John Kearney

In a country where economic collapse and emigration have decimated rural services of all types, local communities are creating new structures to save their own lives. Irish Community Rapid Response is creating a medical specialty to deal with emergencies; setting up local volunteer networks to capitalize on existing resources, build a highly reactive network of experts, and bring the ER out of the hospital and directly to the people who need it.

John Kearney is breaking down the traditional structures of emergency care and creating volunteer networks of responders to dramatically transform rural medicine. Through his organization, Irish Community Rapid Response (ICRR), he is creating desperately needed care systems for patients in rural areas, dramatically improving survival rates for time-urgent medical issues and saving lives. In times of acute medical need such as cardiac arrest, 70% of patients in Ireland, particularly in rural areas, die at home while waiting for care. Particularly in rural areas, ambulance services are overstretched and it can take hours before critically ill patients can reach an emergency care unit. John Kearney’s ICRR is focused on the “golden hour” – the critical time when high-level early intervention can save a life.
He is building a new field by creating a medical specialty in the gap between injury and hospital treatment: pre-hospital care. He is bringing the ER out to the patients, building a network of highly trained volunteer emergency medical personnel who can provide near-intensive care level treatment in life threatening circumstances in order to stabilize lives, building structures of community demand and support to spur growth. Beginning in Cork, John’s model creates community run rapid response teams trained in this pre-hospital specialty for medical emergencies throughout Ireland. He is utilizing existing resources and training them to operate at as high a level as ER-level doctors, in the field instead of in the hospital.
Partnering with national 999 services (equivalent to 911 in North America), ICRR offers the simultaneous deployment of off duty volunteer medical professionals including doctors, paramedics and other skilled practitioners such as police officers and fireman whenever a 999 emergency call is placed. ICRR supports each community team with infrastructure development, intensive bespoke training, and communication strategies to ensure that volunteers are organized and enabled to respond to medical emergency calls quickly and succinctly. ICRR volunteer response teams are provided frontline emergency response training, such as cardiopulmonary defibrillation, and are also supplied with proper equipment, such as Basic Life Support units, which can be transferred into existing ambulances as well as deployed in the field. As a result, community teams—similar to military medics in combat--are able to provide ER-level care, increasing the chances of recovery and survival.
John’s model builds a powerful current of community demand, creating local associations that allow rural areas to support their own medical care, fundraise locally, and dramatically improve their own safety in times of emergency. John is building partnerships with corporations, insurance companies, universities, and the Health Service Executive (national health department). He is designing new technologies to facilitate emergency telemedicine and local treatment. His model is rapidly expanding all over Ireland and has powerful implications for countries across Europe.

People in rural areas are at a significantly higher risk of dying during emergencies. The recession in Ireland brought cuts in rural services – from post offices to ambulance services. Much of the medical service for areas such as oncology was centralized in “centres of excellence” in Ireland’s three major cities. While this was an effective solution for these illnesses, it caused an increase in fatalities in rural areas for those medical emergencies where time is the deciding factor. 70% of those who face severe emergencies, such as heart attack, die at home in Ireland. In these incidences, the likelihood of death increases significantly with every passing minute without the right equipment and training. In much of rural Ireland, if an ambulance is even available, it can take over an hour to reach a sick person, making a two-hour delay in between an emergency and arrival at an ER. Ambulance workers have a main goal - -to get people back to the hospital as fast as possible – and they have a “ceiling” for the level of care they can administer at the scene, which includes administering oxygen and basic pain relief—an inadequate skill set to respond to deep trauma or urgent serious illness. There are also a limited number of ambulances available at all. For example, John’s home county of Cork is a two-hour drive from one end to the other, and the county as a whole has four ambulances available for use at any given time. Police officers often arrive at the scene earlier than ambulances, but do not have equipment, training, or permission to treat the injured.

Currently, some local off-duty medical professionals will respond on a volunteer basis to support emergencies in some rural areas. However this approach has great limitations such as unstructured response systems, lack of emergency training, and lack of proper equipment and support. Other programmes deal with small pockets or tackle smaller elements of the problem and are often inefficient. Organisations seeking to put more ambulances on the road do not address the key challenge that is lack of coordinated local personnel. Lack of communication and integration keep any initiatives from having systemic impact. There is a deep disconnect within the health system between management structures and medical personnel themselves. Built from this problem, ICRR is integrating the full spectrum of resources for immediate response.

