Monday 7 November 2011

To Blue or Not to Blue?

"30 year old male, unconscious"

Can I just say, before I rant, I like nurses. Most, who I come into contact with are very nice indeed. Some are a bit moody, some are a bit snappish, some epitomise the 'matron' we all fear but generally I won't have a bad word to say about them. Generally.

We arrived on scene and soon realised it was the same guy we picked up yesterday. An alcoholic. He was a young guy, about 30, well dressed, but clearly fallen on bad times. He was lying at the bus stop, on the floor, empty bottle of vodka next to him. A picture paints 1000 words. Attending so many alcohol related calls can and does become frustrating and it's easy to become complacent and lazy. I try not too. You never know when complacency will bite you in the arse. Due to my over caution and paranoia this 'drunk' got assessed and treated the same as everyone else.

A quick primary survey told me his airway was slightly compromised, his respiratory rate was low, around 8 breaths a minute, and he a weak radial pulse, probably due to low blood pressure. We loaded him on to the bed, I inserted an oropharangeal (OP) airway and my cremate 'bagged' him while I put some fluids up. We also raised his legs to try and raise the profound hypotension. At the end of the day, this guy may be drunk, but left to his own devices, was in real risk of dying through positional asphyxia or aspiration, not to mention the long term effects of alcohol abuse. Alcohol damages almost every organ in the body, including the brain. The cumulative toxic effects of chronic alcohol abuse can cause both medical and psychiatric problems.

I only ever pre-alert the hospital if I genuinely believe the patient is severely ill, at risk of rapid deterioration or there is airway compromise. The fact this guy was tolerating an airway, was unresponsive to fluids or any pain stimulus I deemed that he warranted a blue call. The fact his condition is self inflicted has no bearing on the clinical decision making process.

We arrived at our local hospital. Every crew likes their local. They know the staff, the staff know them and it generally makes for a more pleasant experience. We went straight into resus, transferred patient to bed and began a handover to the waiting Dr. During my handover, the nurse in charge came marching over.

"I knew it would be him, he certainly doesn't warrant a blue call, you should know better"

"He's GCS 3, tolerating an airway and not responding to treatment, that's airway compromise. Blue call"

"No, it's a waste of my bloody time. I'm just gonna stick in 2 grey cannula's, give him a litre of fluids until he wakes up then let him stagger out"

"And there lies the problem"

"What would you know, I spend all day every day in this department and you clogging up my resus with pissheads doesn't help"

On that note, I walked out rather than get embroiled in an argument I wasn't going to win. She had a chip on her shoulder the size of Peru and views ambulance staff as untrained stretcher monkeys who bring her work. She was rude, dismissive and in many ways, adding to the problem. Professional courtesy is a big thing for us. We are treated like the pond life of the NHS food chain by GP's, some nurses and our own management and without good cause. They may not have faith in our abilities and that's fine, but there is no need to be rude and condescending. Like nurses, we work long hours, are treated like crap by peers and patients alike but at the end of the day we are doing a job. We are working for the same team. If someone phones an ambulance, they get one. If that person wants to go to hospital, we have to take them, and if that person is unconscious we will take them. That's how it works. What does she want us to do? Leave him in the street? Dump him in the waiting room? Has she not heard of the duty of care or is it only something that applies if she deems the patient to be deserving enough of her oh so valuable time. I for one will continue to do what I do, treat how I treat and 'Blue in' who the hell I want to regardless of her issues and PMT. The funny thing is, if we hadn't blued him in and gone to triage with a patient with an OP airway being bagged not only would we have been sent to resus but would have more than likely got a complaint!

This job also highlighted one of the major problems with the NHS. As the nurse said, she was basically going to wake him up and push him out the door. Yet she seems surprised that he is back the next day. And the next and the day after. What he needed was help. I spoke to his family. He is a good guy. He had a good job and wife he adored. She died. And so will he unless he gets help. For too long the NHS has been throwing money at 'cure'. Perhaps if that same money was thrown at 'prevention'  in the long term maybe those cut backs may not need to be so severe. 


  1. I have been on the service for 9 yrs now. When I started I always remember being horrified at the way a Paramedic I was working with spoke to an overdose pt. I couldn't believe my ears.
    As my career developed, I have to be honest, as I attended more & more overdoses, including that very same pt on numerous occasions, I started to understand the cynicism of that paramedic - similarly your nurse. Yes there is a story behind every 'drunk' or O/D but its just sometimes really hard to remember that, especially on a relentless 12hr shift with no break. Wow our job is challenging! But we love it & that's why we do it. Another thought provoking topic, thanks Ella ;) Adam

  2. Sounds like that nurse needs to get out of that job before she burns out, total loss of compassion!


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