Monday, 28 January 2013

Back to Basics

“23 year old male, hand injury”

Right, the time has come to get back to basics. This blog is aimed at anyone who isn’t in the know or is confused about what’s what when it comes to getting treated by the NHS. So, first things first.

Hospital: A hospital is a health care institution providing patient treatment by specialised staff and equipment.

Accident and Emergency: Accident and Emergency is a department within a hospital and is a facility specialising in acute care of patients who present without prior appointment, either by their own means or an ambulance. Due to the unplanned nature of patient attendance, the department must provide initial treatment for a broad spectrum  of illnesses and injuries, some of which may be life threatening and require immediate attention. All A & E departments in the UK are financed and managed publicly by the NHS. As with most other NHS services, emergency care is provided to all, free at the point of need and regardless of an ability to pay.

Ambulance: An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury. The word is most commonly associated with road-going emergency ambulances which form part of an emergency medical service, administering emergency care to those with acute medical problems.

Triage: Triage is the process of determining the priority of patients’ treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to separate, sift or select. In a hospital setting patients are divided into three main categories based loosely around the old wartime triage process:
  • Those who are likely to live, regardless of what care they receive;
  • Those who are likely to die, regardless of what care they receive;
  • Those for whom immediate care might make a positive difference in outcome.

Ill people go to hospital. Really ill people go initially to accident and emergency. If they can’t get there due to their illness or injury they get an emergency ambulance. Once at hospital they are triaged. That triage will determine the speed of their treatment. Those rules apply to everyone.

So, we were called to a young guy with a hand injury. Not a bad hand injury but a painful one all the same. He had managed to close his finger in a door. It was swollen. It was bruised. He couldn’t fully bend it. He was in pain. He didn’t take any pain killers. He called 999 and asked for an EMERGENCY ambulance. This was deemed to be one of the acute medical problems that we are there for. He lived half a mile away from the hospital. His girlfriend was there. She had a driving licence. She owned a car. Her car was parked outside. His brother was there. He had a driving licence. He owned a car. His car was parked outside. His mum was there. She had a driving licence. She owned a car. Her car was parked outside. His dad was there. He had a driving licence. He owned a car. His car was parked outside. On the notice board in the kitchen was a business card for a local taxi service. They did not use it. 30 yards from the front door was bus stop. The bus which stops at said bus stop also stops outside the hospital. The patient had legs. They were not injured. He could have walked to the hospital. He chose not to. 

After a brief assessment in the £750-a-call-emergency-ambulance we drove him the half a mile to hospital. His girlfriend and mum came with us. The brother and dad followed in the car and parked in the pay & display car park. We walked the patient into the accident and EMERGENCY department. We spoke to the triage nurse and gave her a detailed history of what happened, what we have found and how he has been with us. She then triaged him based on what we told her and what her cursory look at his finger told her.

  • Those who are likely to live, regardless of what care they receive;
  • Those who are likely to die, regardless of what care they receive;
  • Those for whom immediate care might make a positive difference in outcome.

“Waiting room please”

The girlfriend with a driving license and car stepped forward.

“The waiting room? He’s in pain, you haven’t even treated him yet”

“He has a hurt finger. I have 46 patients in the department now, all of which are a higher priority. There is a baby in there who may die. There are 2 patients in there who also may die. There are 16 patients in here who NEED a bed and require treatment because they are THAT ill. There is 1 doctor on duty, 4 nurses and 2 health care assistants. There are no beds free at all. The fact you called an ambulance for a finger injury is a gross abuse of the NHS. The fact I am sending you all to the waiting room should tell you that his hurt finger never has and never will be an EMERGENCY, now go and wait for your name to be called like everyone else.”

With that, she walked off. I was in awe! She summed up in 30 seconds what I have wanted to say to every single patient who has called an ambulance for nothing and who has been sent to the waiting room.

Why do people think there are long waits in hospitals? 

Erm...because there are people who could wait to see a GP who are sapping resources.

Why are people surprised they sometimes have to wait a long time for an ambulance? 

Erm...because so many people are calling an ambulance for the most puerile of complaints.

Why are people surprised that they are send to the waiting room? 

Erm...because they don’t need to be there.

