulance system and I feel should be owned and run by the same people who run the present system, ensuring a truly comprehensive and co-ordinated pre-hospital and inter-hospital transport system.
We will have a system that we can all be proud of, and the needless loss of life and disability through lack of HEMS will be past history.
• Dr Jerry Cowley TD represents Mayo.
Next week: Billy Kelleher (FF, Cork North Central)