THE THIN BLUE LINE

Issues with ambulance cover and paramedic burnout persist

AMBULANCE crew shifts in Cavan and Monaghan continue to be regularly left unmanned exposing emergency patients to increased risk and leading to low morale and burn out among local paramedics.

That’s the picture painted by a paramedic ‘whistleblower’ working in this region.

In November, we reported how there was reduced ambulance cover in Cavan Town over several dates in October.

The Celt learned that, on one of those dates, when there should have been four ambulance crews operating, there was only one Cavan ambulance covering the whole of Cavan town and county over a 12-hour shift.

Today, rosters seen by the Celt, show that there are six shifts per week where no paramedics rostered to work in the Cavan Town station.

Cavan and Monaghan have two ambulance stations each located in Cavan Town, Virginia, Monaghan Town and Castleblayney.

In Cavan, there are currently 19 full-time paramedics who cover 24 “lines” in pairs. Every week, six lines remain unmanned, claims the whistleblower.

National Ambulance Service (NAS) say they have addressed the issue by deploying an ambulance crew from Finglas, north County Dublin, to cover the vacant lines in Cavan.

In Co Monaghan, meanwhile, crews from Swords cover Castleblayney when required and a crew from Dundalk is sent to cover vacant lines in Monaghan Town Ambulance Station.

However, a paramedic whistleblower who has spoken to the Celt claims the Finglas crew will be dispatched to attend the incident they are closest to and therefore “rarely make it to Cavan at all”.

“If a call comes in at the start of their shift and they are the nearest ambulance, they will respond to it. So, it could be a couple of hours before they are released to depart for Cavan.

“It takes them two hours to get here and then, to avoid overtime, they have to leave Cavan at six o’clock to be back in Finglas for the end of their shift at eight o’clock. Finglas never does a full 12-hour shift here,” the frustrated crew member said.

The whistleblower told us that four ambulances operate from Cavan Town Ambulance Station during the day, four days a week, and this is reduced to three on Thursdays, Saturdays and Sundays.

“There is a shortfall especially at night,” the whistleblower said.

“That leads to increased workload for paramedics and, in turn, low morale amongst us.

“There’s little opportunity for staff to have any downtime or normal breaks. We’re always on the road. More staff are taking leave on night shifts because they know what to expect. From what I can see, sick leave has increased during night shifts also.”

The Celt has also learned that the model used by the National Ambulance Service (NAS) for dispatching “the nearest available ambulance to the most urgent calls” means a Cavan Town ambulance could be sent to Leitrim or Meath on an emergency call, which also leaves patients in this county exposed during these times.

The paramedic also described a recent incident when their ambulance was dispatched to a neighbouring county for what they were informed was a high-priority call. An ambulance from the same county was also sent to the call-out, which turned out not to be an emergency.

The local paramedic said: “We arrived in 42 minutes but the local crew arrived in 38 so, if questions are asked of the NAS, the paperwork will say they sent the closest resource in the quickest time.”

Another local ambulance crew was dispatched to County Wicklow recently to answer a call to a sick baby but by the time the ambulance arrived the mother said the baby was asleep and she didn’t want to waken her child.

In addition, the paramedic says NAS call-takers handling 999 emergency calls ask callers a series of questions from a script and can only upgrade a call from low priority to high but cannot downgrade them if the situation becomes less urgent.

“Call-takers ask questions like is the patient experiencing chest pain or difficulty breathing,” the paramedic said. “If the answer comes back that there are respiratory problems then the call is automatically prioritised as an emergency but, when you get there, you could be told the person has had a chest infection for a week.”

Transfers

The whistleblower also complains that emergency ambulances are used for non-emergency inter-hospital transfers from Cavan General to any of the hospitals in Dublin.

The Celt put the paramedic’s claims to the HSE through a Freedom of Information request.