Why do people seem to want to spend night after night sat in a hospital? 

I have no answer to that. Maybe a hospital lover can enlighten me!

When I am ill I want nothing more than to lie in bed and feel sorry for myself. I will ONLY go to hospital if I absolutely have to. I would never called an ambulance unless it was a life or death emergency or if I was too injured to get myself into a taxi or a car. People seriously need to get a grip and stop expecting miracles from our free health care service. The NHS is being killed by its misuse. Accident and Emergency. THE CLUE IS IN THE NAME. Emergency Ambulance. THE CLUE IS IN THE NAME. When someone picks up a phone and dials 999 they are greeted with a question. ‘What’s your EMERGENCY?’. How anyone can hear themselves say ‘I need an ambulance because I have hurt my finger’ or ‘I have a headache’ or ‘I can’t sleep’ is beyond me! In London alone the call rate has doubled to around 1.7 million calls per year in less than 10 years. Of that, 1.2 million people get an ambulance. This jump is not down to an increase in population, nor is it down to a population that is more ill or more accident prone. It is because people are not using the services as they are intended to be used. They have become lazy and reliant on a free service and are abusing it.

Please please please people! Stop killing our NHS. Once it’s gone, it will not come back.

45 comments:

  1. Why is it only we, ambulance staff can see this, or is it, as I suspect more, people really are too thick and lazy to take responsibility for their own wellbeing

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    1. It's not just ambulance staff that can see this - I'm sure it feels like it but as a member of the public, I wouldn't dream of calling an ambulance for anything less than a major emergency! Some of us are sensible about these things but as such, it means you never really get to see us!

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    2. There is no responsibility! Youre right!

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    3. I know most of the public see it too, but therefor they are not the members of the public that we see lol!

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  2. Perfect couldnt have said it better myself. We r allowed 2 treat and refer had similar job treated ptn n told relative 2 take them 2 hosp 2 free up ambulance, saw them there later n they were fine got pulledbin 3 mnths later cos a complaint had bn sent in. Bosses eventually agreed but not untill we had both bn grilld so now jus take them in i can do without the strain.

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  3. Go that nurse!!!

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  4. Genuine.question here, is there no way of charging people for innecessary ambulance call outs? In sure this would make many people think twice. I have the upmost reapect both for what you do, and for your parience with the idiot people in this country xx

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    1. what about those that can't pay...

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    2. I think it should be done like a prescription charge. If you are exempt from prescriptions you are exempt from paying for the ambulance! Only £7 something but in London alone that would raise about £12 million!! Thats enough to buy 100 ambulances!!

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  5. Well said. It disgusts me the way the nhs is abused. I'm fed up with going on blue lights to people who do not need an ambulance. Then a member of the family saying I'll meet you there cos I'm taking the car so we can get back!!! Nooooooo. It's a disgrace and people just can't see that.

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    1. We do in our service, after checking everything, doing a proper assessment, I quite often tell people to get their relatives cars. If you look at the wording of the services charter, it usually says something like, to carry out treatment and if needed convey to appropriate care. As long as you check everything and document it all, you can refuse to take someone if they don't need an ambulance. It is easier to do if your on an rrv, if they don't see an ambulance they don't assume they're going to get one!

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  6. Problem is that people don't realise that there is a finite number of resources for an infinite possibility of requirements I would never call an ambulance for a sore hand... I have had to go to a&e for chest pains (history of a heart problem) and hate that I wasted people's time but while the nhs appears to be free some people will continue to abuse it

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  7. The day must soon come when time-wasters and drunks/drugged people are forced to pay a fee.

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  8. I've only had an ambulance called for me, not by me. I had labyrinthitus, was sat on my sofa and passed out with left side chest pain. Came round and the pain was worse, and left arm was twitchy. I phoned NHS direct, and they said ambulance now as was alone and showing worrying symptoms.

    I got to a and e, I was instructed to the waiting room and made to feel like a time waster. Although I didn't get that kind of rant from the lady on the desk.
    The time I nearly died, sudden bleed a week after birth, my partner was very good. I know I screamed for help and went blank I remember a split second of being over his shoulder fireman style, him running. I know he put me in his car but I knew nothing more until I was in the hospital. He'd decided apparently that the average ambulance takes 8 mins, we were 4 mins away and I think he did it in three, he said he didn't want to risk waiting.
    I'm guessing this is the point Ella. Use the car!

