Monday, 16 December 2013

You Just Wouldn't.....Would You?

Recently East Midlands Ambulances Service launched a new campaign to try and reduce inappropriate calls. It was inspired!


You really WOULDN'T do either would you! For the people with any common sense and even the smallest amount of intelligence, it is clear what is meant by these posters. STOP calling ambulance for coughs, cold, cuts, scrapes, bumps, bruises, headaches, lifts to hospital, tiredness and the plethora of other minor ailments that some people seem to think warrant an ambulance! The new is overrun with stories about long delays waiting for an ambulance or 12 hour delays waiting for treatment in A & E. This is just fodder for the Daily Mail and Evening Standard to get their NHS bashing teeth into. What the stories don't expand on, is what was actually wrong with those poor individuals who had to wait 12 hours to be treated! I can assure you, it wasn't anything that needed treating immediately! In fact, I'd be happy to lay money on the fact that it probably wasn't anything that they even needed to see a GP about! Some people just don't seem to understand that people get ill!we all do! It sucks, we can't sleep, we cough, we splutter, we moan, we get hot, then cold, we ache and eventually we get over it. By 'we', I mean normal people.

Sadly, these campaigns appear lost on so many people, as today's shift proved......

"36 year old, diabetic problems"

Let's be clear. Just because you have diabetes does not mean than anything wrong with you is due to your diabetes. It is however a good trick to get a quick ambulance to your place of work. Lying in the first aid room like a dying swan was our patient. His 'diabetes with a reduced level of consciousness' was what got us there quickly. If he'd actually said what was wrong, we'd never have been sent. 

The reality was is that he was tired. Just tired. I know diabetes can bring fatigue but this guy had diet controlled diabetes. It was also well controlled and monitored. He had young kids and wasn't sleeping. His blood sugars was completely normal and he knew it. For effect he kept pretending to drift in and out of consciousness to the first aider. He 'couldn't walk' and 'couldn't open his eyes'. He 'couldn't talk' and 'couldn't be roused'. Needless to say, he was quickly roused, eyes the promptly encouraged open, he spoke when spoken to and obviously walked to the ambulance. Not impressed. Oh, and if you can’t cope with the tiredness that comes with parenthood, you should have kept the mouse in the house. Just sayin’.

General Public 1 - 0 Ambulance Service


"44 year old female, not alert with head injury, there is serious bleeding, abnormal breathing"

Blimey. SERIOUS bleeding. It MUST be bad. It appears whoever had called 999 had swallowed the textbook on how to get an ambulance quickly. 'Head Injury', 'Not alert', 'Bleeding' and 'DIB'. It sounded like the poor patient was in a whole world of trouble.

Has anyone ever had that horrible experience whereby you bend down to get something out of a bottom cupboard, stand up and hit your head on the open cupboard above?! Horrible isn't it?! Call an ambulance for it?! Didn't think so....

That is exactly what had happened. The head injury was a bump on the head as a result of standing up into a cupboard door. The serious bleeding created about as much blood as a paper cut. The patient was fully alert and putting on an Oscar winning hypochondriac performance. The was no difficulty in breathing whatsoever. He inability to walk was promptly converted into a walk to the ambulance. Another waste of a resource.

General Public 2 - 0 Ambulance Service


"30 year old female, drifting in and out of consciousness"

LOSING CONSCIOUSNESS! Quick, sound the alarm, send the cavalry, time is critical, run for your lives!!! OK, slight overreaction but she got the quick response due to her critical medical condition....

On arrival she was sat up grinning like a Cheshire cat, awfully proud of ailment. From her comprehensive handover it was clear that she had a degree in ‘Google Medicine’ and had self diagnosed an abundance of medical conditions. She busted out some medical big gun terminology too like ‘wobbly’ and ‘jittery’. Needless to say, her two week history of vague symptoms didn’t lead us to believe she had anything wrong with her that warranted an ambulance. This was confirmed by her feigned reluctance at going to hospital followed by an avid insistence it was the right thing to do! Better safe than sorry eh?! 

Yes, i’m safe in the knowledge that there is nothing wrong with you and sorry that you’ve hoodwinked the ambulance service into sending you ambulance.

General Public 3 - 0 Ambulance Service


“27 year old male, chest pain, DIB, fever, not alert, shaking”

Poor, poor guy. To have central crushing chest pain is bad enough, but difficulty breathing too?! No wonder he needs an ambulance! A fever?! He must feel awful and not to mention the shaking! Wow! What a trooper. 

After a thorough examination it was just as I feared. Neither of us wanted to break the news to him. These life changing moments are best delivered by trained professionals, not us meagre ambulance drivers. Eventually my crew mate plucked up the courage.....

“You have a common cold.”

Silence engulfed the ambulance as the gravity of what had just been said sunk in. As with any tragedy there are 5 stages of grief this guy went through them all bless him.

“I know my body, it can’t be a common cold!” DENIAL

“It is.”

“This is ridiculous, I want to see a doctor.” ANGER

“That’s fine, we’ll pop you up to hospital.”

“Are you sure it couldn't be meningitis?” BARGAINING

“I’m sure.”

“I just feel so weak and ill, I’m always ill, I don’t get it, I’ve got so much on my plate at the moment.” DEPRESSION

“*silence*”

“OK, but I still think I should see a doctor, be on the safe side.” ACCEPTANCE

“Good idea, put your seat belt on.”

Yep, always best to be on the safe side. I’m not sure what it is the safe side of but always best to be there. Another waste of an ambulance though!

General Public 4 - 0 Ambulance Service


It goes to prove that no matter how effective an advertising campaign is, ambulance services can only go by what they are told. People know the buzzwords, people exaggerate, people think they are the priority and people think they are entitled to an ambulance at the drop of a hat. The sad fact is, if someone wants an ambulance enough they will most likely get one. Today they won. And when they do, genuine patients will suffer, A & E departments will get overrun and the Daily Mail will have a field day. THINK before you dial! 

*          *          *          *          *

FYI!!!

It appears that in some of the comments it has been perceived I took all these people to Accident and Emergency and this, as such means I'm an awful clinician. On the contrary. Hospital doesn't mean A & E for starters. Most of my local hospitals have Urgent Care Centres (UCC) attached and when appropriate the patient is taken there. So, just to clarify.....

"36 year old, diabetic problems": Due to a history of diabetes, pre existing co-morbidities and a history of increased lethargy, to err on the side of caution, the patient was taken to an UCC attached to an A & E. Therefor, if as I suspected it was tiredness, and being run down he could be discharged by the nurse led centre. If on further examination it was deemed necessary to be seen by the doctors in the A & E, then he would be. For the ambulance service that is a good use of an Alternate Care Pathway and totally appropriate to his presentation.