The HSE denied there were so-called vacant lines in Cavan and Monaghan for three months from September to November last year stating there are “zero” vacant lines because “NAS has recruited against vacant lines in Cavan and Monaghan stations, and remoted service delivery to Cavan and Monaghan from stations elsewhere in the Dublin North East Area (Finglas and Dundalk).”

The response reveals that Finglas Ambulance crew covered Cavan 250 times in the three-month period; while Swords crews covered Castleblayney 161 times from September to November.

A request to find out how many times crews from Finglas, Swords and Dundalk did not make it to Cavan, Castleblayney and Monaghan Town during their shift was refused under section 15 of the Freedom of Information Act because that specific record “does not exist or cannot be found after all reasonable steps to ascertain its whereabouts have been taken”.

The HSE confirmed to the Celt that 97.7 per cent of all inter-hospital transfers are carried out by emergency ambulance.

In relation to covering sick leave or holidays, the HSE said: “When occasions arise where shifts may not be covered, such as with unplanned sick leave or staff vacancies, the NAS has mitigation processes in place. The NAS first utilises the in-built roster cover. Where this is exhausted, overtime is offered, and every effort is made to ensure shifts are filled.”

In a statement, the HSE said they operate a clinical hub within the National Emergency Operations Centre (NEOC) or call centre for handling 999 calls.

They are staffed by “experienced healthcare professionals” who work “in tandem with emergency call takers and dispatchers”.

Response times

The health service also pointed to average ambulance response times for life-threatening emergencies. While the aim is to attend such calls in under 19 minutes. The national average in Ireland is 24 minutes and in the Dublin North-east region, which, includes Cavan and Monaghan, the average response time is 22 minutes.

“The NAS remains acutely aware of the unique challenges associated with delivering emergency services in rural areas and recognises the additional resources required to meet these needs,” the HSE statement reads.

A national recruitment competition in 2025 targeted areas of need, including Cavan and Monaghan, the HSE said.

‘Burnt out’

Monaghan-based Sinn Féin TD Cathy Bennett recently raised the issue of adequate ambulance cover in her home county in the Dáil.

Speaking in the Dáil, Deputy Bennett said: “Entire shifts of ambulances are operating in Monaghan without an advanced paramedic car. There are delays in hand-over and staff are burnt out.”

She referred to incidents in 2023 and 2024 when her constituency colleague Matt Carthy raised separate cases of young boys seriously injured at football matches and were left waiting “upwards of three hours” for ambulances.

“What year will you stop failing the people of Monaghan with regard to ambulance services and reinstate the 24-7 advanced paramedic car,” Deputy Bennett asked the Taoiseach.

“There is a broader issue with how ambulances are deployed,” An Taoiseach Michéal Martin replied. “The pre-ambulance emergency council and the national authorities responsible have a clear view as to what is the best and optimal deployment.”

While SIPTU plan to ballot its members on strike action over pay and conditions at the end of the month, it would seem that the issues raised by the whistleblower in Cavan is just a snapshot of what is happening in the NAS nationally.

Cavan-based Aontú Senator Sarah O’Reilly has had her own negative experience with the country’s ambulance service after her mother had to wait eight hours for ambulance transfer from hospital in Mayo to one in Galway with a punctured lung.

“She was so ill I thought she’d never make it, but we were told there were people more ill than my mother,” Sen O’Reilly told the Celt.

“When we finally got her into the back of an ambulance, I could see seven ambulances parked up. I was furious!” the senator said.

Also, the NAS has confirmed to Fianna Fáil TD for Cavan-Monaghan Brendan Smith that despite concerns about response times and growing demand it has no plans to open an ambulance base in west Cavan.

Deputy Smith was told that the stations already operating in Cavan town and Virginia along with units deployed from neighbouring counties, respond to emergency calls across the entire county under what the NAS describes as a “demand-driven model of dynamic ambulance deployment”.

According to the official response, this model “aligns with international best practice” and allows the service to prioritise the most serious cases requiring immediate life-saving intervention.