The HSE has been fined €500,000 for health and safety breaches, which led to the death of a paramedic who fell out of a moving ambulance.

The safety breaches relate to doors on the side of the ambulance, which have hinges at the rear.

This means they can get caught in the slipstream if opened while the ambulance is moving.

Paramedic and father-of-six Simon Sexton, 43, was killed in June 2010 when he was wrenched out of the moving ambulance by the door as a patient was being transferred from Cavan to Dublin.

Dublin Circuit Criminal Court heard that the HSE was aware of the risk after a similar incident occurred in Kerry in 2007. A paramedic suffered serious head injuries in that incident.

The court heard that following the Kerry incident, several safety recommendations were made, which were not implemented by the HSE.

A Health and Safety Authority inspector also said that at the time of the 2007 incident, the HSE was waiting on delivery of about 40 ambulances with similar doors. The manufacturers offered to alter the doors before delivery to remove the danger, but the HSE refused.

Judge Mary Ellen Ring said: "A fine doesn't reflect, in any case, the seriousness of what this court is dealing with. No fine can ever restore Simon Sexton."

She said any fine imposed is not to reflect the value his life.

She added that if the problems were dealt with after 2007 "perhaps Mr Sexton might be with us today".

Imposing the €500,000 fine, she also noted the HSE "is a public body which has many demands made of it. Those demands are ever increasing and resources are ever diminishing".

The HSE pleaded guilty to failing to have a written assessment of the risks to the safety, health and welfare of an employee relating to the rear hinge side door of an ambulance on 3 June, 2010 at Dr Steevens' Hospital in Dublin.

They also admitted to failure to ensure employees had adequate training in the operation of the ambulance rear doors.

HSA Inspector John Sheeran told prosecuting counsel Remy Farrell SC that after the 2007 incident the HSE hired an engineer to make recommendations on making the doors safer.

The engineer advised that warning signs be placed in the vehicle, that an improved door alarm system be installed and that a visual alarm should be mounted in the cab to indicate if the door is open.

The court heard that the HSE only enacted some of these recommendations on Mr Sexton's ambulance.

Warning signs were put in place and an improved door alarm was installed, but it is not clear if it was working on the day of his death.

Mr Sexton was in the back of the ambulance when he heard the wind coming into the vehicle, indicating the door was not shut properly.

He went to close it and as he put his hand on the lever the door opened and "wrenched him out".

His colleagues found him unconscious at the side of the road. He had suffered serious head injuries and died shortly afterwards.

Following his death, the HSA conducted an investigation and discovered none of the paramedics they interviewed had been formally briefed on the dangers of the door.

After the 2007 incident, the HSE was in the process of ordering a new batch of ambulances with the same doors.

The manufacturers offered to alter the doors at no extra cost so that the hinges were at the front, but the HSE rejected the offer.

No reason was given in court for rejecting the offer, but the HSE defence counsel said it was not a fiscally driven decision.

The court heard that since the 2010 incident all ambulances have been altered to include front facing hinges along with several other safety measures.

Defence counsel Shane Murphy SC offered the "sincere apologies" of the HSE for the incident.

He said it was a tragic incident that should not have occurred but asked the judge to note that steps have been taken to ensure it is not repeated.

He said the HSE had fully co-operated with the investigations and that they have operated a large fleet of vehicles without any other incidents.