An Cosantóir

23 SEARCH AND RESCUE to get people by ambulance to an emergency centre, primarily for significant illnesses such as STEMIs.' STEMI is an acronym for ST-segment elevation myocardial infarction, a term cardiologists use to describe a classic heart attack. Such cases tend to be treated at Percutaneous Coronary Intervention centres, of which there are five on a twenty-four-hour basis and one on a 9 a.m. to 5 p.m. basis in the state. 'I was asked to go to a meeting in Naas with the NAS and with Dr Cathal O'Donnell to explore what could be done. Nine months to the day almost, we launched the service,' Clancy said: During that period, I spent my time going to Naas, Tullamore, Portarlington, and I had an Air Corps team that included Phil Bonner and Niall Buckley looking at everything from risk assessments and location, to fuel, hangars and basic supports for the air crews. A forty-five minute response timeline was key, primarily focused on where ambulances by road couldn't meet that time frame. 234 SeArch And reScue It was also clear from the outset that it would have to be an interagency effort, with paramedics provided by the HSE who would be trained by the Air Corps. 'So we could bring expertise in command and control, tasking dispatch, and training advance paramedics to crew the helicopter. All the skills, expertise and competence we had we brought to bear,' Clancy said. The Air Corps team also sought advice elsewhere, including the US and Britain. 'It wasn't perfect, but it was part of an embryonic piece, and everyone was apprehensive as it was a one- year pilot scheme,' he added. It was launched by then Minister for Health James Reilly and Minister for Justice and Defence Alan Shatter, with Robert Morton, then head of the NAS. Establishing the EAS service required a degree of innovation for a military organisation that had been involved in air ambulance services since 1964. Whereas air ambulance work is a type of medical evacuation, an EAS service would require developing paramedic capability. In practical terms, Clancy cited as examples a 'health atlas', which involved overlaying the national electricity cable system onto existing maps. The military had not been on the TETRA communications system used by the gardaí and ambulance service, and this also required a degree of integration. When kitting out the aircraft – initially a Eurocopter (EC) 135 – one of Clancy's colleagues designed and built a secure case for holding gases between the seats, which was then certified. Two weeks after the service began, the EC135 was en route from Athlone to Borrisoleigh, County Tipperary, to bring a patient to a Limerick hospital when it struck a power line. It was just approaching Borrisoleigh, some twenty minutes after take-off. Wire cutters positioned above the cabin and below the helicopter blades snapped the cable, but the aircraft was forced to land. The Air Corps crew and HSE paramedic on board were not injured and the patient was brought the rest of the way to the hospital by road ambulance. 'Initially, it came as a shock, but that really invigorated and consolidated our motivation in showing this could happen – so we adapted approach procedures and the manner in which we select landing sites,' Clancy said. 'It emerged that it wasn't an established line, in that a farmer had crossed a field to provide power. And the wire cutters did the job, so it was a good outcome,' he added. After this and several incidents where an aircraft door fell off – again, fortunately, without injury – a decision was taken to upgrade to the Agusta Westland 139. The EAS was made permanent as a dedicated asset for the NAS in 2015, with funding of 2.2 million euro annually (2021 figures) provided by the Department of Health to the Department of Defence for 480 flying hours and associated costs. Any additional expenditure would be negotiated on a case- by-case basis. The EAS works well with other services, including the Irish Community Rapid Response (ICRR) air ambulance service, which was set up in 2019 to serve the south-east of Ireland on a charity basis an is based in Rathcoole, near Millstreet in County Cork. When the Department of Defence announced that the EAS could not operate for sixteen days between late November 2019 and February 2020 due to staffing and training issues, the ICRR was asked to provide back-up support. In 2020, the ICRR flew a total of 490 missions across thirteen counties to provide paramedic

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