John Kearney’s Irish Rapid Response is approaching the problem in a wholly new way – rather than upskilling untrained people or plugging a hole by expanding basic services, he is breaking down the traditional structures of the hospital altogether, building mechanisms to take the Intensive Care unit out to people in need, rather than bringing them back to the ICU in the hospital more quickly. He is training local people in a new medical specialty, placed between injury and the ER: pre-hospital specialists. At the same time, he is creating a national network of these local specialists who can deploy quickly to reach patients, like white blood cells.

This network is growing more robust and self-directing, as he is engaging with volunteers in regional zones to enable local action groups to lead the local roll-out – a key strategy for going national and international. The combined structure and approach is quite creative and unique in terms of his field. The local association model allows communities to ensure their own health, empowering them to create new structures to help themselves. The community driven approach (rather than trickling down from the Health Service Executive) builds the fabric of communities, connecting various health and public service professionals as well as local councils in a nationwide network. Local fundraising and demand also helps ensure sustainability.

John is training general practitioners (family doctors) first to operate as pre-hospital specialists at the Intensive Care level and equipping them with the tools and equipment—such as ultrasounds for detecting internal bleeding--they need to deliver that level of care in the field. From there, he is moving on to train front line operators like police, fireman, and Coast Guard staff to fill these needs as a second layer. His specialists can respond at the scene, before ambulances arrive, and jump into ambulances with their equipment to work on patients as they travel. Third, he is creating a layer of local volunteers to spur local action groups. He has partnered with University College Dublin to offer a bespoke training programme and is planning a maneuver training initiative as well as a central training centre. He hopes to work with other universities to build this pre-hospital specialty into their medical school training programs. In Ireland, there has never been a training organisation that worked with police, firemen, paramedics, coast guard, general practitioners, and more specialized doctors together.

John has designed several levels of service in structuring Irish rapid response: Bronze, Silver, and Gold. Bronze service includes lay people trained to basic levels of life support, off duty ambulance staff, as well as nurses. Silver service includes doctors who volunteer at advanced life support, bringing critical care as transport is coming. Gold service offers 24/7 advanced trauma teams with potential future air ambulances. Irish Community Rapid Response links in with local 999 services, with trained volunteers on call. If there is an emergency, they divert the call to the closest person – within 10 km – who has the intensive care level equipment and can respond quickly. ICRR is intentionally structured to operate on a part time basis to prevent shut downs of existing services. In 1/3 of current cases, an ambulance was rendered unnecessary entirely.

ICRR connects with general practitioners through their bespoke training programme with University College Dublin, developed initially by sending a local country general practitioner to an ER and designing it around him, as well as equipping ER doctors with head cams and studying their actions. ICRR staff work intensively to build individual relationships with general practitioners and equip them with tools and a network, connecting them with specialists, fireman, police, and hospital consultants. John sees this network building as another massive value-add and a key building block in transforming the system. It is building a network that connects GPs into "a larger picture" and improves communication and access to new innovation growing in pockets in Ireland. General practitioners are connected to specialists and lay health workers on the ground, along with specialists, who are tied to the hospitals. John says that his status as a “non-doctor” offers a level of neutrality that helps him bring together these disparate groups in collaboration. ICRR have strategic outreach to key medical people to draw them into the network. They are tied closely to 999 dispatch to allow for necessary deployment.

John currently supports his activities through a donation base from a wide variety of foundations and corporate sponsors, as well as a growing social business model, generating revenue through the sale of emergency medical equipment such as first aid kits and defibrillators, the proceeds of which go back into ICRR. He is developing three levels of a home first responder kit bag that will have everything necessary to save a life, at a dramatically reduced cost. In 2016, all cars in the EU (new and existing) will be legally required to have a first aid kit. John is capitalizing on this market by offering ICRR bags that fund his work. For example, his defibrillator costs €200 per year, when most others cost €1500. He is also designing a defibrillator that can be plugged into a smartphone, as well as apps which can help people in emergencies, and head-cam tele-medicine with doctors on call.