General Public 4 - 1 Ambulance Service


"44 year old female, not alert with head injury, there is serious bleeding, abnormal breathing": After a thorough examination in the ambulance ensuring the 'wound' was clean and there were no signs of concussion or any other 'Red Flags' I deemed it that no further medical attention was required. Despite this, the patient was keen to be seen at hospital. She was taken to the nearest Walk In Center (WIC) to be seen by a nurse practitioner. For the ambulance service that is a good use of an Alternate Care Pathway and totally appropriate to his presentation.

General Public 4 - 2 Ambulance Service



"30 year old female, drifting in and out of consciousness": A patient with a need to repeatedly 'google' conditions will be a worrier. Despite her ECG being normal and all observations on presentation being normal it was decided that due to the history or dizziness it was felt that further investigations in the way of blood tests should be done. We contacted her own GP and made her an appointment later that afternoon. As it was a GP let health centre her blood test could be done at the same time, thus freeing up space in the overwhelmed hospitals. For the ambulance service that is a good use of an Alternate Care Pathway and totally appropriate to his presentation.

General Public 4 - 3 Ambulance Service


“27 year old male, chest pain, DIB, fever, not alert, shaking”: This patient, most likely had a chest infection. He was slightly tachycardic, slightly pyrexic, a slightly increased respiratory rate and a cough. If left at home I'm confident he would have been fine. As a paramedic, once he is in my primacy of care, it's not good practise to say 'he should be fine' when he has 'Red Flags' and a number of triggers on 'Sepsis 6'. As such, further care was needed, despite the reality of him having a cold, and needing bed rest. He too was taken to a UCC where A & E was on-site if needed. For the ambulance service that is a good use of an Alternate Care Pathway and totally appropriate to his presentation.

General Public 4 - 4 Ambulance Service


This post was about how patients bypass on-phone triage systems and get an ambulance response when realistically they should be making their own way to either a GP, WIC, UCC or A & E if they are worried. I don't routinely take people to A & E and I use the tools that are available to us to avoid it at all costs! Hope this clears up some of the confusion. They may get ambulance but we still score some points! ;-)


188 comments:

  1. If you can walk off an ambucab you didn't need it Waiting room, some also think there a priority because of the mode of transport WAIITNG ROOM

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  2. People really are fscking idiots!

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  3. 8 jobs last night. 2 to hosp. That's 6 cups of tea! It's not all bad.

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    1. Gotta get fluids where you can!

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    2. my nephew is a paramedic and he was telling me about similar cases to the ones above.... it is ridiculous to call out an ambulance unless it is a REAL emergency!..life or death situation, not 'oh dear, I don't feel well'.

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    3. Sadly nowadays people feel ill and call 999 before trying any OTC medications!

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  4. i mean just reading these blogs, made me giggle... however they seem so real.... im constantly looking at what the ambulance service has to deal with as im inspiring to go to uni to become a paramedic... feel sorry for yourself... but glad to hear what your view is....

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    1. Thanks! It's always a mystery what we'll get!

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  5. My favourite to date is a lady who came through as severe DIB/? respiratory arrest. We were 15 mins away so thought it would be bad when we got there. On our arrival, we were met at the door by a women, not worried, not panicked who led us into the living room. Entering the room and expecting to find the pt, the women sat on the sofa and starting telling us the pathetic story. She had seen that advert a while ago on tv about if you have had a cough for more than 3 weeks, you may have cancer and she wanted the tickle in her throat checked out. We then said it came through as someone cant breath and she explained when she was coughing, she couldn't breath!!! My crew mate walked out in anger!!

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    1. Hahaha! It's easy to walk away when driving! Love it!

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  6. hopefully one day one of these morons loved ones will need the ambulance they take/delay for no reason

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  7. I have been a Paramedic for 20+yrs and everything you have published here is spot on. BUT (there is always a BUT), "we" are banging our heads against a brick wall and it's not getting any better. And then "we" read of elderly casualties with #NOF et al waiting 2hrs for an ambulance and their indignant relatives complaining. Take them to ED and they (along with us) can queue.........

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  8. Amazing really and, sadly, all too common. Unfortunately it makes you wonder where the buck stops? If it stopped with the patient, maybe things would not be as they are. The call handler has to go by what they are being told and the responses to the questions asked with little room to deviate. The Paramedics and Technicians often barter and reason but again only have so much power (and confidence) in our lawsuit-happy culture. In cases like those above it ought to become an offence to waste time and NHS funds which could be going to someone who genuinely needs them but it just doesn't. The worst they ever get is told their life's not in danger and even then services are so paranoid that they'll still say, "but call back if you get worse or if you need us".

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  9. You shouldn't have conveyed any of them - this is what alternative pathways are for!

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    1. None of them were conveyed. All were ACP'd. See my editing notes above. Sorry for confusion.

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  10. I assume you are a clinician? If all these incidents are a waste of time and did not need an ambulance- why take them to hospital?

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    1. Arse covering bud ! Plus the NHS constitution states everyone is entitled to go by ambulance to hospital and we can't refuse, guess you're not ambulance ?

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    2. None of them were taken to A & E. See above for details I have added. I am ambulance and I don't do arse covering. Take each patient at face value and refer on where necessary.

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    3. It states no where in the NHS Constitution that patients are to be inappropriately transported to a hospital A&E. Although it does say,
      'The NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources.'
      Correct me if iam wrong, but taking everyone to hospital unnecessarily isn't sustainable. And I hope many will agree that your 'arse will be covered' (not sure what with though) when you appropriately refer the patient on, thus not further wasting the patients' time, your time and our precious 'finite' NHS resources.

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    4. Please read my editing notes above with the patient outcomes. I know I will be supported by my trust and as such utilise ACPs at every opportunity. NONE of the patients were taken to A & E and nowhere in the post did it say they were!

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    5. the constitution does not state that a person has the right to go to hospital, however the patients charter says that you have the right to hospital treatment if in your opinion it is required, no medical professional has the right to refuse you treatment at a hospital, and you can choose where you go to unless it is a immedially life threatening situation where you will be taken to the nearest appropriate receiving unit. this has been interpreted by the lawers and the courts to mean if the patient says they want to go , you have to take them, or you are personally liable for any injury or discomfort caused or sustained, now with our current sue them for all they got and then some attitude ffrom ppl who have never done a days work in their life and still tell me that they pay my wages just says to me that we need a fundamental shift in the setup, medical proffesonals should be allowed nto make the determination of what treatment is appropriate, not the dole dosser with a 40 a day smokers cough that just got his wife to call saying he was not breathing.

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    6. Good point. The world is so risk averse!

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  11. And the annoying thing is when these calls are received they have to be believed even though you know .....

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    1. Can only go by what they are told!

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  12. This sounds so familiar. Same shit different trust area. The best medicine for these numpties is a good 6 to 8 hour wait in A&E to contemplate their lack of intelligence.

