Coroners urged to investigate whether road crash victims could have been saved with better care

AN EMERGENCY MEDICINE consultant has urged coroners to investigate whether road crash victims and other people attended by emergency services received timely critical care to international standards of best practice.

Dr Lisa Cunningham told the Coroners Society of Ireland’s annual general meeting in Mayo this afternoon that Ireland is an “outlier” among European countries in not having specialised pre-hospital medical doctors.

Improving pre-hospital medical treatment is a matter of “equity of care”, particularly given the disproportionate prevalence of road traffic collision deaths in rural areas, she added. 

The majority of road deaths in Ireland occur on rural roads, and the proportion of rural road deaths here is higher here than the EU average.

Cunningham works both as an emergency medicine consultant in Mayo University Hospital and as a pre-hospital consultant with the Lincs & Notts Air Ambulance in the UK, flying to the scene of accidents by helicopter to treat patients. 

She said she believed the nature of rural roads was not the only issue at play, and emergency care response times were likely to be a factor in the high number of deaths on rural roads in Ireland.

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She highlighted life-saving treatments delivered on the roadside in the UK but not routinely available to victims here, including blood transfusions. Pre-hospital blood transfusion is available only in only some areas of Ireland, such as through the voluntary Wicklow Rapid Response organisation. 

Cunningham said it was “so frustrating” that very different levels of care were available on the two parts of the island of Ireland.

“Northern Ireland has consultants in anaesthesiology, emergency medicine, intensive care, that will go to the scene of an accident. We do not have that,” Cunningham said.

“I am not in any way putting down the fantastic work of the National Ambulance Service, pre-hospital personnel, paramedics – they’re my colleagues. I go with with them and respond voluntarily for cardiac arrests in Mayo. I know what they can do, but their level of care is capped,” Cunningham said.

Irish ambulances are staffed by paramedics and advanced paramedics. There are regulatory limits on the procedures paramedics can perform, which means they cannot provide some potentially life-saving treatments that doctors can. Cunningham gave the example of intubation to maintain an adequate airway in cases of traumatic head injury.

In Ireland, intubation is usually delayed until the patient reaches hospital, meaning their brain could have been starved of oxygen for an hour.

Preventability of deaths

Cunningham emphasised that she was not saying that everyone who suffered a traumatic injury could be saved, but she said research from the UK indicated a proportion of trauma deaths could potentially be prevented with intubation, blood transfusion and hemostatic drugs (drugs to reduce haemhorrage).

She said the causes of deaths of people who died in ambulances needed to be audited and collated, and questions such as whether patients had died from airway obstruction or from a lack of blood transfusion needed to be asked.

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She added that with the chief state pathologist, Dr Linda Mulligan, she was conducting analysis of pre-hospital deaths in one coroner’s district in Ireland. One of the first cases she had analysed as part of this work concerned a young man who had died due to blood in his airway, indicating his death was potentially preventable.

She outlined scenarios in which she said coroners could ask questions that would help to shed light on the standard of care the person who had died had received, including whether the time taken for life-saving interventions to be provided was in line with international standards of best practice.

She said such deaths could include those from cardiac arrests, or from traumatic injuries such as from falls.

She asked coroners to consider would they examine such cases “a little bit differently, knowing that we can absolutely change pre-hospital care in Ireland”. 

Feasability study

The National Ambulance Service is currently conducting a four-month feasibility study of crewing helicopters with doctors alongside paramedics. The study is expected to conclude in the coming weeks. 

Taoiseach Simon Harris told the Dáil in May that he would meet pre-hospital emergency medicine consultants campaigning for the same model of care provided in Northern Ireland and the rest of the UK to be rolled out here. It’s understood this meeting has not yet happened.

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