John’s local association model means that each area will be responsible for raising its own funds, which will spread the fundraising burden. At the same time, he has created a centralized structure and support base to ensure a coordinated strategy and avoid fragmentation and unequal regional funding support. He has forged very close relationships with local town councils, which are keen to support ICRR as a funding partner. In several locations, local government councils fund the overhead and administration costs of ICRR, allowing John to apply every euro donated by the public directly to saving lives. In the next two years, he plans to increase corporate sponsorship, charge for bespoke trainings, host a fundraising conference, and expand his merchandise offers to expand the fundraising base. John is also exploring service contracts with Ireland’s public health services (HSE), based on cost savings to the government that the ICRR network creates. He is keen to keep ICRR from turning into “an extension of the civil service,” cultivating a partnership that is “independent, community-based, flexible, and cheap: “We bill them – they don’t pay us.”

Each Rapid Response Merit 3 general practitioner has an initial start up cost of €3000 and ongoing running of €1,000 per year. A rapid response doctor has a start up cost of €40,000 and ongoing of €20,000, meaning that if each rapid response saves 20 lives, each life saved costs roughly €3,100. For every 1000 Rapid Response Call Outs, 20 emergency ambulance hours are freed up.

In just one year, ICRR’s network of rapid response teams has deployed more than 100 doctors to assist nearly 500 patients with an estimated 2 lives saved each month as a result of this service. ICRR is on track to triple its fleet of General Practitioners to 300 over the next three years. The University College Dublin training program will scale the ICRR model to other specialized 999 services including police and fire, who often arrive before ambulance services and are powerless to help the injured. Beginning in Western and Eastern Cork (Ireland’s southernmost county), ICRR is now being scaled to 11 different counties around Ireland. John is developing technological tools that will allow for much faster expansion here and internationally – web platforms for local associations, camera tools for emergency telemedicine, and apps to upskill specialists.

Born, raised, and based in Baltimore in West Cork, a harbor town on the very southernmost point of Ireland, John has been entrepreneurial since childhood. He began working in his parents’ bar at age seven. At age ten, he got a job delivering ice cream all over the region. He saw a lot of broken cones being thrown out, and asked the creamery director if he could have them. He set up a small business selling them to classmates. He was put out of business when the creamery manager realized how much he was destroying local sales figures through his broken cone business. When teachers at his local school went on strike, cancelling classes, John organized a student strike across three schools to protest it; requiring the department of Education to send in negotiators. After his parents split up, John was largely responsible for raising his two younger brothers, which limited the time he had to focus on school.

John joined the Irish Navy and became a diver, where he first began to experience rescue and recovery. He became a pilot and traveled the world – a big ambition for a person from his hometown. After living in a number of countries John returned home and opened his own dive shop at age twenty-two, and set up a dry-suit manufacturing business on the small island of Cape Clear, off the coast of Baltimore, West Cork. A serial entrepreneur, he began to build a tourist market for the diving and other initiatives, including shipwreck trips and energy efficient real estate. His own diving took him on a lot of adventures, including work inspecting Titanic artifacts as they were removed by submersible from the wreck.

He also led the community effort to buy and save a local hotel and health club that was going out of business, leaving the small town without a leisure center. He took over the hotel as a community project. As part of this work, he set up a community networking group called “Community Creating Jobs” to help address the employment gap in his local area. Later, he set up West Cork Tourism and three separate restaurants to bring money back home. As he described it, he has “made and lost fortunes” and “loves when people tell him he can’t do something,” working on entrepreneurial ventures such as sustainable housing and gluten-free breaded fish, which he built into a significant export business.

After the birth of his daughter, John felt his priorities begin to change, and he started to focus more on what contribution he could make for others. A lifeboat volunteer and trained paramedic, he saw the need for a transformation of the emergency medical system. This need struck very close to home. A friend’s child died due to an urgent issue when medical practitioners could not reach this child in time due to the small roads and isolated location in West Cork. Later, a close friend became ill during a dive and John managed to get him to the necessary decompression chamber himself, driving him and arranging an escort from the local fire department. Though his life was saved, he was permanently paralyzed “the only reason being lack of early stage treatment.” John got eight people together with the goal of starting an “air ambulance” service to change the medical mentality, moving to the more strategic idea of a mobile intensive care unit, the core of which became Irish Community Rapid Response.

Among his many accomplishments, John is also a long distance swimmer, having swum the English Channel three times. With regards to his work, he says, “give me a messy situation – that is my adrenaline.”