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    1. Part of me agrees, part says they don't deserve to clutter A & E!

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    2. they don't learn though, and what about the ' regular caller - frequent flyer' types who know they only have to say ' my chest hurts' to get a 999 response, we should be able to direct refer those to psychiatric care and then lock them in rubber rooms

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    3. recently whilst waiting to book in my pt, reception put out a notice that waiting time was a min of 6-8 hrs as several poorly ambulance pt had been bought in, more than half the waiting room got up & walked out........that being the case should they have been there in the 1st place!!??

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  13. Love this, and love the fact you've got the balls to do it, one job at a time bud, sent from my ever so sloooooow tough book !!

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  14. So true!
    And play the game of guess the real problem by the age and address before you get there.

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    1. Always a good game! I have a great success rate!

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  15. I think some of the worst people are those out on the booze at weekends and use the ambulances to get them home or spew up in A.and E and expect the overworked nurses to clear it up, already short staffed and no hope of getting any more, always run ragged, always off late, no time during their shifts to take a break to eat or drink, or even go to the toilet, I think as a penance these type of people should spend a day as a fly on the wall and see how much trouble they cause to all n.h.s. staff, as when the likes of them are using ambulances because they are drunk and incapable of even standing up, go to A and E as time spent dealing with them, stops these poor nursing staff dealing with genuine sick people.

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    1. Alcohol is a huge problem as they have to go to A & E and invariably need a bed!

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    2. Bring back the drunk tank, all it needs is a cage with some padding on the floor and 1 PCSO to sit there and keep an eye on them, make it with washable padding, and put a grid in the floor, then all you need to do is hose it out in the morning ( letting the drunks out first is optional) and remember that it IS still an Offence under the law to be drunk and incapable in a public place, and also the actions that make you incapable are also part of a breach of the peace, so bang em up, hose em off, charge em, put them( still dripping) in front of a magistrate and fine them 2 years dole/income support/universal credit/asylum seekers pocket money/ each time

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    3. Yep! This year funding for it was lost. The hospitals didn't want to pay so it stopped. Now they are overrun they want it back but its too late to set up now!

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  16. Start to charge people 150 pounds for time waster calls as the ones above clearly are. Make a point of this to said patients on phone before sending ambulance and see them regain conciousness as if jesus himself was sat next to them.

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    1. I'd like to see a charge. Even the prescription fee would be a start!

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    2. Sadly I fear this would also deter the people who really need an ambulance through fear of being charged, especially the elderly who apologise for being an inconvenience already when often they are the ones who really need help.

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    3. The problem is though, you'll have people who are genuinely ill and can't afford the fee that will second guess themselves to be fit enough and not call when they are needed. Maybe rather than utilising a full size Ambulance, we could incorporate more cars / motorcycle advance units to get there first. I begrudge going to the doctors or hospital unless I deem it really urgent. I suppose thats just me, I don't like wasting my time or theirs when there could be worse than me needing the care. Job well done to you all in such difficult circumstances.

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    4. The problem is though, you'll have people who are genuinely ill and can't afford the fee that will second guess themselves to be fit enough and not call when they are needed. Maybe rather than utilising a full size Ambulance, we could incorporate more cars / motorcycle advance units to get there first. I begrudge going to the doctors or hospital unless I deem it really urgent. I suppose thats just me, I don't like wasting my time or theirs when there could be worse than me needing the care. Job well done to you all in such difficult circumstances.

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    5. Couldn't agree more. Can't risk putting off the vulnerable!

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  17. Haha! This is a perfect account of my average day at work also.
    I'm a paramedic in New York City and the abuse of the EMS system is ridiculous. The other day I asked a gentleman why he told of 911 operator he has difficulty breathing and he said 'well I needed you guys to get here quicker'. At least he was honest.
    I wish we could launch a similar campaign here in New York but I'm sure countless law suits would be the result.
    I hope it works for you guys even if it reduces the idiocy by one patient a day.
    Thanks for the awesome post!
    Keep up the hard work!

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    1. Hello New York! Same thing other side of the pond it appears!

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    2. Same thing Everywhere. I'm an EMT in New Zealand and we get this. a couple of months ago we got sent to a finger slammed in a car door that was barely bleeding and not broken.
      thankfully, in our service, the Clinical Practice guidelines state that while competent patients have the right to refuse transport, patients and family do not have the right to insist upon transport where the crew do not believe it is clinically indicated. but you do wind up spending an extra half hour or so on scene butt covering with several sets of complete vitals, completing PRF, making and communicating a plan, and seeing the patient mobilise effectively before leaving them at home.

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    3. Hello NZ! It's going that way but will take time!

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  18. The other day, working in Birmingham, I was send to a 22 year old male, unconscious/passing out.

    Needless to say this became a RED 2 incident and we were sent blues and sirens to get to this top priority patient, who's condition was deemed immediately life-threatening because he was unconscious. As anyone with first aid training will tell you, unconsciousness can lead to death due to airway compromise very quickly! Time was of the essence.

    We got there, we were directed inside the Hostel to a gentleman stood in the reception, on his mobile phone. It soon became apparent he was on the phone to the ambulance service, getting immediate life-saving advice from the call assessor.

    Upon sight, he put the phone down and we asked him to show us to his friend/colleague/co-resident who was so immediately at risk. The look of confusion on his face soon brought us to the realisation that he WAS the 'unconscious' patient.

    We walked him to the ambulance, where he divulged that he's had a headache for 7 hours, which he woke up with at 1300!!

    When asked if he'd taken Paracetamol he said 'No, I haven't got any and the nearest shop is 5 minutes to walk'.

    Have you seen your GP? 'No, he only comes in on Mondays and Thursdays'.

    Have you tried an NHS Walk In Centre? 'No, that's too far to walk'

    Take a bus/taxi/get a friend to give you a lift? 'No, that costs too much money'.

    When there is such a blatant feeling of entitlement for an EMERGENCY AMBULANCE because members of the public are too lazy/tight/ignorant to seek their own medical attention from a GP, Pharmacist or Walk In Centre, this won't get better!!!!

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    1. Entitlement is the key word. Previous generations used 999 properly, sadly not any more!

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  19. Why on earth did you take these patients to hospital? You say you are a paramedic yet seem to use no clinical judgment. Unless you work for LAS who do just take everyone to hospital it seems. The more I read your blog the more I worry that the public will expect us all to be as incompetent.

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    1. I completely agree. Have some balls and say no!

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    2. None of them were taken to A & E. None. I have clinical judgment and I use it. I use ACPs wherever possible and have given the outcomes of all patients in the editing notes above. Sorry that wasn't clear. The point of the post was about people calling 999. Hope that clears it up!

