Wednesday 8 October 2014

A Bad Habit

"50 year old female, back pain, #111"

I pulled up outside the house, grabbed my bags and a full PRF and headed in. On the car, we use mini-PRFs as we normally hand over to the crew. If we leave someone at home then a full size PRF is completed enabling you to go into further detail. This patient was not going to be going to hospital! A one week history of back pain in the middle of the night was not an emergency, nor did it need to waste the time of a busy A & E, a heaving walk in centre or a snowed under out of hours GP. 

I listened careful to every word about the back pain and followed up with a long list of probing questions. Sometimes it only requires a few, others it requires an very in depth history. This was somewhere in the middle. I assessed her pain, her mobility and decided she, as predicted, had non-traumatic back pain with no relation to the heart. I did an ECG, and all her observations. All were absolutely fine. She hadn't taken pain killers or anti-inflamatories so I gave her both and left her with advice for now and future. She was a perfectly nice woman, polite, offered me coffee and some food so I have no complaints. I declined all the offers, said goodnight and headed back into the darkness. 

I have ranted at length before about people not using the ambulance service appropriately. In fact, its not just about the use of the ambulance service, it's about the use of NHS services as a whole. Mis-use of GPs, A & E and NHS111 all lead to a strain being placed on an already stretched service, but why?! Why do people do this?! I refuse to believe it is just about education and that people didn't know what they were really doing when they called 999.  They know exactly what they are doing! 

They know when the GP receptionist says 'is this an emergency?' the patients (myself included in the past) will say 'yes' invariably! Why? Because they will get an appointment. They also know if they mention discomfort in their chest when phoning 999, they will get an ambulance quicker. The fact is, the way patient uses the NHS is relative to their previous experience. If someone can never get a GP appointment, they'll lie to get one. If someone had to wait 4 hours for an ambulance, they'll lie to get one quicker. If someone had a bad experience at an A & E, they'll tell you they are under a different hospital to avoid going there. Previous experience will always mould future behaviour, it's basic human instinct. 

The problem is, like I have discussed before, experience is so varied depending on postcode and area,  and will also be heavily swayed by the quality of staff who deals with you. For example, say I've not been feeling right for a few days. I would phone my GP, it's not an emergency so I'm offered an appointment in 10 days time. That's no help really but I take it. 10 days later I may or may not be feeling better and I go to my appointment. The GP decides I need bloods. He gives me a letter, I then I have to go to  blood clinic which is miles away. Anyway, I go. I take a ticket, wait ages in line, get my bloods and go home. I'll never get those results unless something is wrong. That said, it could be an anxious wait. All in all, after a phone call, a 10 day wait, a trip to another hospital for bloods and then a week wait for the all clear I'm done. Alternatively, I could go to A & E, ham it up a little, get my bloods taken, wait 4 hours for the results and get discharged with piece of mind by a doctor. What's preferable to the patients?! 

This is why year on year ambulance services and hospitals are getting over run! Because between us we provide a one-stop-shop fix to most of our patients. People who are anxious about something want an ambulance to merely give them a check up. They say they can't get a GP appointment so we are the only option they see as viable. It's not the GPs fault either, they are over run with 1000s of people with the most minor or ailments who simply can't cope with a days pain or discomfort. We as a country are become less and less able to deal with illness! And why?! Because we have been nannied for too long! People can no longer cope with a cold or a chest infection. There is a huge expectation on what medical professionals can do and the magic wands that we carry. 

I think there are two things that have to happen. I think a move away from the traditional GP surgery and a greater use of GP led walk in centres and urgent care centres needs to continue to grow. Secondly, the NHS has to stop being so risk adverse and needs to say no to people. The second someone says they have had their back pain for 5 days you say no. No ambulance. No GP appointment. Go to your nearest Walk In Centre using your own means of travel, a bus or a taxi and wait to be seen. Don't do that until you've attempted treating it yourself with pain killers, anti-inflamatiries, heat packs and rest. The problem is, that conversation and history taking takes time. The government insist on the absurd 8 minute target so the ambulance service is forced to use a triage system that is scared of saying no quickly. The use of others take longer and that is time we don't have. 

