The staffing of ambulances at the moment is…to put it bluntly… poor.

Working on the FRU/RRU means that I often get to a call within minutes (yes, within 8 minutes) of that emergency call being made.  Unfortunately with so few ambulances on the road, the patient and I are often left staring at each other for long periods of time.  Up to an hour in a couple of cases.

I was sent to a young man having an asthma attack.  It was late at night, and he had been queuing to get into a nightclub, had started to feel his breathing getting tight, so had headed to a taxi office in order to go home.  Unfortunately his asthma progressed and so an ambulance was called.  What he got was me.

After dealing with the drunk group of teenage girls that were waiting for a cab, loudly ’caring’ for my patient, I started my assessment.  It was a cold night so I sat the young man in the taxi office, and listened to his chest.  I could hear a nice loud wheezing from his lungs, so I started him on the first dose of our asthma medication.  I got his details and vital signs, and waited for the ambulance to turn up.

It takes between five and ten minutes for the asthma medication to finish, and by the end of it there was still no ambulance.

I listened to his chest again, still an audible wheeze, so I gave him a second dose of the medicine.  So there he was, sitting in a cab office at three in the morning with a mask over his face, ‘smoke’ pouring from it, and all around us were intoxicated people getting cabs home.

Not very dignified.

We started chatting, and I was impressed by this polite young man with manners and common sense.  The second medication finished and so we continued to wait, and wait, and wait for the ambulance.  I phoned up my Control and asked them if there was an ambulance assigned.

“Sorry EC50, we are still holding calls in that area”.

So I was on my own with this patient for the foreseeable future.

Sometimes I can transport a patient myself to hospital, it’s not technically allowed.  Actually we’ve been told that we shouldn’t do it at all, but in some cases I think I’m doing the right thing for the patient.  So I will load them into the car (which only has the front passenger seat, the rest of the car is taken up by equipment) and nip into the nearest hospital.  Control are often happy for me to do this, as it means one less job that they need to send a proper ambulance to.

I couldn’t transport this patient though, he wanted to go to his local hospital, which would mean driving past two other emergency departments and out of my area.  I couldn’t see Control, or my bosses being to happy with that.

So the patient got a cab to hospital.  At his insistence.  The double dose of medicine had cleared his lungs up nicely, but he would probably need some short-term steroid treatment.  I rechecked my assessment of him, and was happy that his physical condition was well enough to get a cab to hospital.  But I wasn’t happy that there was no ambulance for this patient who actually warranted an ambulance.

As I write this I wonder what would have happened if he hadn’t responded to the medicine that I gave him.

18 thoughts on “Taxi”

  1. Its his callsign Gekko. Every shift is given a callsign. All FRUs are given a callsign for the area they're working in, so EC50 would mean that it's an FRU working in East Central sector.Does that make sense?

  2. It's posts like these that show the rest of us what it's really like out there on the frontline in the health service.Someone should forward this post onto a government health minister – maybe that way they'd finally understand how badly the NHS needs funds.

    Here's hoping that Random Acts – the book – gives the government a wake-up call…

    Keep up the good work (helping people and writing) Tom.

  3. My girlfriend is an asthmatic who gets serious heyfever which sets the asthma off into steroid-requiring territory. I have seen her have nasty asthma attacks three times, and I never want to see her like that again. Asthma is deeply scary and as you say can become 'improved' in a non stable kind of way.I'm sorry that guy had to get a taxi to hospital, things like that shouldn't happen. I concur with the above commenter who advised sending a letter to some government bod.

    I do appreciate your blog a great deal for giving me a better idea of when and when not to hit those three 9s. Next time my girlfriend has a serious asthma attack I'm not hesitating – I did that once before and it was luck that meant she finally got control of her asthma and that it didn't deteriorate further. She needed medical treatment 18 hours later as she used up all the salbutamol she had on her and steroids were absolutely necessary to stop reoccurence of serious attacks.

    What would happen in the case of lack of response doesn't bear thinking about, but it should be thought about. How deeply scary.

  4. Christmas is a bloody nightmare…. our off duty is done 2 months in advance, with 11 on every shift, by yesterday i was down to 8 (sickness) by then people won't move shifts to cover. i work in an ITU, and we had relatives refusing to allow their dependants to be moved to other hospitals, becasue we had become overloaded and patients we no longer getting a safe level of care….. the public really don't understand how poorly resourced the NHS really is, and that only the goodwill of its employees keeps it a decent level of service. all that “investment” was what should have been given anyway just to bring it up to a decent level, not “improve” breathe in, hoooooold, aaaaaaaaaaaand relax šŸ™‚

    i feel better now for that rant.