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  20. Just say no? I'm afraid it seems to me that you compound the problem by being so keen to convey these people.

    Until clinicians grow the balls to non-convey the rubbish, and tell the caller that they are wasting our time, how can we complain about them calling?

    "Ths Paramedics took me to hospital, so it must have been right to call" is what they will have been thinking.

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    1. I do say no, when appropriate. I also refer to an ACP when appropriate. None of these were taken to A & E. See my above editing notes for an explanation. Sorry if you thought I'd actually take these patients to a busy hospital. It would compound the problem!

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  21. Please don't tell me these were all conveyed to hospital???? No matter how inappropriate you may think a call is, if you take them to hospital then that justify the 999 call in the first place?

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    1. They weren't! All ACP'd! See my editing notes above to see the outcomes!

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  22. Surely by taking these people to hospital, for no good reason only perpetuates the problem though?

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    1. They weren't. See my editing notes above. All were ACP'd to appropriate HCPs.

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  23. So true. The public learn very quickly to work the system. I did two RRV shifts last weekend and only sent one patient to hospital. They need to supply us with man-up pills!

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    1. Those pills need more research! In some parts of eastern europe doctors give placebos!

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  24. (Be careful as your name appears on the bottom of the blog. My employer is pretty hot on this sort of thing. Dont publish this comment)

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  25. Yet if these people had rung 111 for advice, they'd probably still have been sent an ambulance - this does not really help us get the message over!

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    1. not only an ambulance but one as a red 2 call that has never seen a triage system or even the dispacher

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  26. If the ambulance service charged a call out fee this would no doubt stop. Introduce a user pays system!

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  27. I thought this was quite a good article until I read the bottom, shame you lump us HART people in with racists and homophobes! There's idiots in all walks of life that let the rest if us down, you've obviously come into contact with one or more of those. We're not all like it you know! Just saying.

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    1. I didn't mention HART and I didn't mention an racists or homophobes. Confused by this comment!

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    2. Ok but this appears at the bottom of your blog -" I love comments! All bloggers do! If you have something to say, agree or disagree I would love to hear it! I will reply to all! (or try my very best!) However, if you're a racist, a homophobe or a bitter HART team member with an ego problem, your comment will not be published!"

      I'm a little confused too! 

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    3. Touché! I should remove that now! One post criticising HART and I got all sorts of abuse! Sorry!!!

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  28. As a related issue my son cut his finger quite badly, not gushing blood but did it need stitches? I didn't know. Called the GP surgery (out of hours) response was "Well if you're not sure take him to A & E". I had transport so that's what I did. Did he need stitches? - no he didn't I'm convinced the GP could have told me that and had he needed a couple he could have put them in. Had I not had transport I may have called an ambulance. In which case wasted ambulance and A & E time for want of a few minutes of the GP's time.

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    1. GPs are responsible for a lot of time wasted of ambulance services. An annoying problem!

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    2. GP = Generally Pass the buck and go play golf

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    3. "Had I not had transport I may have called an ambulance."

      Why? Because it's free? Why not call a taxi? That would solve your transport issue just as well, without tying up an EMERGENCY ambulance.

      If you're unsure whether to call a taxi or an ambulance ask yourself this question - 'what will the difference be?' Presumably by now you have wrapped your son's finger and stopped the bleeding. So: a taxi driver would have driven you to hospital to see a nurse. Assuming that bleeding has stopped and nothing else can be done immediately an ambulance crew would have.... driven you to hospital to see a nurse. Ambulance crews don't do stitching, so all they would have done was load you in the back and made polite conversation on the way to hospital, same as the taxi driver. If the difference is so little then put your hand in your pocket and call for a taxi. If you think you genuinely need expert care *on the way* to hospital, then by all means call 999.

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  29. Couldn't have put it better myself, this is a real "it's funny because it's true"!

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  30. Hi Ella,
    here in the SW we simply would not take any of those patients to hospital - we might refer them on to the GP or whatever, but no way would they be using an ambulance. If they were really hassling, I might tell them to make their own way in so they can wait. I leave around 60% of my patients at home, with a safety net of course. Why are you conveying under those circumstances? Interested as to why your Trust clearly isn't supporting you to do this!

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    1. Same here then! None were taken to A & E! All were ACP'd, see my edit notes above for patient outcomes!

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  31. Does your Ambulance Trust genuinely not allow you to decline ambulance transport to these people?

    Round here, they'd get a car sent, a set of obs done, including a 12 lead but forgetting to tell them to take the dots off straight away, and maybe get told to see their GP.
    That's IF they didn't get spotted at the Call stage and redirected to talk to an HCP,
    Even if a DCA went out, they wouldn't transport if there's no reason to - and they'd take a lot more persuading than stated above.

    Oh, and if they did get to A&E they'd get taken in to the department, scowled at by the Triage Nurse, and either sent to the waiting room for 3h57 or get seen quickly and booted out with a flea in their ear about wasting ambulance resources.

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    1. We do refuse to send, and in certain cases refuse to transport. Generally we refer to ACP's. See my above editing notes for the patient outcomes. Sorry for the confusion.

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  32. Several points here. The ambulance service should not be taking these patients to hospital if there is no need.

    Staff should be supported in doing so based on there sound clinical assessment skills.

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    1. We didn't take them to hospital and we are supported. Have included patient outcomes above!

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  33. If they were obviously time wasters, did you take any of them in?

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    1. None! All referred on. See above edit notes for patient outcomes!

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  34. So in each case you took them to hospital anyway? The arse covering phenomenon is rife in the police (where I work) too, so I don't blame you. We just need to stop accommodating idiocy!

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    1. I didn't take any of them to hospital. I've added the patient outcomes at the bottom of the post!

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  35. There are crews all over the country giving you a standing ovation! Well said!

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  36. Bloody brilliant! Having experienced this first hand for many years Im glad someone is speaking up! My best was being sent to a patient who couldn't find his own pulse! Yes blue lights and all the frills, Needless to say he was fine! complete muppets :-)

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  37. Do you not ever worry that your heartless sinical outlook on your time wasting patients will cause you to overlook a genuine big sick patient one day ?
    We can't all be 100% correct all the time, can we ?

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    1. I may be cynical on reflection but I treat every patient at face value. I very rarely discharge a patient out of my care without a complete assessment and referral on to another HCP. That way I am confident I don't miss Big Sick patients. Obviously we all make mistakes, myself included but overlooking ill patients isn't one of them. I've added the patient outcomes above so you can see what happened to them all. Sorry for the confusion.

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  38. As a fellow Paramedic I really hope you take this in the way it is meant. I think you need to do some serious reflecting on how this post came across. It makes you appear quite incompetent. I am not Hart or anything special I am just another working Paramedic in the NHS. Gibbs Reflective Cycle is a useful tool. Maybe your trust has a culture of conveying but recent government reports quite clearly show we should be using alternative pathways. If you are as competent as you are confident then should these patient have been conveyed? If you convey them, then they needed an ambulance... otherwise you should have educated them and provided them with alternative care pathways and safety netted.

