I've mentioned before how the ambulance service and the A&E department is often seen as a “safety net” by other healthcare providers. Both yesterday and today we had perfect examples of this.
Yesterday we were called by a 70 year old man with a urinary catheter which had blocked. This is a fairly simple thing to solve as it just needs a flush of water up the catheter to clear the blockage. It's a five minute job that we, as ambulance crews, aren't allowed to do – however it is the sort of job that District nurses are supposed to do.
So why hadn't a district nurse been to see the patient, so that she could flush the catheter and prevent the patient from having to attend A&E? Why was the patient, who had phoned up the nurse himself, and told her exactly what he needed doing, forced to call an ambulance?
Because the nurse didn't have any water to actually flush the catheter.
It's a bit like if I turned up to someone having an asthma attack, and didn't have any oxygen to give them.
So the district nurse told the patient to dial 999 for an ambulance. We arrived and found him with a bladder so full it was causing him severe pain. We took him into Newham hospital, who, within minutes had cleared his catheter, and eased his pain – then they gave him a 'takeaway' bottle of water so that the district nurse wouldn't have an excuse the next time she needed to visit him.
Today, we were called to a patient who needed his anti-Parkinsons disease medication. He had a carer, who was supposed to visit him once a day to clean, and arrange his medication. But for the last two days, because the 'carer' couldn't get in touch with the patient's GP, had just left him without his medication. We turned up, not knowing what we could do to help. The flat in which the patient was living is brand new, and yet was already very untidy. The patient told me that he was lucky if the carer spent longer than 5 minutes with him (the carer is contracted to work with him for an hour a day).
This poor man was left, alone and shaking, with a carer who seemed to think that if he ignored this 'problem' it would soon go away.
So we did the only thing that we could – we took him to hospital, so that they could sort out his medication for him. Meanwhile I filled in an 'LA260' which is a 'vulnerable adults' form, and allows the LAS to bring situations of abuse, and potential abuse to the attention of the local social services. They now have the name of the care agency, and this problem can solved before it repeats itself in a months time.
Hopefully someone will get a bollocking, and our patient will get a carer that actually cares for him.
It often feels that we, and the local A&E departments, are left to do the jobs that other people should be doing, but because we are there, these other agencies don't seem to care about doing a competent job. I'm aware that there are probably loads of health visitors/social workers/district nurse/CPN's and GPs who do actually give a damn about their patients – it's just that we never seem to meet them.
If I were on a desert island, then yes – boiling up some water would do just as well. However being in a first world country, the nurse would be worried about being sued/struck off/etc. Simply put though, the nurse should have had some with her, as it's one of her basic jobs.
Hi CAC person – I like CAC people, so don't worry – I mean it's not your fault that such bloody idiots keep phoning us up.Agreed though on the general state of 'caregivers', the ones we meet are bloody awful. I particularly like GPs who call for an emergency ambulance and then leave the patient. If the patient needs an emergency ambo, then surely the care of a doctor would be needed?
So…London? Which sector?
That sounds like a decent idea – and one that I think we are working towards with the new Paramedic practitioners. The best thing for people is to stay out of hospital, but with the amount, and right type, of care that they need. Unfortunately it seems that no-one is willing to take responsibility for that role.
Can I ask you about “paramedics”, the kind of people who do emergency response and yet are also trained to give certain medication and therapies? If you were a paramedic, you would not have to wait for a nurse or roving doctor to solve simple problems. we have paramedic teams here in Ontario. Do you have them in London? Would you feel a bit less frustrated if you were one?
Am I being very dense here because I am wondering why the nurse couldn't have boiled some water to sterilise it instead of leaving the patient without alleviating his problem at all!
ok cat out bag – i work in CAC (please dont hate me :-0 )the 'carers' i encounter are anything but!
i've had carers who dont even know their patients name which to me is a pretty bad start to anything.
if an elderly/immobile pat is unable to open to door we ask if the carer will stay on scene or if there are any other keyholders. too many say they can only stay 5mins. its unbelieveable – its almost as though they want crews (and the police) to force entry.
if a carer arrives and finds a patient on the floor or bleeding i've been told too often 'i cant touch him'. i put that down to fear of litigation but its still wrong.
and dont even mention residential 'care' homes!
wiskers
[/end of rant]
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We have a system where if there is nothing acutely wrong with a patient, it's more a concern for welfare, we can contact a rapid response nurse who will come out, usually within an hour, and assess the patients needs. They are in direct contact with social services but if they feel the patient would be better in hospital they can arrange an urgent rather than 999.For example, if a patient has fallen over due to general weakness following a steady decline but we feel they don't need to go to hospital, we will contact the rapid response nurse or GP (who does occasionally come out!). The nurses will assess mobility and ability to care for themselves and set in motion plans to aid the patient and their family.
You're right – there's a hell of a lot of them out there who are superb. Fortunately I've only come across these saintly beings but I do know an awful lot of people who have totally different experiences and end up calling you guys because there's no one else left.My mother in law routinely has to call an ambulance because nobody else, including me, will talk to her (I haven't spoken to the evil old bat for about 2 years but then I don't get paid to). Each time I have had a vital organ come detached or explode, some kind soul has sorted it out for me without having to resort to 2 tones and flashing blue lights. Maybe A&E should start dealing people on an appointment only basis. I'd give it about 12 hours before someone thought it was time to listen.
Best
Cass
Heh, we don't like the sirens on because they are bloody noisy… Bad enough when one drives past, it's no wonder my hearing is failing because I'm sitting under the bloody things all day.I agree that there are a lot of excellent carers out there, when I did my stint with some District nurses, they were all very professional and had a real rapport with their patients. In fact they impressed me so much I though about changing from A&E nursing into being a District nurse.
And I think every ambulance district has at leat one person like your mother-in-law. We have about three…
phew :)good blog btw, been reading it while. nice inisght into the mutaul frustrations we share, and obviously we have fairly limited dealings with crews on the road and how they really feel. so thanks.
yes london, and its south of the river.
wiskers