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New Pre-Hospital Pathway will reduce UHL Emergency Department ambulance journeys



Responding to calls on the first day of operations for the Alternative Pre-Hospital pathway in the Limerick region were emergency medicine SpR Dr Callum Swift and Michael Marrinan, emergency medical technician, National Ambulance Service. 

UL Hospitals Group and the National Ambulance Service announce new Alternative Pre-Hospital Pathway which commenced in September

A new collaboration between UL Hospitals Group and the National Ambulance Service will see definitive care provided in the community to patients who call 999/112 – and reduce the number of ambulances bringing patients directly to the Emergency Department.

The Alternative Pre-Hospital Pathway (APP) involves specialist emergency medicine doctors and NAS personnel responding to low-acuity ambulance calls.

This service commenced in Limerick on September 11th and is initially operating from 10am to 6pm Monday to Friday. The APP team responds in a NAS vehicle to appropriate calls within a 45-minute radius of the ambulance centre in Limerick city.




Providing definitive care to patients at the first point of contact is a key aim of Irish healthcare delivery as described in the Sláintecare report. The APP team will respond to low-acuity ambulance calls in the community; provide that definitive care directly; or refer on to the appropriate community or specialist service.

Where the APP team is the nearest available resource, they may also be despatched to care for or assist pre-hospital colleagues in caring for, critically unwell patients in the community.

The Emergency Department at UHL receives more emergency ambulances than any other hospital in the country and the APP service will, where appropriate, reduce the number of ambulance conveyances to the hospital. This will both improve patient experience and free up valuable emergency ambulance resources for critically ill or injured patients.

The APP team comprises an emergency medicine specialist registrar (SpR) or registrar and an Emergency Medical Technician (EMT) or Paramedic in a NAS response vehicle.

The APP is one of a number of ways in which NAS has responded to a growth in ambulance use for non-emergency calls. This service has been operating in the Cork city area since 2019.

Commenting on the introduction of the service, Dr Damien Ryan, Consultant in Emergency Medicine, and Clinical Director, Urgent and Emergency Care Directorate, UL Hospitals Group, said,  “This service will allow Emergency Doctors to attend to patients in the community, who have called for ambulance transport, where their need for hospital care is deemed low. This will potentially obviate the need for that patient to come to hospital. Advice can be provided regarding the most suitable options for further care in the community, if necessary, and in some circumstances care can be provided directly at the scene.”

Niall Murray, General Manager, Area Operations, NAS said, “The National Ambulance Service (NAS) is moving from an Emergency Medical Service (EMS) to a Mobile Medical Service (MMS) which aims to deliver the right patient care in the right setting. 

“The Alternative Pre-hospital Pathway (APP) Team is a bespoke model of pre-hospital healthcare delivery which complements the national shift toward integrated community care. Increasing demand for emergency care and an aging population is necessitating a re-design of traditional models of emergency care delivery and the Alternative Pre-Hospital Pathway (APP) Team is one such response.”

Find out more here.
Read more UL Hospitals Group stories here.

Richard is a presenter, producer, songwriter and actor. He was named the Limerick Person of the Year (2011) and won an online award at the Metro Éireann Media and Multicultural Awards (2011) for promoting multi-culturalism online. Richard says that the concept is very much a community driven project that aims to document life in Limerick. So, that in 20 years time people can look back and remember the events that were making the headlines.