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    1. I didn't convey any to A & E. They all got a full assessment and were referred on to ACP's . I personally do do a lot of reflective practice and I also utilise all ACP's were appropriate. I understand your point and Ive added editing notes to the post to outline all the patient outcomes. Hope this clears it up!

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  39. Why are you taking these patients to hospital if they don't need to be there? Paramedics are autonomous practitioners and can decide whether to admit or not. You have diagnosed simple and non-urgent conditions, yet you still take patients to A&E. If you ask me, one of the major problems with all the "inappropriate admissions" to A&E, is that crews shouldn't be taking them in the first place!

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    1. In the post I never said I took any to A & E and I didn't. They were all referred to ACP's be it a UCC, WIC or GP. See my added patient outcomes above to see.

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  40. If the police were called out to these people, they'd be charged with time wasting, how is it right that they can waste the system like this and nothing is done about it? How would they feel if their relative was lay dying but an ambulance couldn't come because it was busy with someone who had a cold????

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    1. It can be frustrating. Hopefully some carefully worded 'health promotion' prevents future misuse!

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  41. Thanks for summarizing my just completed 4 night shifts so succinctly..with my symptoms today Im sure I could get myself a red 1 response...but no doubt I will be back for more at 7am tomorrow..ready to counsel some more stressed teenagers over their failing love life..Grrr!!

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    1. Thank you! We've all been there, all do the same job! It has it's highs and lows!

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  42. Why did all these patients go to hospital when there is no clinical need? Can you not leave them on scene with advice as we would have done? However a very good article which highlights the problems of our A&E departments and I love the ambulance adverts which hopefully will reduce the pointless calls we receive.
    Paramedic, Southwest Ambo service. (Not a HART team member)!

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    1. None of them did! All went to ACP's! I've added editing notes to explain the outcomes. The post was about why they get ambulances. Hope my addition has cleared it up!

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    2. I wish some of the people reading your blog, would actually read all of it....its not rocket science how many times DO you have to say, you didn't convey to A&E I think its probably your ex pt's who are commenting!!!!!!!

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    3. Haha! Possibly! At last though, someone who noticed at no point did I say I took ANY to A & E!

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  43. You know I wish I could say I found this shocking but sadly I don't. People today are selfish they don't care that they are putting someone else's life on line because they have morning after stomach upset which is obviously appendicitis or a hang over which is clearly an aneurysm. I sincerely hope that these people start getting fined for wasting time maybe then the NHS could get the money it needs to pay their hard working long suffering staff.

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    1. That's the key, people today! Big shift in what people think 999 is for over the past decade or so!

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  44. Why are you taking these people into hospital? Have you not heard of alternative pathways?

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    1. None of them went to A & E and every single one went to an ACP. In the post I didn't say any went to A & E. I've added the patient outcomes at the bottom of the post to explain!

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  45. Makes me sick, maybe i should ring 999 i have severe shaking, diaphoresis, pallor, tachycardia, DIB and nausea - EMERGENCY??? Nah i am just livid and angry at the abuse of our emergency services. Let's keep our ambulance service used for true emergencies. I have seen ambulance staff bringing a 19 year old girl to AED because she had stubbed her toe and the nail was broken, not to mention coughs, colds, sore throats. GET A GRIP!! While these time wasters take up a valuable ambulance and it's personell lets hope it isn't THEIR relatives waiting with an MI, CVA or life threatening condition.

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  46. I woke 6 years ago in agony head to toe. I could not move a digit an inch without extreme difficulty & suffering. I was in shock I did not call an ambulance. In fact, my then partner went to his pharmacy to enquire & returned 7.5 hrs later to tell me it was arthritis. To take anti inflammatory meds. I was so exhausted but could not take them as I was breast feeding my 3month old. I just lay there crying, immobile not even able to reach to the phone nor dial. I did need an ambulance. But couldn't function. He is no longer my partner. I am sorry there are so many service abusers.

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  47. why are these people being taken into hospital? The buck should have stopped with you at least with the last job.

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    1. It did! I ACP'd all of them! Have added the patient outcomes above to clear that up! I hate taking patients to A & E!

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  48. ah but not to mention the real loser in all of this! the 65 year old who is having a screaming MI but does not want to bother anyone because he knows we are busy! he plays it down on the telephone and due to this ends up behind the guy with the cold!

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    1. Very true! Saying that, I haven't been to an MI for ages!

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  49. Why are you conveying?

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  50. Having recently returned to front line work after an absence of eight years I have found that crews are too scared to deny the trip to hospital because the powers that be, in their air conditioned offices, are likely to hang them out to dry if they ever get it wrong.

    Despite the introduction of super hero paramedics the deskilling of the tech grades has resulted in a lower level of confidence, and consequently, an increase in the number of unnecessary visits to A&E, with all the knock-on effects that brings with it.

    Reluctantly, I am moving towards the idea of charging for ambulance transport, waivable if the patient's condition turns out to be genuine.

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    1. I'm happy to refuse. Hate A & E! Have added the patient outcomes to explain the ACP's I used!

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  51. Yes, members of the public call ambulances inappropriately which does tie up resources unnecessarily. But not as much as conveying patients that clearly do not need to be in a hospital. Discharge on scene, go clear and attend another call in the time that it would have taken to take them to the ED.

    Yes it frustrates me when we get jobs that aren't an emergency but it's a bit hypocritical to sit and complain about them when you are as bad as them.

    They ring an ambulance because they want to go to hospital, so you take them to hospital. If you didn't they might think twice about ringing next time because it doesn't get them where they want to be.

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    1. Sorry, I wasn't clear. NONE were taken to A & E. All were ACP'd. I've added editing notes above explaining the patient outcomes!

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    2. Maybe if 'baffled' read your complete blog he could have know that and been 'unbaffled'...

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  52. I'll just want to say to all those that don't know " if a patient calls us and wants to go to hospital, we as the ambulance service can't refuse to take them" its called the NHS constitution, this person has git this blogg spot on, half the problem is the control centre sending us to crap in the first place, let alone 111, don't get me started on that massive public waste of money.

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    1. I refer where I can and will always suggest an ACP but if they insist on A & E it's a grey area to point blank refuse when they are in your ambulance and in your primacy of care!

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    2. Anonymous - Absolutely nowhere does it say that if a patient wants to go to hospital then we have to take them. I regularly refuse to convey patients that simply do not need to go to the ED never mind by ambulance! What you're referring to is our obligation to take anybody that "needs" to go to the hospital, not "wants". By the same logic, everyone that dials 999 should be sent an ambulance which just isn't the case.

