'Category A call – 25 year old woman with thrush, itchy genitals. Difficulty in breathing'.
Yep. Thrush.
This warranted a fast car response as well as my fully equipped ambulance.
I have two options here.
Option One
I explain exactly how this is a waste of an ambulance, especially as how the hospital is 800 yards away from the woman's address. I suggest that a taxi would have been more appropriate. I could explain how people who are actually ill are now waiting for an ambulance while she gets a free ride to hospital. I could refuse to take her.
Then I get a complaint, then I get fired.
Option Two
I shut up, take her to hospital, make ready for my next call as son as possible and get to keep my job.
Yeah, I'm a coward – I always take option two.
The problem is this, the people up in Control aren't allowed to use the 3lb of grey squishy stuff nestled between their ears to determine how important a call is. They have to mindlessly follow a computer script, if they deviate from the script they'll miss out on any chances for promotion.
While the computer script is useful it's a real shame that our call-takers can't use their common sense. It's why we end up going to people who 'aren't breathing', yet are able to make a 999 call.
And all because the computer system we use has never been sued.
I have to ask Tom…..why are you taking these people to hospital?I've hunted high & low in the Patient's Charter & elsewhere for the definitive indication that you HAVE to convey if the patient wants a ride in the big white taxi – but can't find it. Would love to see a link if you have one.
I know we're very lucky down here in rural-ish Devon…..a few numpty jobs but not nearly as many as you, but I can't remember a patient insisting on being taken against our advice. I've asked a few of my more experienced colleagues too, & they seem to believe that there is no such obligation if there clinical judgement suggests an alternative.
I'll try a get a proper answer out of our chief exec next time he runs a chat-room session!
And from a management point of view…..with Call Connect startting (officially) in a couple of days, how do they expect you to hit those all-important targets if you're picking up rubbish like this?
All I can say is…you have my sympathy. It must be very hard to keep motivated when dealing with such dross. And I believe our management are rather more supportive than yours (though I'm saying this as someone who has never had a complaint against them….I reserve the right to change my mind).And as for the quiet life……….working in Newham?????
I don't want to depress you, but I'm writing this 7 hours into a shift……….we've nearly seen a patient, but not quite.
“The problem is this, the people up in Control aren't allowed to use the 3lb of grey squishy stuff nestled between their ears to determine how important a call is. They have to mindlessly follow a computer script, if they deviate from the script they'll miss out on any chances for promotion.”Ah yes, let me guess: Dr. Clawson's “Priority Dispatch” system? I will also venture that they have a sign outside the dispatch center that says “Please Leave Your Common Sense At The Door.”
Now, there is no doubting that dispatchers have a tough job. Some of my best friends in EMS were dispatchers. They are in the same boat you are, in that either you do what they want you to do, or you get canned. The problem is that the decision makers who procure these CAD's are either:
1. Managers that have never worked on an ambulance/dispatch board a day in their lives, or;
2. Medics and EMT's that climbed the ladder up through management and forgot to look down and remember where they came from.
I would have opted for a combo of option 1 and 2. Taken her to the hospital to fulfill my obligations, and then let her have it all the way there as to what an abuser of the system she is.
I have done that in the past…..
Zen breathing Tom, Zen breathing……
I work for NHS Direct and our call handlers are also very tied into the CAS system, very difficult job they have, people wil say they are gasping for breath but talking in sentences on phone!! The lay person in general has such a limited amount of medical knowledge that makes triaging some these callers a very tricky job. I love reading your blog and read our book practically in one sitting! I couldn't put it down. Keep up the good work!
This really is a great blog Tom, congrats – Have added you to my blogroll if that's alright.One thing, remind me never to buy a house 800 yards from a hospital in London, that distance seems to particularly unlucky!
Sue the computer system! What a brilliant idea! The NHS is just the beginning. There's Verizon. Anything that does voicemail. Blue Cross. (You think the NHS is bad. Hah!) And so many more. Where to start? Where to start?
The one thing that recurs in this blog is the number of times the patient is within walking distance of a hospital and can easy use Shanksey's to get there, yet prefers to call for an ambulance. Not an FRU, only a big green and yellow job will do.Must go, have an itchy toe. Just off to dial the three 9s. Even though I'm sitting in a pub next to the hospital I still want a big green and yellow taxi. It's my toe that's itching and I have a right to expect transport to be provided.
