You Again?...

"48 year old male, ? Hypo"

Every ambulance service, every ambulance station and every ambulance crew have frequent flyers. Patients who abuse the service, some of which call in excess of three times a day. The average person only needs to call 999 once in their lifetime for an ambulance but these people feel compelled to call repeatedly. Be it through boredom, attention seeking or medical need it bears the same cost, a financial one and a resourcing one. At the best of times the ambulance service just about copes with the call volume but at weekends and peak times it doesn't. This isn't a dig at the service, it isn't through poor management or poor performance. It's through a lack of core funding and an inability to put enough ambulances on the road. The limited resources available can ill afford the additional waste caused by regular callers. They really are a drain. As road staff you see the same patients so often that you memorise their name, their address and in some cases their date of birth and medications. As soon as the address pops up on the MDT you know exactly what you are going to.

This particular shift had been spent miles out of area. At about 2am we got sent the above job. We knew the address, we knew the patient, we had seen him yesterday, and the previous week and in excess of 20 times previous to that. We were off to see Steve. Steve was an insulin dependant diabetic who lives with his mother. Steve doesn't control his diabetes well and often has hypo's. We are called by his mother every time. Sometimes we are needed, sometimes we are not. The problem isn't just Steve, his mother is also a huge part of the problem. She will call us if she thinks he's having a hypo, more often than not in  the middle of the night. Half the time we enter his filthy bedroom to find him asleep in his single bed, in his sleeping bag and he is simply that. Asleep. His blood sugars are normal. We still have to check him over and fill out paperwork. On other occasions he is hypo. Sometimes we have to give IV glucose, other times glucose gel and sometimes just food and sugary tea. No matter what the treatment we have to stay until his sugar levels are up, give the same advise, leave the same paperwork and fill out the same frequent referral form. On the living table is a pile will no less that 300 PRFs that have been left by crews in the past two years alone.

We pulled up outside, grabbed our stuff and knocked on the door. Like always his mum answered, dressed in a dressing gown and what looks like a tea cosy on her head. 

"Hello again, is Steve hypo?"

"Yes I think so, I can hear him snoring"

"Have you tested his blood sugar like we suggested"

"No"

She never does. Ever. We went into Steve's room and woke him up from his sleeping bag. We tested his blood sugar. 3.1. A blood sugar reading should be somewhere between 4 & 8 in a healthy person. His sugar was low but for him they weren't too bad. Regardless we couldn't leave him like that. He got up and he went to the toilet as per usual. I went to my seat at the dining table where I do my paperwork. Another thing worth mentioning is that he never goes to hospital. He always refuses despite being advised otherwise. He came and plonked himself down in the armchair while his mother made his tea and gathered his two pre-packed sandwiches and fruit cake. It's the same, night or day. A black tea with 6 sugars, a salmon and cucumber and a chicken and bacon Waitrose sandwich and Tesco fruitcake. Like always the offer is extended to use and like always we declined. Like always I wrote while he ate and I advised him to see his diabetic nurse, to adjust his insulin levels and I told his mum to test his sugar before calling. Yes, Yes and Yes.  My crew made did his ECG and all his OBs, then I re-tested his sugar, it was fine, he went to bed, we put our PRF on the pile and we left. It is beyond deja vu. Once in the truck I fill out a vulnerable adult form and a frequent caller referral form. Job done.

Clearly the frequent caller form has no effect whatsoever. What can be done? That isn't an open question or a rhetorical one. What can actually be done? I have no idea. I would love to have an answer. It's not like he is calling for attention. He has a chronic condition he seems unable to manage. You can't refuse him an ambulance. Half the time he has a medical need and without one could die. You can't charge or fine them for misuse. They have no money, neither of them are able to work and his mum, as annoying as she is, has cancer and is getting very frail. The cold fact of the matter is, this abuse of the service will stop relatively soon. His mum will die and when she does he will die too. He will enter a diabetic coma and there will be no one to phone an ambulance. That's when it will end. Unfortunately you then have a question. How can a man be left to die when in the past two years he has had more than 350 ambulances? Why has nothing been done? Why is this allowed to happen? All good questions. It's just a shame in the society and system we live in it'll only ever be post mortem questions and not anti mortem solutions.