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    3. I'm aware of at least 3 trusts where refusing to convey where clinically appropriate is not only accepted, but encouraged. I find it's mostly about the way in which you talk to your patients, however, I can generally get most people to follow my care plan, and most are pleased not to have to go to hospital.

      I find this concept of "ACPs" baffling - it implies there are prescriptive options (perhaps a cultural difference between trusts). My trust basically allow all staff to do whatever they can achieve in terms of referrals, I've taken patients to walk-in centres, intermediate care wards, direct to wards, the pharmacy, hospice care, home. I've contacted DNs to arrange wound care / EoL care, social services to sort intermediate home care, private care companies to discuss patient's care packages, equipment maintenance companies, patient's GP, OOH GPs, specialist nursing teams, and falls teams - all without a single official referral pathway in existence, and I'm far from a special case.

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  53. They can't sack ya for taking patients to hospital.

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    1. Perhaps. Because you can for being incompetent.

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    2. No, but maybe they should start. Taking people to ED because they have annoyed the paramedic isnt ok either,

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    3. Have I done anything incompetent?! Every patient assessed and referred to an ACP?! None taken to A & E. What's incompetent about that?!

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    4. Sounds competent enough, but when clinicians are challenged and expected to do 12 leads on everyone, blood sugars on everyone, at least two sets of full obs on everyone and numerous reams of forms do you start to wonder if you are actually trusted to leave someone on scene with a simple cough?

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    5. You have a point. We shouldn't be 'marked down' for not doing various OBs and an ECG. We should do what is appropriate. I've been criticised on here before because I dared to say we shouldn't routinely do ECGs on people that don't need them. If they are young, have no risk factors and are presenting with something completely non-cardiac then why are we doing an ECG?! The reason most GP surgeries don't have an ECG machine is for most people it isn't c]necessary for a minor ailment!

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    6. HCPC says that observations and investigations should be appropriate to the condition presented, and only if warrented should further investigation be performed, as to the GP and the ECG, they could not read one if it was in plain English, had one the other day 40yr old male sharp right sided chest pain, worse on inspiration, worse when coughing, Hx Unproductive cough for 1/52, GP diagnosis = MI, no chest exam done, no aulsulation of the chest, just ' sit in the waiting room' and call 999, crew arrives and gets told by GP that PT MUST go to hospital, and MUST go to local A&E, crew explain to GP that if the Pt is having an MI then they will have to go to a specialist cardiac center, GP gets stroppy saying he knows best, crew try to explain that the current pathway is for Primary PCI at a specialist center, GP says NO, Must go to Medics at local A&E ( all this is going on whist the para is doing the ECG and other obs in a treatment room, chest sounds basal creps with ronchi on exhalation, no plural rub good air entry, expansion equal, percussion normal, ecg NSR No changes, Pt asymptomatic of MI, but symptomatic of chest infection, GP still Insists That pt is trabsported ot hospital as ' he has the experience and the (20 yr service ) para does not know what he is talking about.' crew transport to local A&E :- pt outcome chest infection, home with antibiotics, Crew :- formal complaint about GP and lack of professional attitude to crew, result crew get told off for trying to explain the procedures GP gets away with misusing ambulance

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  54. I had a call once. The patient had a headache. When we got there he said "I have a headache because I can't see properly. Its too dark in here". He still had a wrist band on and had been transported home by PTS an hour before.

    Diagnosis - lightbulb needed replacing!!! REALLY??????

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    1. I totally agree with your comments and I use ACP's when I can, BUT GP's are too busy, OOH struggle to attend, ICT wont accept a pt if there is the hint of any medical problem, cant access a CPN, cant access social services, DN's don't work weekends (in our area) when we're sitting with a 93 y/o lady who has had a non injury fall pleading to go to hospital because she is lonely and has no family I challenge any of YOU to leave her at home, yes its not what we are here for and according to the trust people don't fall at night ! Thats why we don't have a falls team after 5 pm plus the funding problems as well, again I reiterate that if a pt wants to go to hospital I'll take them, because im sick of arguing with relatives and pts stating its a waste. Yes the adverts stating you wouldn't call the fire service out etc, so why and how do jobs to earache get through the system ? Would any of you call an ambulance for earache ? No you wouldn't, so why does our service send us. Btw im EMAS to.

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  55. Perhaps if all calls you went out too were, emergency orLife threatening events, as it should be then the Health Service could save on money and the cost of so many Paramedics. Know it is very frustrating for the Ambulance Service!

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    1. It is! Especially when all services are so woefully short on paramedics!

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  56. These posts have made me giggle as I used to work in a hospital but 4 years ago when I became ill and my mum called an ambulance they came, looked at me and told me I was hyperventilating and left, the following day I had to go to the doctors out of hours in the hospital, he looked at me and rushed me in and said I needed emergency treatment I only had roughly half hour to live!! Thanx to the docs I'm alive to tell the tale. I had swine flu!!

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  57. You may have used an ACP but you still used an ambulance, with lots of life saving equipment on board, to convey them to the ACP. You're Trust should be supporting the use of the word no! I always ask the patient what their expectation of being in an ambulance with a fully trained crew is.If it's transport they should be offloaded.

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    1. You should know then that an Ambulance Service is a big machine! It takes time to make big things happen. ACP's is a step in the right direction. We can now refuse transport under certain criteria which is currently being trialled but the patient needs to be in agreement. It's moving in the right direction but still work to do. It's easier to refuse an ambulance when on an FRU but if the patient is in the ambulance it is harder to kick them out!

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  58. Ah, took a moment. DIB for us means 'dead in bed'.

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    1. Hahaha! I can see how that may have been confusing!

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  59. Under the NHS constitution a person is entitled to an "ambulance response". This could be anything from a full dual manned ambulance down to a telephone triage/referral from the duty clinicians at control.

    What it does not say is that you are entitled to an ambulance conveyance.

    In our area, if a patient is appropriate for a walkin centre, then they make their own way there. Same for all other ACPs. Ambulances to ED/ppci/stroke unit etc. only.

    Much love x Portly x

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    1. It's going that way with Pathfinder but will take time. We can now leave a patient for PTS transport, a taxi or make their own way under certain circumstances but you know as well as me, a difficult patient overhyping symptoms is hard to leave behind once on board!

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    2. Pathfinder(pathways) says send amb on 99.9% of the calls, combine that with non clinical call takers and triage desk personel, = 1 official 8 hour shift becoming a 13 hour shift with no meal break and 18 jobs

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    3. Our Pathfinder isn't a phone triage tool, it's algarhythm to determine suitable destination on scene. On the phone we use AMPDS not Pathways

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  60. A& E is for accident.& emergency Not anything and everything keep up the good work

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  61. Ella, whilst I applaud your attempt at making a salient point I think that in trying to be too clever about the way you presented it you have caused more negative than positive comment ...

