Sunday 10 February 2013


“18 year old female, chest pain, dizziness”

I’ve spoken before about young people and chest pain. Basically, I think common sense should prevail more often when it comes to sending an ambulance and a car to a teenager with chest pain. I once went to a 23 year old having a heart attack, it was the youngest the cardiologist had ever seen. On top of that, he had risk factors and presented like a heart attack; central crushing chest pain for more than 15 minutes, shortness of breath, cold, clammy ashen skin blah blah blah. If I had THAT information to go with this 18 year old I may, unlikely, but may suspect it was something more than a panic attack or anything equally as minor. My point is, based on what the caller had told the call taker this should not have wasted resources with two vehicles, especially as we were no more than 50 yards to the A & E entrance!

Regardless of what my opinion was, we pulled into the road at the same time as the FRU. En masse we headed down to the garden path to the front door. It was eventually opened but a guy styled on Kurt Cobain. You know the type, long hair, baggy trousers, skater shoes, a jailers chain hanging down to the ankles, black nail varnish, a beanie hat, scruffy bum fluff and a lip piercing to one side of the top lip. Oh....and can only grunt answers and is physically incapable of smiling! Anyway, as the door was opened and I’d looked up and down the smell of skunk, cigarettes and cheap cider hit me! Aaah THAT is what ‘teen spirit’ smells like! We followed ‘Kurt’ into the kitchen where our patient was sat on a stool. She was also having a teenage identity crisis! A cross between a goth and punk with a bit of hippy chucked in for good measure. One look at her and I knew she was stoned. Pupils like saucers and an inane look of amusement with a hint of confusion. 

“Hello there, what’s the problem today?”

She looked at me blankly for a moment, her head swayed slightly and after a few seconds to re-focus she mustered the energy and brain power to respond.

“Got chest pain”

“How long have you had that for?”

Again, the stoned routine of saying the question back in her head, concentrating hard, putting together a balanced, well conceived response and then saying it. The whole process takes about 10-12 seconds.

“All day”

“OK, now I can smell some pretty pungent drugs, how much have you had and have you taken anything else”

A look of sheer panic spread across her face and ‘Kurt’s’ for that matter. It was if they didn’t think we would be able to smell it because they had opened a window! 

“We are the ambulance service, not the police, you are adults, I don’t care what you’ve taken but I need to know because you have chest pain, you’re not in any trouble.”

“Well i’ve been on a 2 day bender, we went on a rave last night and didn’t get home till about 10am today.”

“So what have you taken?”

“I took some pills last night, and some cocaine, few spliffs here and there, and a bit of MDMA. Maybe some ketomine to.”

Brilliant! Well that would explain the chest pain! A drug cocktail, possibly with some horse tranquiliser in the mix!

“No probs, and have you been drinking to?”

“Yeah, on and off all day really, I only slept a bit.”

“And have you eaten?”

“Not really, I’ve only eaten a few bags of crisps in the last few days.”

Bingo! Well that will explain the dizziness! Sherlock Holmes would be proud as punch! Why she didn’t think that the best part of 48 not eating, not sleeping, drinking, smoking and taking all the drugs she could find wouldn’t cause her to feel ill is beyond me! Why the call taker wasn’t able to establish any of this I don’t know either! 

“Right, shall we pop you out to the ambulance so we can do an ECG etc then pop you up to hospital?”

“Do I have to?”

“No. You don’t. But, you called 999 for chest pain and diziness, you still have chest pain and dizziness so it’s a good idea to come with us.”

“Yeah but if you say it’s cause of the drugs i’ll be fine”

“But until we’ve done an ECG we won’t know what is going on with your heart.”

“I think i’ll leave it for now and if I feel worse i’ll call you back.”

“No, we are here now, we are next to the hospital, that would be a massive waste of an ambulance. Let’s get it sorted now.”

She shared a look with ‘Kurt’.

“Nah I think i’ll leave it.”

“So why did you call us?” 

“Cause I thought I was dying.”

“So let us check you over and take you to hopsital,”

“It’s OK, don’t worry about it, i’ll just get some sleep.”

AAAARRRRGGGGHHHHH!!!!! Seriously!!! Why call an ambulance?! There are very few things that wind me up more! It drives me absolutely bonkers! As kid, infact, even as an adult before I did this job, I would look at an ambulance and think that they were a) going to a life threatening emergency and b) be taking someone to hospital. I had no idea that people would actually call 999 and then did not go to hospital. There is a drive within our service at the moment to leave more people at home and apparently that is the future but personally, as much as I do that, surely the main problem is the amount of people calling 999 who clearly don’t need to be in hospital or don’t want to be?! That is why we NEED to leave people at home. That is why hospitals are at breaking point. JUST.....SAY.....NO!! I was barking up the wrong tree with this patient. No matter what I said, she was never going to go in. I got her to sign the back of my paperwork and ticked the box ‘declined aid against advice’ and stomped off.  


  1. Call takers aren't allowd to make those decisions, alas. Any chest pain above age 35 in men and 45 in women is an automatic send, if you're younger than that you have to have breathing not normal and/or clammyness. If you don't have that then it's a callback but if you're a silly hypochondriac then you probably think you are clammy so off go those reds. It pisses calltakers off as much as you. Grrraahhh

    1. For the most part I think this is great, but part of me wants to kick someone. I'm now 38, but at 22 I had severe chest pains, and at the hospital I was treated like a drug seeking malingerer. It took 6 yrs and tons of testing to find out that yeah, I was having pain that started underneath my left shoulder blade, radiated up my back, into my left arm and shoulder, up the side of my neck into my jaw and also around to the left side of my chest. No, though they symptoms are pretty classic for a female, I wasn't having a heart attack, I was having esophageal spasms.
      I can see why they thought I was drug seeking. It hurts like hell and makes it hard to breath, but all the ECGs and blood work were normal. There is more than one cause of chest pain, and if you don't know the cause it is very scary.

  2. Echo the pisses us off comment. For us this patient would be getting an ambulance regardless of whether it could all be explained by drug use (we don't really have a don't send policy except for minor Cat Cs (it's a major bugbear)). The only difference it would make is that the EMD's tone goes from "professional and interested" to "Don't give a shit, stop wasting our time, why are you calling us, but I can't say that on a recorded line".

  3. Also with chest pain they will be asked if they've taken anything in the last 24 hours so if nothing came through then they've lied, and while I'm sure it was blatantly obvious they were lying (it always is) there's not much you can say to challenge them on the phone.

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