Many HSE paramedics lack Garda clearance

Almost half of the paramedics checked out in one Health Service Executive ambulance service region had no Garda clearance, according to unpublished inspection reports dating from 2011 and 2012.

The reports also found patient clinical records in some ambulance bases were stored in open baskets or on open shelves with no clarity as to who was in charge of them. The details have been released to The Irish Times under the Freedom of Information Act.

The inspections by the Pre-Hospital Emergency Care Council (PHECC) found both HSE and Dublin Fire Brigade (DFB) ambulances were not fully stocked with necessary equipment and medication. Continual professional competency training of paramedics in some HSE areas was found to be in need of "urgent attention".

Inspections
PHECC is the independent statutory agency responsible for standards and training in pre-hospital emergency care. It conducted inspections of the ambulance services provided by the HSE National Ambulance Service (NAS) between November 17th and December 8th, 2011, with follow-up inspections between July 16th and 18th, 2012.

It inspected the DFB ambulance service on November 2nd and 3rd, 2011 and followed up on May 24th, 2012. No inspections have been conducted since.

Inspectors looked at three NAS ambulance bases in each of North Leinster, South and West, and inspected DFB bases in Swords and Finglas.

Paramedics’ Garda vetting clearance was examined by taking randomly selected lists of names. Some 48 per cent of the names provided in the NAS region of North Leinster had no Garda clearance.

In NAS South, 17 per cent had no Garda clearance, while in NAS West 12 per cent had no Garda clearance.

In follow-up inspections seven months later, no Garda clearance was provided for those without it in the South and West, while in North Leinster clearance was produced for just 6 per cent of those without it.

In DFB, Garda clearance for 10 randomly chosen names could not be produced. In follow-up inspections, Garda clearance files could be produced for seven of the 10.

Serious concerns
The inspectors raised serious concerns about storage of patient clinical records (PCRs), particularly in NAS North Leinster bases. In Maynooth "PCRs are stored in an open basket in the ambulance parking area . . . Simliarly in Athy base, PCRs are stored in an open box in an open office.

“In Navan the PCRs are stored in a lockable drawer, however they are accessible at all times in the building. The potential for breaching the confidentiality of patient clinical records had not been identified by any of the practitioners involved . . . It was not clear as to who had overall responsibility for the storage and management of the PCRs.”

The issues at Navan and Athy had been addressed at follow- up, but not in Maynooth.

In DFB, patient records were “stored in a secure and safe manner”.

In NAS and DFB bases, ambulances were found to be missing medications and equipment “which would inhibit the paramedic from performing optimally”. There were also specific items “as outlined in the medication and skills matrix” which were not being carried at all by the NAS.

“This implies that clinical practice guidelines or part of the CPGs are not being utilised as part of patient care . . . It beholds the NAS to inform PHECC of such practices,” the report said.