The old adage of everyone needing to work together is a cliche, but true. GPs need to work with other areas of healthcare more closely, as do ambulance services and A & Es. The problem is, everyone has their own pressures and their own targets to meet and that is the priority to each trust. No one wants fines for failing. Therefore, just as with the patients, organisations behaviour is relevant to previous experience. If they have been fined in the past, they will do everything possible to avoid it in the future. If that means abusing another trust, department or organisation then so be it. 

We are all in this together, but we aren't working together to fix it.

Monday 6 October 2014

The Good, The Bad and the Ugly

"66 year old institution, near collapse."

I don't really know where to start on this one. Usually I am ready to commentate on all things ambulance, especially when we are in the news, being thrown under the bus or maligned. A few months back The Spectator published the first of two articles regarding the current crisis within the ambulance service. It touches upon the amount of frontline staff leaving in their droves, and asks the very simple question, why? Fast forward a month and a second article was published, in what was a hard hitting, painful accurate portrayal of the crisis facing Londoners and all the ambulance services up and down the country. The official line, was that everyone was leaving because of pay and cost of living. Sadly, this couldn't be further from the truth. Whilst the article had some inaccuracies and was biased in some areas, the theme and overall mood of the piece was spot on. 

As I sat doing paperwork after dealing with a total time waster I listened to an urgent request for a vehicle, for a child vs a bus, trapped and screaming. I was a good 10 miles away but offered up all the same. 18 minutes later, I was shocked to discover that I was first on scene, on my own, in a car. To cut a future post short, the injuries were horrific, the child was in a grave situation and there was so much to do in terms of injury management that I needed more than my pair of hands. Unfortunately, more pairs were not forthcoming. It was an hour before backup arrived. An hour with a patient who's injuries still haunt me. An hour with the crying, screaming, panicked family, friends, neighbours and members of the public. If there was ever a situation to highlight the current crisis, it was here and now. With call demand rising week on week, staff leaving day by day and sick levels at an all time high, it certainly feels from where I am sitting that there is no way out. It feels like the ship is sinking, and everyone around me is jumping.

Over years of working with the same people, you forge very close friendships. Friendships which in many ways you rely on as part of your working day. I ended up with a close group of 5-6 friends with whom I could laugh with, confide in and socialise with. Within the last 12 months, all of them have left. Some to other ambulance services, others to other areas of healthcare. None of them cited money as the reason for leaving. The main theme was a lack of respect, lack of career progression, exhaustion and working conditions. The ones who went to other areas of healthcare, who don't necessarily enjoy their new job say 'well at least it's not the ambulance service'. People have quite simply had enough. 

From a personal point of view, I stopped blogging because I had nothing positive to say. Every day at work filled me with more negativity. And negativity breeds negativity. There was nothing I could write, without it sounding miserable and that's not what I'm about. The crisis within the ambulance service is caused by a domino effect of knee-jerk reactions from top to bottom of the NHS. The main issue from where I am standing, is the fact that for too long, the NHS functioned well but propped up by good will. Remove the good will, and everything slowly collapses. 

The Tory government insisted on huge cuts across the board and no matter what comes after, these ill advised, poorly implemented cuts to aid privatisation are the root cause of the problems. They are not the sole reason behind the current crisis though. Ambulance chiefs had to make savings but did so in panic and with what appears to be with little thought or planning. Again, it was a knee-jerk reaction. The problem was, in the panic, they made cuts in the three areas where cuts should never be made. They stopped investing in recruitment, the stopped investing in training and stopped investing in equipment. That left what was essentially a time bomb, and sure enough, 4-5 years on, that bomb has exploded. Richard Branson once said that "you must train your staff well enough so they can leave and treat them well enough that they don't want to". By doing the opposite, a mass exodus was inevitable. Unfortunately, by dangling the carrot of money, the service continued to just about cope with a lack of staff by filling the gaps on overtime. Time and a half, then double time, then triple, then double plus a bonus, then triple plus a bonus. Whilst this happened though, the void behind the good will got bigger and bigger. Eventually, the good will wasn't enough and in many cases stopped altogether. Fed up with being run ragged day after day, on an ancient, poorly kitted vehicle, with no rest break, having had no training for 5 years, and no prospect of career profession people left and on mass. In my service by all accounts it has been 30+ leaving a month, for a long time. And now the exodus won't stop. Day after day, you hear of more good people leaving. And none of them are citing money or cost of living as the reason. At least not to their friends and colleagues. 

