Two short years ago, Health Minister Mary Harney announced that overcrowding in Irish emergency departments constituted a 'national emergency'. It is surprising then to discover that the 'Preparing for Major Emergencies' booklet that went through the letter boxes of every house in the country this week bears no mention of what one should do should they find themselves in an Irish A&E.

According to the booklet, the Health Minister is right. It defines a major emergency as 'an event which, usually with little or no warning, causes or threatens injury or death, or serious disruption of essential services.' So far so spot on in terms of Irish A&Es, with patients unexpectedly showing up in their droves, their sheer numbers threatening injury or death by virtue of the fact that the unit is unprepared to deal with them, disrupting essential hospital services as they go.

Where the booklet seemingly begs to differ with the Minister, however, is in terms of what should be done in the event of said emergency. It recommends the 'use of additional resources to ensure an efficient and effective response'. Doh! Maybe somebody should push this document through the Department of Health's letterbox.

Mary Harney's 'national emergency' statement coincided with the first meeting of the ED Task Force. It concluded its report in December 2006 but this was not published by the HSE until June 2007.

It found that seven of the 18 EDs were 'unfit for purpose'; that most EDs had inadequate physical infrastructure; and that key delays in EDs were due to inadequacies in hospital and community services. It recommended that the health system should adopt a 'zero tolerance' approach to trolley waits, with a six-hour total wait time cited as a realistic operational target.

Two years later and, according to the Irish Association of Emergency Medicine (IAEM), little or nothing has changed. Seven EDs are still 'unfit for purpose', most EDs have inadequate physical infrastructure and there is still a culture of acceptance of trolley waits.

Normal service was due to resume at UHG's A&E last Wednesday following a 'meltdown' at the unit the previous day that saw 40 people waiting on trolleys. But, as the second anniversary of the Minister of Health's 'national emergency' statement came and went, it now seems likely that 'normal' service is something Irish A&Es will never see. Maybe it's time for a booklet on what to do in the event of finding yourself in A&E.

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