Irish Examiner has learned that the 10 highly skilled advanced paramedics who crew the HSE’s Helicopter Emergency Medical Service (Hems) from bases in Athlone and Cork have resigned from the service, and have requested a return to their original ground-based ambulance duties.

Their request comes amid fears the National Ambulance Service (Nas) wants to cut the number of paramedics on each aircraft from two to just one.

Farm safety minister Michael Healy-Rae has described any such move as “reckless”.

HSE and National Ambulance Service management have been warned that a solo paramedic crewing model poses a risk to patients, to the paramedics and pilots, and poses a flight safety risk.

They have been told that if the National Ambulance Service can’t provide two paramedics for each aircraft, then the air ambulance service should be stood down on those days.

A senior manager has warned that a single patient safety incident — such as a drug error, an in-flight patient emergency, or a crash would bring the crewing issue “sharply into focus”.

There are also concerns that the National Ambulance Service is recruiting emergency medical technicians (EMTs) to replace the second paramedic on each aircraft.

Qualifying as an emergency medical technician takes just five weeks. Internal emails warn that an emergency medical technician will not be able to carry out any of the major “interventional skills” required to help critically ill patients such as intubation — the placing of a tube in a patient’s airway — and the IV administration of powerful painkillers.

While the HSE has denied there are any plans to change the crewing model, the Irish Examiner has learned that a single clinical crew model was trialled after the State took over a charity-funded, Munster-based Helicopter Emergency Medical Service in 2023.

An unpublished internal report on the trial said the introduction of a solo advanced paramedic (AP) crewing model “had a detrimental impact on the primary role” of Helicopter Emergency Medical Services that being to provide safe and effective care to patients.

It described the single crewing model as “unsustainable” and one which poses “safety concerns with a measurable increase in risk to both the patient and the practitioner”.

It found multiple incidents of increased risk to the patient, which were directly related to a solo practitioner trying to manage multiple aspects of complex trauma cases while also preparing patients for flight, coordinating all communications to the flight crew, and loading and unloading the patients onto the aircraft.

Among its recommendations were the scrapping of the advanced paramedic and emergency medical technician crew combination, and the maintenance of two advanced paramedics on the aircraft while the Helicopter Emergency Medical Service moves towards a doctor-led service.

The Irish Examiner has also seen a raft of internal emails from clinical risk and clinical development experts warning senior managers about any potential move from a two-person advanced paramedic to a solo advanced paramedic crew.

Siptu, which represents the 10 advanced paramedics who are now working the air ambulance roster under protest, is liaising with the National Ambulance Service management on their concerns about the future crewing model.

However, industrial official Graham Macken accused management of frustrating the talks.

“Unless we see progress in the short term, we will formally refer this matter to the Workplace Relations Commission (WRC),” he said.