The management are trying to solve the problem, they really are, but there is only so much that they can do. The problem is though, they made widespread, wholesale changes to the working lives and practices of staff with little consultation. In fairness, the changes had to be made. Again, it was the lack of change in a previous regime that led to it, but it's one thing to change practices during the working day, another to effect peoples family life. As much as this has had a negative effect on staff, this didn't cause the crisis, it was more a result of the crisis. Morale is at such a low ebb now, every promise of new staff, new vehicles and more training is met with cynicism, sarcasm and more resignations, and in many ways, rightly so. There is no trust any more. Unfortunately, the actions of previous management teams will continue to make the current ones efforts to solve it, near impossible.

This is the point at which I am getting frustrated though. It is all very well moaning about what is wrong, but personally, if you're going to moan, you have to be willing to work to help fix it. Sadly, you're left with half a workforce who are willing to help change things, willing to make positive suggestions and act upon them, and other half who won't, who block positive change, dig heels in and who spread a feeling of bad will throughout the work force. And it is THIS makes any positive change very slow to appear. Too slow in fact, to stop the rot. I also think the unions should be bearing the brunt of the blame when it comes to this. For too long they didn't represent the interests of the staff. The reps looked after themselves and saw their role as a great opportunity for time off the road, ignoring the wishes and concerns of large chunks of new staff and relief staff all because they were not considered  'core staff'. This fragmentation has led to the divide in working relations and is the cause of many newly qualified paramedics leaving the service after just a few months service.

The problems have been caused not only by lack of funding and lack of management but also poor working practice on behalf of some front line staff, throughout the NHS. It would be unfair to lay all the blame on the doorstep of managers. We as a work force should be taking responsibility for some of the issues we are faced. Call volume is at an all time high, the consequences of which we all face,  and various initiatives are being brought in to combat this. Hear and Treat, alternative care pathways, various streaming techniques and patient ring backs are all being used to try and lessen the impact on hospitals and the service. Not all staff are willing to help though. There are those who will take everyone to hospital because 'that's my job'. It is all well coming up with a solution but if everyone doesn't pull in the same direction you're left with a stalemate. 

There are some FRU's who cancel most ambulances, discharge and refer and try to save resources. There are others who won't cancel an ambulance and deal with the patient themselves because it means more paperwork or they are too risk adverse. There are ambulance crews who use as many alternative care pathways as possible and will offer up for calls being held. There are others who will sit there and not offer up for even a cardiac arrest being broadcasted because they are fed up being off late or haven't finished their tea. There are staff who drag their heels with everything they do from activation to at hospital times, just because they have had enough. There are some team leaders who are proactive and look after their staff, keep them current with their development and lead by example clinically. There are others who do literally nothing for their team and just come to work, take everyone to hospital and go home. There are good managers who manage staff well, and bad managers who don't. All positive dealings with any job role, any department and any service is always superceeded by the bad experiences. And here for me is where the problem lies. There are the good and the bad in every level, throughout the ambulance service and naturally, it is the bad that stalls progress. For too long the NHS has allowed bag eggs to stay in their jobs, preventing good people from progessing. There is a culture of blame and no cohesion within the ambulance service and people quickly become disillusoned. The camaraderie that once was, is diminished. The good will that held the service up is gone. The pride in the job we once had, is non-existent and you're left with a self destructive, miserable, tired workforce. 

And who suffers because of all of this infighting, poor working practice, bad management, budget cuts, staff resignations? The patients. The boy lying in front of me, screaming, his parents crying, his friends terrified. They don't care about all the crap. They don't care if we are recruiting from abroad. They don't care in our training course was cancelled. They don't care if it's the fault of the government or the fault of the previous management team. They don't care if the ambulance is old or if our rotas are changing. They care about why there is no ambulance in the here and now. We all have issues, but we have one fundamental responsibility, and that is to provide care to the people who need it, when they need it, in a professional and timely fashion. Anything short of that is a critical failure. 