    That said, had the majority of respondents questioning why you would have taken these patients to A&E actually read your blog in entirety then they would have surely realised (as I did) that it doesn't say anywhere that you did - merely utilised the ACP's available to you..

    So, there are 2 learning curves to be had..
    a) It's better to be clear than clever when submitting articles or comments on open forums and
    b) It's always best to read an article fully before posing unnecessary questions; unnecessary in this instance because there was nothing in the second part of her blog to suggest Ella had actually done anything more than refer on post-assessment...We've all done it at one time or another - half read or not fully digested something - can cause problems, not to mention embarrassment at a later stage?

    Just saying.....

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    1. The article has been edited since I (and others) commented regarding why these patients were conveyed, hence looking as though we've not read the thread.

      Also, not sure I count conveying to UCC as non-conveying. Non-conveying is "you have x, you need to do y, and call back if z", probably combined with a referral to GP / OOH GP for info, prescription or assessment.

      Rightly or wrongly, the perception was that Ella had conveyed these patients whilst simultaneously denouncing them as time-wasters. Other than those who deliberately abuse the system (eg. claiming non-existant symptoms in the knowledge that these prevents clinicians from justifiably non-conveying), I take issue with any patient being described as a time waster by a clinician not brave enough to leave them at home - if we as professionals think their symptoms warrant attending an A&E / UCC, then how can we simultaneously argue that there's nothing wrong with them?

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    2. Because it's about striking a balance between leaving them at home and risking further resources and biting the bullet and taking them where they should have self presented in the first place. As an FRU i'm more inclined to cancel an ambulance and non-convey. However, in a public place, a 3 of them were, there is non ability to refer to GP as they won't visit or call back a non-residential address and it's best to ensure the care is continued once in the ambulance. Sure, I could have booted them all out but I think that would have achieved very little. I never stated they were taken to A & E, that was presumed and for ALL patients I followed my trusts existing guidance and protocols for every patient. In an ideal would I would have sent them all on their way but my service isn't there yet. I don't see how Im coming into criticism for taking referring them all to ACPs, freeing up the hospital waiting room!

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    3. Can I also add that I didn't edit anything of the original content. It never said anyone went to A & E. I have however added the patient outcomes. Besides, this wasn't what the post was about. It was highlighting how patient get ambulances despite having minimal symptoms, not about what to do with them. In that respect the comments have gone seriously off piste!

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  62. What a great article. Here in Canada you get a bill for an ambulance unless you are on home care. That sorts out the people who think an ambulance is cheaper than a taxi or hospital parking.

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  63. As a fellow paramedic, the thing that I find the most disturbing about this entire thread is the seeming willingness of other paramedics to firstly judge and then secondly accuse the author of incompetence, despite her repeated clarifications that show her to be anything but incompetent. Why are we as a profession so quick to assume incompetence in each other and to go on the attack? Why do we not automatically show more support and more confidence in each other? There are so many others who are happy to criticise us, we do not need to act like this as well. If others judged and accused you personally as being incompetent, that naturally would make you pretty cranky as that (most likely) is not the case, so what makes us feel it is ok to do that to a fellow paramedic? Where's the love?? Come on guys, we've got to stick together!

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    1. THANK YOU whoever you are! I was also a tad surprised I was coming under attack! Thought I did right by all my patients personally! Followed guidance and protocols in place and all got the correct treatment. In our profession there seems to be a trend of oneupmanship and a determination to undermine others for personal gain. It'll get us nowhere! Thanks for speaking sense!

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  64. I can honestly say (thank the Lord) that in almost 57 years I have never called for an ambulance. I also have to say that after reading this I would be terrified to call for one in case I was labelled a time waster. I would never make the call unless I thought it absolutely necessary, but how would I know? I am not a medical practitioner. I hope that if and when the time arrives the person on the other end of the line will be able to make an informed decision as to whether or not I need an ambulance based on the honest information I give them. Just saying xxx

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  65. I work in a very busy EOC and sympathise with what you have to deal with - in the control room we hear everyday (and night) of cases that don't require an ambulance, yet our hands are tied as we have to process the call as to what's given to us. I fact on most days it can be rare to even take a genuine emergency call and at weekends it's just pissed up people who can't handle their drink and expect to be picked up and taken home, they also think that by travelling into A&E by ambulance will give them a priority.
    Overall it's all about EDUCATION, I see the East Mids campaign, but don't see any of these type of articles in local papers,GP surgeries,etc etc - The lack of money stops this happening, but surely having an effective campaign would save the service money in the long term !!!
    Keep up the good work - and we'll keep doing our best to help you.........

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    1. I think it's too late for some generations. Need to start the process from primary school and in 10-15 years we'll see the difference.....hopefully!

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  66. Are you all f!@$#g stupid it is reiterated time over no patient was conveyed. Maybe some of you need to do a reflection on reading articles fully.

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    1. Hahaha! Thank you! I never said A & E even once! Even when I added their destination people still assumed wrong! Never mind! Haters will always hate!

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  67. Conveying someone to a WIC or MIU takes up about the same amount of ambulance time as taking them to A&E, also giving the moronic patient what they wanted.

    Instead complete a thorough assessment, concise water tight paperwork then stick with your diagnosis as a clinician and leave them at home or tell them where they need to take themselves (GP, MIU etc). Then get back on the road ready for that genuine call... or hurty finger!

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    1. I'm more than happy with my diagnosis as a clinician, and I'm more than happy following the guidelines and protocols that are in place. It is different from trust to trust. I'm not in the business to cause a rift with a patient and boot them off an ambulance. I will give advice, health promotion and refer onto another HCP via an ACP as is our policy. You didn't see my patients or how I treated them so you're not best placed to criticise what I did, how I treated or presume what kind of clinician I am!

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    2. Dear Anonymous, this is just a query in response to your reply. Do you honestly believe that none of what you have written had ever occurred to the author? If this is not what you believe, then why write it? It just seems to insult the author's intelligence, and I'm certain that was not your intent. My query could easily be directed to many of the respondents above as well, it's just that you're the last person to have replied to the post. Thanks :o)

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  68. I hope these idiots got a bollocking too - should have to attend some sort of course too in the same way dangerous drivers do to educate the fools.

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  69. I recently heard a Senior Paramedic on our service, whilst counting paracetamol on a drugs check, say "We shouldn't have to carry things for 'Mild' pain, if they only have mild pain they shouldn't have call". PROMPT him now, he has my vote for Head of Service!!!!

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  70. LOVE this Blog. You guys and girls do such an amazing job and as if the Ambulance service/NHS isn't strung out enough. These people actually make ME sick so i can't imagine how it must make you guys feel! The amount of people that purely need a nice warm cup of "Man the F**k Up" you'd need a reservoir of the stuff to make sure everyone got a mug full!

