Defining the Future of MICAS - Identifying a Shared Vision for the Future of Adult Critical Care Retreival in Ireland

David Menzies
Irish Management Institute, University COllege Cork
April, 2020
Dr David Menzies is a consultant in Emergency Medicine at St Vincent’s University Hospital in Dublin. He is the HSE National Clinical Lead for Adult Critical Care Retrieval services and also the Chair of the Medical Advisory Committee of the Pre Hospital Emergency Care Council.

He trained in Ireland, the U.K. and Australia and is a fellow of the Royal College of Emergency Medicine and the Faculty of Sports and Exercise Medicine. Additionally, he holds the Diploma in Retrieval and Transport Medicine from the Royal College of Surgeons in Edinburgh.

He has sub-specialty interests in education and Pre Hospital Emergency Medicine and is the Medical Director of CFR Ireland, Wicklow Rapid Response, Dublin & Wicklow Mountain Rescue and the Motor Cycling Ireland Medical Team.



Background: The National Ambulance Service Critical Care and Retrieval Services (NASCCRS) was established as a new service within the National Ambulance Service (NAS) in 2018. Prior to this, a HSE Clinical Programme, the National Transport Medicine Programme (NTMP) undertook this function, but it was recognised that a Clinical Programme structure was not ideal for the organisation and delivery of complex care across traditional hospital group boundaries. The Mobile Intensive Care Ambulance Service (MICAS) currently provides a critical care retrieval service for patients aged 16 years and over from three sites (Dublin, Cork and Galway). MICAS provides a doctor and critical care nurse together with a critical care ambulance and NAS emergency medical technician (EMT) to facilitate the interhospital transport of critically ill patients.

Objectives: The overall aim of this proposal was to explore the views of key stakeholders in the Mobile Intensive Care Ambulance Service and determine if there is a shared vision regarding the future development and direction of the adult critical care retrieval service in Ireland.

Methods: A qualitative study using semi structured interviews and subsequent thematic analysis was undertaken. Key stakeholders with a representative, professional, clinical and geographical spread were recruited to participate.

Results: The views of stakeholders in MICAS are relatively homogenous. While there is some variation, there is a broad consensus that the MICAS service should evolve further. Areas for development include training for current staff and the development of new roles such as Critical Care Paramedic and Advanced Nurse Practitioner. Expanding the scope of MICAS to include some elements of time critical and pre-hospital retrieval will require increased consultant level support and tight clinical and operational governance arrangements.
Conclusion: There is a broad consensus among key stakeholders with respect to the future development of the Mobile Intensive Care Ambulance Service. Future development should include new staffing models and scope of operations.