The ambulance service is broken, there is no hiding from that, but if we want to fix it, everyone has to work for it. There is no switch, no quick fix. There are some people who need to take a long hard look at themselves and decide if this is the job for them. In the last few months I have been disgusted with the attitudes of some and the behaviour of others. It's disruptive and doesn't help the problem. There is so much to be proud of within the NHS, but if we continue to act to the detriment of the patients, it will only pave the way for full privatisation, and that would be a grave grave day. If you are not part of the solution, you are part of the problem. 

Friday 30 May 2014

The Students Guide To Blogging

This post is the result of various requests and emails I have had over the last few months, mainly from student paramedics. Being 2014 and very much an online world, prospective students and current students, and indeed anyone else, turns to the Internet to find out what the job is like from the people doing the jobs. Many, it appears have stumbled across my blog as a point of reference! In a number of cases, it has led them to want to start their own blog of their experiences from training, all the way through to qualifying! I've been asked the same questions on a number of occasions so thought I'd stick my answers into a post for them, and anyone else, whatever level, who was considering starting an ambulance blog or similar. These are my views from my experiences and by no means are a strict set of rules! However, they have kept me out of trouble and generally well received! 

For The Love Of God, Why?!

Why are you blogging? Seems a stupid question to ask, but the answer will impact on how successful you are and how much you enjoy writing it. My only advise on this matter, is to write it for you and you alone. If you start writing what you think other people want you to write or hear, invariably it won't work. Don't try and be something you're not and don't lie. By lying, I mean to embellish to point it's unbelievable. Don't pretend you are doing things way outside you clinical scope of practise. By all means you can and should use poetic license but do so for the right reasons. Also, don't write wanted fame, fortune, awards and a book deal! If you deserve any of the above, it will come to you because of your writing, not because you want it to happen! Trust me, I'm still waiting patiently for all of the above! ;)

To Be (Anonymous) or Not To Be?

This is one of the biggest decisions when you start out. Do you write anonymously, or as yourself. There are advantages to both and don't rush the decision. Personally, I decided to write under a pseudonym. I felt I had more freedom of expression anonymously and I wouldn't get personally judged face to face. That said, being anonymous also has it's drawbacks and frustrations. Do whatever is right for you. What I would say, is try to avoid being anonymous because you think you can get away with saying what you want. You really can't and if you overstep the line, you'll quickly find your anonymity isn't as sacred as you may like.

Do You Want The Sack?

Will you get in trouble? You might. Firstly it depends on your employer and their social media policy and secondly, it depends what you write! Although I write anonymously, I have been made aware that my employer is aware of who I am! Why am I still writing? Because I haven't crossed a line. At no point in any of my posts have I ever mentioned the name of who employs me, nor have I ever criticised them. Sure, like all organisations, the one I work for has its faults, but by openly criticising them I'm simply putting a target on me! It is also not why I started a blog. I started to share my experiences, good and bad, in my life as a paramedic. I didn't do it to moan about policy and procedure and personally, I don't think that content has any place in a blog of this kind. Be all means ignore me, but I know of plenty who have fallen foul of this and paid the price. Be wise!

Confidentiality 101

As a healthcare professional you have a duty to protect the anonymity and confidentiality of your patients. As a paramedic, you not only have to respect this on behalf of your employer, but also the HCPC. Follow the codes of conduct and don't write anything that could be linked back to a specific patient. No names, no addresses, no nothing that could lead anyone back to them! And no bloody photos! How you do this is down to you, but there are plenty of jobs I would love to write about, but they are just too high profile. I change the ages, the sexes, the circumstances and everything else I can to protect the identity of my patients. Sure, what is left is as much a work of fiction as it is reality, but I get my point across. I also don't publish posts immediately after the event. Always leave it as long as you can. If you think 'I might get in trouble for this post' then you probably will!

Don't Be An Idiot!