    Happy New Year

  5. I get that he'd prefer to put himself in a taxi and take himself to hospital than stay sitting in the taxi office being stared at, taking up your time, waiting for an ambulance that it's obvious is not readily available, while taxis are coming and going all the while. Frankly I'd feel exactly the same.But I understand your frustration.

  6. I actually think alot of patients do know how badly funded it is, the ones who have regular contact anyway. This is no reason for patients to give in though, letting yourself be pushed around different departments because one doesnt have the money to treat you is effectively just letting the government get away with it.

  7. whether you “let yourself be pushed around different departments” or not has buggerall to do with whether or not the government get away with it. It's just to do with whether you're making life a misery and being a pain in the backside for the frontline staff who have no choice but to work within the constraints placed upon them by higher powers. 'The Government' won't even hear about it.If you want the government to hear about it then your best bet is to appreciate that the frontline staff – the doctors and nurses and paramedics and so on – are doing their best, and then get involved in a serious attempt to lobby for improvement.

    Sitting in the A&E with your arms folded going “I'm not being pushed around, the government isn't getting away with this, I ain't going NOWHERE” won't help you or anyone else.

  8. I really must be missing something. Why on earth can you not transport patients if there's no ambulance available? Sure, it makes sense that patients with back or neck injuries can't be transported in an FRU as there isn't enough room for a spinal board but for the majority of other ailments, it stinks to me of blatant inefficiency to tie you up sitting with a patient rather than blueing them into a hospital. I think I'd be rather pissed off if I was having a fit/attack and the paramedic that arrived refused to take me into hospital because he was in a car rather than an ambulance.

  9. In a sick way I'd quite enjoy seeing you try and get a patient who is fitting into the front passenger seat of a car…..You've got to remember on the cars you are on your own, if you are going to transport a patient on your own you have got to be 100% happy that they are going to remain stable on the way and you aren't going to have to intervene and actually do something. Worst case scenario patient arrests…….

    Another thing the back of ambulances are designed to be “wipe clean” cars aren't!

  10. I have to go observing with the ambulance service as part of my course. Whilst working in MAU and A&E as a health care assistant I was also allowed a coupple of shift a year out with the ambulance service.On a coupple of occasions we have transported patients in the cars (we have bigger cars than london which have five seats) I can sit in the back with granny who's broken her wrist/arm without any problems and we dont tie up two more people from a crew. HOWEVER apparently their insurance doesnt cover them! so its full ambo or nothing.

  11. I disagree, though I have little experience of casualty issues.A few months ago I had to return a sharps box to my local GP surgery, the treatment room specifically. The nurse tells me, you now have to fill in the form on the side of the box to hand them in. I ask if it will make me liable if the box bursts open and someone gets stabbed in the foot, yes she answers. I refuse to fill in the side of the box. The nurse tells me, please fill it in, “we get into trouble if you dont”. The nurse clearly didnt agree with making patients fill in the box, but management had made it a policy. I was not nasty to this nurse, who chose not to fight the system, but I will not give in in order to make a frontline persons life a little easier, everyone has to fight this.

  12. and how exactly did that help matters?The time you saved filling in a little bit of information, you spent arguing with a nurse.

    The nurse had to spend time trying to persuade you to do what you should have done anyway, rather than doing her job.

    Unless you took the box away with you again, the nurse then got in trouble with her immediate superiors.

    The people who MADE the policy, several levels up, never even found out about the incident.

    If, instead of making yourself a pain in the backside for a frontliner, you had gone away and expressed yourself clearly in writing to the people who make the policies, you might have got somewhere.

    You're reminding me of the tracksuit-clad teenagers in the DSS arguing with the frontline staff there about how 44 a week isn't enough money. Like the frontline staff can do anything about it!

  13. It was a small act of defiance which I expected to be reciprocated by all medical staff in my GP surgery. Words and letters are generally ignored, although I do also write them, if every patient, nurse, GP, etc just refused to go along with these things the powers that be would have a much harder time enforcing them.Time didnt really come into it, the whole episode took about a minute. Nor did I argue, just stated me case politely and left.

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