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    1. Labyrinthitus is horrid! I had it recently! Yuk!

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  9. That nurse was awesome. I think the only way the fuckwits will be cured of this dependency that is destroying the NHS & Ambulance services is if all the available tv & radio channels carry free adverts for the NHS that are a summary of what that nurse said.

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  10. That nurse was awesome but will probably be disciplined for attitude problems. Welcome to the NHS

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  11. That nurse was awesome but will probably be disciplined for attitude problems. Welcome to the NHS

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  12. I sympathise with this poor young man; I shut my fingers in a door the other day and it was very painful. Oh but wait, did I call an ambulance? No, I went to work on one all day instead.

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  13. Excellent blog - I feel sorry for Ambo staff, Plod get a lot of timewasters as well but at least we're in a slightly better position to tell them 'how it is'.

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  14. Makes you sort of wish the management in the NHS had the balls to in input a telephone triage system where calltakers are actually allowed to say this to callers that call up with a hurty finger, etc, but alas you have the utter bollocks that is Pathways or AMPDStelling people what to say, common sense or, in most cases, not.

    Andy

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  15. Hurrah that nurse! By the way, it's 1:31am. My boyfriend has indigestion. Shall I call an ambulance?

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  16. If only we could say what we really think to some of our calls. But some of our abusive calls are being made by third parties ie Out of hours Doctors and Care lines..

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  17. Since the advent of the 111 service in our area, our workload has increased dramatically with jobs just like this. Its insane and something's going to give at some point. We simply cannot handle the rubbish that gets put through. We cannot 'work harder' to cover the workload and the hospitals don't have endless beds. The campaigns obviously aren't working because the amount of jobs has not decreased. The next stop has to be introduction of charging but look at all the problems that will bring.

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    1. Exactly! They seem to think we can! Not looking forward to 111 being live here!

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  18. The irony is Ella, a lot of the 111 callers didn't want an ambulance and are surprised/embarrassed when we turn up. All they wanted was advice but the stupid questions 111 ask lead to an ambulance being called.....they almost suggest the caller has cardiac chest pain or sob when in fact the caller just wants antibiotics for a throat infection.

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    1. I know! A lot of our jobs are from NHS ReDirect and the patients dont know we are coming!

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  19. I've had the ambulance called out for me once. ONCE. I'd collapsed and was having a non-responsive fit so the place I was at got a tad scared (and it was in the middle of nowhere). Even when they thought I had appendicitis as a kid the doctor who got called out told my parents to take me to the hospital.

    Not to mention the people who call 999 with a hurt finger are clogging up the lines for anyone who is calling with an emergency.

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    1. Collapse is a good enough reason lol!

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  20. Here you pay a small fee for almost everything except being in hospital - that is free. Emergency transport and treatment are free, you get a bill sent if you don't pay it at the time. An attendance at A&E costs 15 euros - introduced to stop the idiots with indigestion after eating too much (Italians on ski holiday usually and always between 10 and midnight) or a minor cut that needs a band aid. It seems to work quite well. If you join the White Cross you can have 6 free transportations per year - they provide part of the ambo service here, some as volunteers, some paid. If you have the all singing all dancing membership it includes helicopter retrieval and air repatriation from anywhere in the world.

    High time there was charging in the UK - especially for an episode you put yourself at risk for (like drinking 3 bottles of wine and 20 vodka shots...)

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  21. Unfortunatley peoples attitude is 'I pay my national insurance so i can just go there'!!! No, you pay your national insurance for when (god forbid) you get cancer or have a heart attack or a serious life threatening injury. Then the NHS can spend the thousands of pounds you've paid in, on getting you better, not giving painkillers for a toothache!

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  22. I'm currently receiving IV infusions through a PICC line, halfway through it now in fact. I have been informed of potential issues yet I would still get the bus! I don't expect preferential treatment because of PICC etc. I spend a lot of time in hospital, not because I want to mind you. Oh & the PICC is in because I'm too stubborn to be an inpatient! I personally want to slap people like sore finger guy.

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