It goes without saying, that if you are writing about your treatment of a patient, don't write things which are clinically wrong or incompetent. Don't write about giving Diazepam to someone with back pain, when you know it isn't indicated! At work, you always act within your guidelines and scope of practise, don't change that when you write! You need to think about each post and stand by it. If you can justify everything you did and everything you have written then the chances are it's fine. If you have doubts about part of it, get rid of them!

Haters gonna Hate!

If you are publishing a blog it is in the public domain. If you allow comments, anyone can comment. Remember that. Also remember that no matter how hard you try and no matter how well you think you did something, there will always be someone who thinks different, and they will tell you. There will be people who hate you! I used to let it bother me but try not to let it! You'll find some bloggers will be supportive of you, some will be negative. Some think they are wildly superior and will get their cronies to say the same as them. Ignore it all! Two years ago I was told I was unprofessional and no place in the blogging community. Well, jump forward two year, 1,000,000 blog hits later and finalist in various blog competitions, those words and threats mean nothing. Remember, write for you and only you! Also, you write about a controversial subject you are guaranteeing negativity. Personally, I enjoy being the fox in the hen house. I'm an opinionated know it all and will say what I think! That may not be your style, but if it is, expect the agro that can and will follow!

Share Share Share

USE SOCIAL MEDIA! People won't happen across your blog and become an avid reader. You need to put it out there. Get on Twitter, Facebook, Bloglovin etc and talk to people! Invite bloggers to guest blog on your page to get people reading! When you start out you want to post regularly so people have stuff to read! However, if you have nothing to write about, don't force the issue! Talk to people, start conversations, engage in conversations. Just get out there! Have your own opinions and share them! No one wants to read about someone sitting on the fence! If you don't want it 'out there' then write each post in a book instead and start it off with 'Dear Diary'. 

Jerry's Final Thought

Finally, enjoy it! I write because I enjoy writing! Plain and simple. I stop blogging from time to time and take a long break, mainly because I lose enjoyment. When you aren't enjoying writing, it shows. The social media and blogging community can be such a welcoming place. There are great people out there, some of who are now my closest friends. Just because yours is an ambulance blog, that doesn't mean you can only interact with similar! I hardly talk to any ambulance bloggers (Apart from Binder, his antics amuse me). There are police bloggers (MentalHealthCop), family bloggers (MamaOwl), parenting bloggers (MyTwoMums), fashion bloggers (BigFashionista - bitchy opinions for free) and many many more to enjoy! So go and enjoy them! You'll get much more out of blogging if you don't seclude yourself to one small group of people!

Get involved and don't be an idiot! 

PS: You know what I said about haters? If I see any of you hating on me, I'm gonna hunt you down!

The X Factor

“45 year old male, bleeding penis”

Yes, I’m a 6 year old. When the word ‘penis’ appears on the screen in front of me I laugh, every time! Actually it’s more of a snigger, but still, I’ll admit I’m a child! Unsurprisingly, neither my crew mate or myself wanted to have to examine a bleeding penis. We don’t even need to see it. There is nothing we are likely to do other than get the patient to apply pressure themselves. I certainly won’t be applying any direct or indirect pressure to a strangers penis (unless utterly necessary) ! The amazing thing about a bleeding penis, or any penis injury for that matter is the fact that the patients are always desperate to show us! FYI, unless it’s been cut off, or severed, we don’t want to see it! We have absolutely no training on penis injuries and therefor all we would be doing is looking and agreeing with you that it is indeed bleeding / weeping / swollen or erect, none of which I want to see! 

Anyway, what made this particular bleeding penis all the more ridiculous was the other information we got on route.

UPDATE: “45 year old male, bleeding penis, had circumcision today, now swollen and bleeding”

You don’t say! Surely, if you’ve had part of your old fella' chopped off, it would a) have a wound which may bleed and b) swell up! Unfortunately for me, I was on the board and my crew mate made it perfectly clear that if said penis made an appearance, I would have to look at it! Dammit! 

