Friday 18 May 2012


"56 year old male, abdo pain"

Pain is a funny old thing. I am told it is subjective and it is different for everyone. Different people have different pain thresholds. Women are better at dealing with pain than men. The same things are said repeatedly. Personally, I think that some people are just wimps and need to man up but that's just me! The ambulance service isn't very well equipped to deal with pain either. We have entonox and morphine which are two extremes. Basically, fancy oxygen or heroin! The latter relies on there being a paramedic available to give it and the former seems to be way over and above the comprehension of the lay man. The concept of sucking air threw a mouthpiece is lost on so many, not to mention the vast number of people who would rather be in pain than suffer temporary light headedness. In fact, most patients seem less than willing to do anything to relieve their pain! The mind boggles!

We arrived on scene and were let in by the patient's son. We were shown into the living room where our patient was sat on the sofa with a pained look on his face. To be fair he looked in discomfort, so whilst checking his vital signs I asked about his pain. All EMS staff will recognise the following conversation:

"Are you in pain at the moment?"

"Yes, it's really bad."

"How long have you had the pain for?"

"About 8 hours"

"Have you taken any pain killers?"


"Why not?"

"I didn't think they would help"

Really?!?! The clue is in the frickin' name! PAIN......KILLERS. They will kill your pain. They are cheap, can be bought anywhere and you have tonnes to choose from; Paracetomol, Aspirin, Ibuprofen, Codeine, Co-codomol, Tramodol, Gabapentin, Pethidine, Naproxen, Diclofenac & Morphine to name but a few. OK, so a lot of them require a prescription, but there is a clue in that. Go and see your GP! The conversation continued:

"Do you have any pain killers in the house?"


"What do you have?"

"Nurofen, Paracetomol or Aspirin"

"OK, lets take some Paracetomol"

The son went off to go and get them while I continued to find out about the pain and look through his medications. 

"If you were to give the pain a score out of 10, 0 being no pain and 10 being the worst pain you can imagine, what would it be?"

"It's just really bad"

"OK, but how bad, out of 10"

"It's just there, it's hard to describe"

"OK, but I need a number out of 10 to judge how bad it is"

"It kind of comes and goes"

"So when it's at its worst how bad is it, out of 10, I need a number"

"I don't really know"

JUST GIVE ME A GOD DAMN NUMBER! Seriously, why is that concept so difficult?! Obviously I didn't say that. That is what is happening inside my head; in reality, I gave up and gave him the Paracetomol! The job ran its course. We ended up taking him for a GP appointment that he already had arranged; complete with his bag of medications including prescription Tramadol no less!

This job is not an isolated case, far from it. It's the norm. People appear to not take pain killers for pain, although they do like to have them in stock anyway. WHY?!! Some people believe that by taking analgesia their symptoms would be masked by the time we arrive and therefore we wouldn't treat them! Perhaps... Perhaps if you took them and your pain went away you might not actually need us! Just sayin'! Pain killers are there for a reason; there are few things more frustrating than being told by a patient that they are in pain but haven't tried to do anything about it. Far too often 999 is the first point of call when someone is in pain but it shouldn't be. It is perfectly treatable without us and there are other ways to get to hospital. There is NHS direct, pharmacies, GP surgeries, walk-in-centers, urgent care centers, minor injury units, a lift from family or friends to A & E, a taxi. But why bother?! We are free phone, we guarantee to come, and guarantee to take you to hospital, we will give you pain relief and it's all totally free! FTW!

NB: I must add, if you ARE in severe pain, and you ARE genuinely worried do not hesitate to call 999. We will come and you will get the same treatment and options as everyone else.


  1. I think the key question is: Is this an EMERGENCY?

    Emergency covers: bleeding profusely and you can't stop it, absolute agony and you've got nobody to take you to hospital, lost a limb, run over and can't move, gone into labour and very near to delivery.

    How many times has any of us had a genuine emergency? I haven't. I fell off a horse once and was in absolute agony with a bad back and broken arm but someone drove me to the hospital.

    Makes me cross.

  2. Yes! It's a shame people don't share your thoughts! Lets not forget, they pay my taxes and it's their right lol!

  3. I'm sorry but all of the alternative options involve taking responsibility for yourself. Unfortunately taking responsibility for yourself is now against the law. Seriously, if you didn't call an ambulance and go to hospital, who would you sue if it all went wrong?

  4. I'm sorry but all of the alternative options involve taking responsibility for yourself. Unfortunately taking responsibility for yourself is now against the law. Seriously, if you didn't call an ambulance and go to hospital, who would you sue if it all went wrong?

  5. I share your frustration, see it all the time. Pain is what the patient says etc! But what if they won't tell you?!

    The World Health Organisation (WHO) pain scale helps people describe pain and how it relates to the 1-10 scale. It's ace! You can also use it to estimate a pain 'range' 1-4 mild, 4-7 moderate, 7-10 severe and what analgaesia is appropriate for these ranges.

    Google it. It's worth it. Your clinical supervisor will love seeing it used on a PRF as justification for giving paracetamol for a 10/10 pain score thats sitting chatting to you with a pulse of 72 and BP of 125/70 and not short of breath!



    1. Thanks! Really helpful! I'll do just that!


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