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  71. LOVE this Blog. You guys and girls do such an amazing job and as if the Ambulance service/NHS isn't strung out enough. These people actually make ME sick so i can't imagine how it must make you guys feel! The amount of people that purely need a nice warm cup of "Man the F**k Up" you'd need a reservoir of the stuff to make sure everyone got a mug full!

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  72. The problem is that we are dealing with the Jeremy Kyle culture of want and need. They want something. They need it now. There is no consideration for others and certainly no "cost" consideration - be it emotional cultural or finacial. Education is not something that will work as - from my experience of 12 years front line police work - there is nothing so overriding as the panic of confusion and need. Rather than a financial penalty the only way to combat the waste of time would be to stop them watching TV for a week...

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  73. I'm a dispatcher in a very busy eoc and spend most shifts in acute frustration with the idiots i am sending my valuable crews to. Ampds is a good tool but as calltakers cant deviate from the questions at all it is wide open to misinterpretation eg a g2 call male laid out inhaler by his sid car and dma sent i should have diverted to a higher grade 111 call but something made me leave both running to the g2 which was actually a cardiac arrest. Now im not god but we are faced with these decisions daily and for what unfortunately the god of our bosses is the orcon! We on the 'frontline' do our best all the time via whatever pathways are available but we are NOT a bottomless pot. Education must start at an early age a free nhs is the greatest privilege the uk public has but this continued abuse and mindset that it is a right to use it at will is what will ultimately destroy it. Best wishes to you all working the festive period as i am, it is worth it for the genuine ones whose lives we change however briefly. Bless the nhs and all who work for her x

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  74. Always love your blog posts :)


    Shame that my trust wants everyone to be conveyed (Hell, we are one of the last few trusts to still transport every arrest!)

    Even if there is no problem, I would still have to offer you transport to a UCC, and if you insist on going to the A&E, then off we go!

    ACP's are far and few between, with no backing, but a full bollocking, should you leave the triage flowchart (yes a flowchart to tell you what to do). We must follow the triage tool, and we cannot call the patients own GP to arrange an appointment.

    When a self care pathway is not able to be used (very very strict parameters), staff aim to get a refusal from the patient, but are still unable to say "you do not need to attend A&E at this time" and most handovers at the A&E start with "I'm sorry but....."


    Annoying, but there is a glimmer of hope. New ACP's are slowing coming in and more safety netting (till the funding finishes anyway)

    But all useless, if the patient says that they want A&E.

    I do sometime wonder why I am at university for two years, but such is life!

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  75. Lastnight got a female with a cut finger, ok it was'nt just a paper cut,but they rang 3 times, lived 1.5miles from the hospital, it was a RED 2 (CAT A for old school), they sat like idiots and waited 1.5hrs for us! And no she was'nt bleeding to death and never had been! Got another female who took own BP and it was over 200 systolic which had been going on for a while, GP had refused to give BP meds, however it still didnt need an Ambulance to take her. Also got plenty of 111 calls for total rubbish. Lets just say out of the 9 jobs we did in 10 hours the stretcher didnt move once! We need to cut out the middle man (us) so that we are there for genuine emergencies- im sure we all get frustrated when an MI, CVA, RTC knock down etc have to wait 30 mins or more, it happens enough in my area. I personally advise people not to bother with 111 for things like children with a rash or high temp etc as we know the end result- you called sir/madam?!

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  76. It is sad, being a pre NHS child I remember we only called a doctor when Mum had completely run out of solutions/remedies.

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    1. And this is the precise problem we have now. 999 if the first consideration for so many minor ailments; and sadly the education the isn't there. People genuinely think they are doing the right thing when calling us out for 2 weeks of knee pain... Ella your blog is entertaining as usual. Thanks!

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  77. I have huge sympathy for all ambulance personnel who are sent to inappropriate calls - but the triage system our Trust now uses can cause serious problems for a genuine caller.

    My husband is insulin dependent, and occasionally has a severe hypo during the night. Normally, I manage him myself, but sometimes I need assistance (for example, on one occasion GCS 4, BM 1.4). The last time I called 999 for him (about 3 months ago) was one such - he was flopping and thrashing around, part in bed and part out, and (amongst other things) had sent flying the bedside table with a TV on it. He was not able to co-operate to take anything orally, and I could not keep any part of him still enough to use the glucagon injection safely - had I attempted to do so, there is a real possibility that the needle would have broken as he jerked around. I know my limitations, and so I called for help.

    The call-taker clearly followed her algorithm, but this did not seem to allow for the possibility that the caller was genuine, knew what was wrong and was physically unable to manage the patient without help. I was even put on hold while she spoke to a nurse. Meanwhile, I was unable to do anything to care for my husband (for example, by trying to keep some bedclothes on him, or try again to get GSF gel into his mouth), because I was concerned that if I put the phone down, no help would have been sent.

    A crew did attend. As it happened, they were both men - which was good, because I think that a 2-female crew would have had great difficulty dealing with my husband, even with my assistance. One restrained him while the other inserted a cannula, and administered 2 x 50ml glucose IV. By this time, my husband was also hypothermic, and the crew then stayed until he was re-warmed - a total of nearly two hours (which I consider vindicated my decision to call for help) - before leaving him in my care.

    So the algorithm doesn't necessarily work even when a call is genuine ...

    [BTW, I'm a former (non-NHS) ambulance technician.]

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  78. Hi, I agree that there are people who abuse the service. Just be careful please. Last year I got a phone call at 3am from a paramedic who sounded a bit cheesed off. My 92 year old mother had called 999 as she had been vomiting all day and had stomach pain. The paramedic told me that all her obs where fine and he didnt see a need for her to go to hospital. After I asked a few questions he added that she had told him she thought she was dying. When I heard that I said that I thought they shoud take her to A and E. After 2 days on the obs ward and having faecal vomits she had risky (because of her age) surgery for a complete bowel obstruction. She died 2 days later. Im just saying that until I was told that my mum had told him that she thought she was dying, the paramedic convinced me she was time wasting and if I hadnt been a nurse, I may have agreed with him.

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  79. Interesting blog!

    I'm curious - how (in general) is something like panic disorder perceived? I've had this bothersome irritation for about a decade, and have, for the most part, learned to deal with it. However, in the first few months, I never called for help myself, I might add - either a friend or passer-by who would call when I hit the deck / when my slurred speech didn't return to normal after half an hour or so. I experienced everything from sympathetic paramedics, who passed on very useful knowledge about the progression of panic, and how it can affect you, right down to being ridiculed in front of a busy A&E waiting area by the triage nurse.

    I'm not intending to make a 'they were horrible to me....blah blah...." kind of post - I'm genuinely interested to hear opinions.

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