We pulled up to the house and were met at the door by the patient's girlfriend. She led us into the lounge where our patient was sat on a chair, holding a tea towel down his pants. I introduced myself and started my questions about what happened, why he was concerned and how much it was bleeding. Without warning he was suddenly standing up, trousers round his ankles and his swollen, bleeding penis was presented to me like an Amuse Bouche. I gave it cursory glance and suggested he could re-dress himself! I also agreed with him that it appeared to be bleeding slightly. I told him that as I wasn’t familiar with his penis I couldn’t comment on the swelling situation! 

As the surgery was today, we decided to pop him back up to the hospital as it would be seen as a failed discharge, and hopefully he could get his little major looked at by a penis specialist! We got him and his girlfriend onto the ambulance and headed off.

It was at this point, that what was already a rather awkward situation became a lot worse! His girlfriend was very chatty and talked constantly about how talented her daughter was. I smiled and nodded and feigned interest, which backfired somewhat. Apparently she was an extremely talented singer and was going to be on the X Factor. Again, I did a good job of showing surprise and interest. This only encouraged her more and before I knew it, I was presented with a phone. A video of her daughter on YouTube began to play…..

Just so you know, I HATE the X Factor. I think it’s atrocious! I hate how talentless people have been convinced or convinced themselves that they have talent, and then they are paraded on TV like a performing chimpanzee, much to the amusement of the audience! Well, in horror, I sat through this girls video of her destroying Celine Dion's My Heart Will Go On! Without going into detail, she also didn’t have a pop-star look! It was awful! Her voice was painful to listen to, but what could I do! I smiled and had to agree that she was really good, only fuelling the false hope! I could envisage the conversation…. “Even the paramedic who came to us thought you were brilliant.” Gaaaahhh! Three minutes later, the torture ended and I passed the phone back. I hoped that starring intently at my paperwork with a furrowed brow would keep the talent sharing at bay!

I continued to ask penis related questions to the patient when suddenly the phone appeared in front me again. This time, Avril Lavigne's Skater Boy was getting massacred. I sat in stunned silence unsure of how to proceed or where to look. Do I listen and compliment, while ignoring the patient and his bleeding penis or do I concentrate on a bleeding penis and pass the phone back, possibly insulting the girlfriend? I didn’t even have the luxury of a red buzzer to end the madness! Being in my ambulance it was like the NHS version of Judges Houses! My crew mate was well aware of the torture I was enduring and found the whole thing hilarious. It was the longest journey to hospital I have experienced. It turns out this was because my crew mate took a scenic route and drove as slowly as possible. He did so under the guise of ensuring a smooth and comfortable journey to ensure excellent patient comfort was maintained. There will be revenge, that I can assure you!
continued to ask p, Avril Lavigne's

Eventually we got to hospital and I was able to escape! As I left the department I heard a nurse bringing told all about the talented family they had! I'm sure she neither wanted to hear about it, or see a swollen bleeding penis. Unfortunately for her, she was about to get an earful and eyeful both! 

Wednesday 28 May 2014

The Generation Gap

"28 year old male, fall, hip injury"

One of my greatest frustrations about this job is how the elderly don't want to be a burden on us when they need us most, mirrored by young people seemingly being unable to cope without us. The sheer volume of people aged between 16 - 40 who call 999 with a worrying frequency is putting a huge strain on the NHS. People in this age group with coughs and colds, minor injuries and other such benign ailments seem intent to call us out as a first port of call. On the other side of the coin, you have an 80 year old woman who has been lying on the floor, unable to get up for two hours but didn't ask for help through fear of causing us too much work. The amount of young people who spend their days lounging on the sofa is really quite startling. People really need to get a grip! 

This job was a case in point. The location was at the gym, in the shower rooms. I refused to believe that a 28 year old could have broken his hip and if I was correct, there was absolutely no reason an ambulance was needed. We were met by staff at the door who informed me that against advice he had been helped up, got dressed and was sitting on a chair waiting for us. Really?! I was all ready for one of my 'why can't you make your own way?' lectures when a break down in communication became apparent! 

"Hello sir! Forgive me, but you are not 28 are you?!"

"I'm afraid not! I can't even remember being 28!"

"How old are you?!"

"I'm 98 but today is the first time I felt it!"

He was sat there in a wheelchair, in a suit and flat cap and didn't look a day over 70!