If only there was a someone to defend your professional reputation. Then maybe, and this a definite maybe, option one might be possible.I guess from reading this harrowing (but excellent) blog for a while now you seem used to operating without good support from management. What do folks out there think?
(Please note that I just switched from working as non medical staff for a PCT to a leading MDO š so my comments are loaded.
Surely walking to the chemist would have been even more appropriate than a taxi to hospital??
THRUSH??!!!! For God's sake!!!!Last time I was in the A & E waiting room a guy strolled in with his EYE HANGING OUT. 'Oh', he said, 'I'm looking for casualty, is this it?' 'AAAARGH' chorused the entire waiting room. He lived about 800 yards away too, definitely an unlucky distance!!
It's not a cowardly way of dealing with the situation, it's the only way if you want to keep your job, we should ask for gum shields as standard issue to protect our own tongues !!
Our service is just about to implement AMPDS too, (no surprises that a couple of our upper management used to work for Kent AS), looking forward to it with mixed emotions, as currently we use a custom made (by road crews) system that's apparently getting a bit long in the tooth now, and it misses quite a few things, but relies on the Call Taker using common sense… but of course we don't want to get sued!
AMPDS can be really good, in that Omega calls get sent straight to Psiam (the clinical advice desk), which is manned by a paramedic or technician. So if someone phones up because they have an earache – one of the first calls I ever took – I have great pleasure in transferring them to Psiam.But what really gets me is someone who knows the system. With one patient last week I spent ten minutes trying to get the address, which proved very difficult because he was drunk as a skunk at 11am, and then because he didn't seem to be able to give me a chief complaint, I went through the questions for 'sick person'. It then transpired that not only did he have chest pain, he also had extreme difficulty breathing! Funny, why did he not mention these things before? Because this guy knew how to play the system, we had to send an ambulance on blue lights and sirens (and also the police on grade 1, because he had a past history of extreme violence) to someone who just wanted someone to abuse.
Tom (and any other paramedics out there), do you find that these people have any sense of the stupidity of their actions? Do most of them not care or do you think they're a few sandwiches short of a picnic?I don't know if I'd be able to stop myself from giving them a mouthful, I'm afraid. And as I said in relation to your previous post, it really is time that fines were imposed on these idiots.
some are a few sandwiches short of a picnic, some were not aware there was a picnic going on at all. Most are lazy and the rest think that because its free its there to be used. The ones we don't get to go to are the ones who make their own way (with eye hanging out etc) and not only warrant an ambulance, but deserve one….
same thing here – we use a system not because it makes sense but because it apparently saves us legally…or so we're told.how long ago was it that your dispatch started using cards? we had paramedics working as dispatchers for a long time and the street crews were always happy with their dispatching skills. now we have new administration, no paramedics in dispatch, and some company's cards that we're paying for, used by civilian dispatchers. it's killing us. everyone seems to get coded as a difficulty breathing because they are always happy to answer “yes” to “are you short of breath?” even if their original complaint was something to the effect of a cut to the hand.
when i was at a first aid duty i had to call county because we had a cas who had a mi. i said to the member of staff that resus was in progress and defib had been used the question i got back was and i quote “is the cas breathing”
Just got off a hell of a night shift in London Control. Can't remember when I last had so many selfish/stupid people demanding (yes, I do mean demanding) an ambulance for the most stupid things. What made it so much worse was the fact that we were holding 'genuine' Cat-A calls because we were so overloaded with calls. The only people who piss me off more than the stupid ones (like the 50 year old woman who called because she was having a heavy period) are the bare-faced liars (like the young guy who's girlfriend had a stomach ache, called back all of 7 minutes later demanding to know where the ambulance was then, not liking the reply, insisted she was uncons and not breathing despite me being able to hear her moaning dramatically in the background).
I really feel bad when I send these “Cack-As” to crews. There really should be some covert way we can let crews know on the screen when it's a pile of sh*t, I'm thinking of putting a subtle ^ symbol in the special instructions box by way of apologising to the crew for sending them a load of rubbish.
How about SBTS – “Sorry, blame the system” ?
I had a woman in my clinic the other day with a bad cold who was complaining about various things, but did say that she got an ambulance and went to A&E for her cold the other day. I ask you. How effing ridiculous.
We don't have to convey (I think), but given the culture of today it's too easy for someone to sue us.That or write in a letter of complaint, the actions of which my our management are 'suspend first, then investigate'.
I like the quiet life and am deed down a coward.
*sob*