Operational leadership shortages in National Ambulance Service

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The Irish Society of Paramedicine (ISP), with the clear support of its membership, is writing to formally call for the full reinstatement of the Paramedic and Advanced Paramedic Supervisor grade (known as leading EMT, or LEMT) and the introduction of a dedicated ICO/EMT Supervisor grade within the National Ambulance Service (NAS). The NAS is currently under immense and sustained pressure to operate effectively and safely, both day and night. A critical and increasingly evident factor undermining service delivery is the severe shortage of supervisors on duty across the country.

Supervisors are fundamental to the safe and efficient running of the service. Their role is not peripheral, it is essential. On every shift, supervisors:

• Ensure emergency vehicles are safe, roadworthy, and within service limits

• Manage and replenish medication bags and controlled drugs

• Oversee fleet defects, servicing, and compliance

• Support staff operationally and clinically

• Troubleshoot issues that, if unresolved, directly reduce response capacity

In short, supervisors keep the wheels turning. Without adequate supervisory cover, ambulances are taken out of service unnecessarily, medication bags are not reliably restocked, staff are left unsupported, and patient care is indirectly compromised.

Over recent years, the progressive erosion of supervisor numbers – combined with a lack of active recruitment – has left the remaining supervisors carrying an unsustainable workload, often while continuing to work full-time frontline shifts. This is neither safe nor fair, and it is no longer viable.The ISP is therefore calling for:

• The full reinstatement and active recruitment of Paramedic and Advanced Paramedic Supervisors (LEMT grade), with appropriate recognition of the responsibility and accountability associated with the role.

• The establishment of an ICO/EMT Supervisor grade, reflecting the vital contribution of EMTs and ensuring appropriate supervision, support, and career progression across all frontline grades.

• The implementation of the 1:5 leading EMT to EMT/P/AP ratio – as agreed and signed by management and unions in Deployment of additional leading EMTs - Version 5.0, dated January 9th, 2007.

• Formal establishment of protected time for supervisors to perform their essential duties.

These measures are not optional enhancements, they are operational necessities. A modern ambulance service cannot function without a robust supervisory structure, and continued failure to address this deficit will only compound existing pressures on staff, vehicles, and patient safety.

We urge all unions representing NAS staff to engage constructively on this issue and to support a coordinated call for action. The ISP stands ready to work collaboratively with unions, management, and stakeholders to progress this matter in the best interests of staff and the public we serve.

This is a moment that requires leadership, foresight, and decisive action. The service cannot afford further delay.