"Well you don't look it! What's happened today Sir?"

"Well I came for my yoga class and slipped over in the shower afterwards, now everyone is making a bloody fuss."

"Wow! Yoga at 98, that's amazing! More importantly, I was told you'd hurt your hip? Have you got pain anywhere?"

"Well my hip is a bit sore. But nothing too bad I don't think."

"OK, well I'll check you over, give you a quick MOT and see if you need anything. Sound like a plan?!"

"You just do what you've got to do duck!"

It turned out that this lovely old man comes to the gym three times a week for different classes! He does yoga, water aerobics and a seniors spin class! I did ask if he did Body Pump, but he just laughed and said that was a young'uns game!

Unfortunately, I quickly established that he had indeed broken his hip. How he had got himself up and dressed I don't know! I broke the news to him and his was viably frustrated and rather upset. Clearly a man of routine and activity, the thought and prospect of resting was not one that sat well with him. 

He declined all pain relief and was content to just sit in the chair until the ambulance arrived to take him off to hospital. What a guy! 98!!

The rest of the shift continued to pass without incident, although it also passed without any characters quit like my elderly fitness fanatic! I had time for one more job......

"23 year old male, abdo pain"

I suspected this was going to be one of those 'bite lip and count to ten' type jobs. As the CAD updated on route, the more information I got, the more frustrated I became! 'Feels nauseous, has a headache, feeling dizzy, already seen GP, now feeling worse'. Oh please! For the love of god, people need to just cope! Unless he had a ruptured appendix or a diagnosed chronic condition he was making a mountain out of a mole hill! I was desperately trying to reserve judgement until I arrived, but it's a hard thing to do!

I was met at the front door by his girlfriend who looked wholly unimpressed by the entire situation. I'm not surprised! I could see him lying on the floor in the background, writhing around and groaning. 

"What's the problem today?"


"What's the problem today?"

"Aaarrrgghhuuurrrghhg. My stomach."

"What about your stomach?"


"What about your stomach?!" my voice now sounded more and more frustrated.


I looked at his girlfriend in frustration! 

"He's got a stomach ache and heart burn. He saw the doctor who said it was reflux and gave him these." (Omperazole, Paracetomol & Gaviscon Advance)

"Thank you, are you going to talk to me?!" I said as I took a seat.

"Aaarrrgghhuuurrrghhg. it hurts."

"Have you taken your pain killers or the Gaviscon because it doesn't look opened."

"Aaarrrgghhuuurrrghhg. Not yet. I can't just be reflux so I haven't bothered."

This was a red flag to a bull! I gave him a rare telling off and told him he needed to buck his ideas up. I assured him I wouldn't be crawling on the floor to examine him and if he wanted my help after calling 999 then he would need to get up off the floor, sit down and start answering my questions with answers, as opposed to groans. I also let him know the cost to the NHS for an FRU and an ambulance  and that so far, he was just abusive the privilege of having one.

I think he was a little stunned that he had called 999 and was getting told off, not mothered, but it had the desired effect. After a minute of over-acting in getting up he was sat upright in his chair and I gave him a full examination. His abdomen was fine, all his OBs were fine, there was no signs of an infection and the history he eventually gave, combined with the description of pain led me to agree with the GP. Reflux. 

I told him he didn't need to go to hospital but he felt he did. His reasoning behind this was that tomorrow was his first day in his new job and he wouldn't be well enough to go so therefore going to hospital would mean he could get a letter etc etc. I told him that's not how it works and that I would be cancelling the ambulance. I don't think I was his favourite person! 

To be honest though, sometimes we have to be strict! There are finite resources available and when people are using them incorrectly they need to be told! These two jobs highlighted the huge generation gap that exists in the tolerance of illness and injury. Unfortunately, the elderly will continue to see themselves as a burden and the young ones will continue to see all treatment and resources as their divine right. The knock on effect will be, in 20 years when our current elderly generation are gone, we will be left with the next generation of people who have been brought up thinking that you dial 999 when you don't feel well, not just in emergencies! I suppose the problem lies in the perception of what an emergency is. Clearly the advertising campaigns to date need some work!