Picture the scene.

You are in a house that hasn’t been cleaned in years – the walls are filthy, there are carpets rolled and stacked in the stairways.  The occupant, our patient, lives alone in a tiny room at the top of this house.  His heating is a paraffin burner and there are half full cans of fuel dotted around the room.  Actually, I nearly hang myself on a bit of string stretching from one corner of the room to the other.  I can’t see the carpet because of all the rubbish on the floor.

Our elderly patient has obviously been wearing the same clothes for weeks on end.

The patient’s ex-wife is the one who called us, she is pawing at me, telling me not to let him die.  He isn’t going to die today, his blood sugar is low and he has had a diabetic collapse.  We give him some sugar and he comes around.

There is something ‘not right’ about him.  I don’t think that it will be safe to leave him here, besides his diabetes there is a good chance that he’ll burn the place to the ground one day.  He seems somewhat confused, he won’t talk to me although his wife is clear that he can speak English.  We’ll need to take him to hospital.

So it boils down to ‘capacity to refuse’; does he have enough presence of mind to refuse treatment and be left at home.  I tell him this, and he doesn’t answer me.  I explain that if he wants to stay at home he just has to talk to me – he just says ‘No’.  We recheck his blood sugar level and it is back to normal, there is no obvious medical reason for him to be ignoring us.  I consider that he may have something neurological going on inside his head, that or psychiatric.

Without him answering me, I can’t tell that he has capacity to refuse.  This means that in the patient’s best interests I can forceably take him to hospital.

I don’t like doing this.

Actually I REALLY don’t like doing this.

So after half an hour of trying to persuade him, during which he blatantly ignores me we realise that we will have to get him out via other means.

If his house wasn’t such a tip we could maybe wrap him in a blanket and strap him to our chair and carry him out.  But the amount of rubbish in the stairwells means that we’d probably break our necks.

So we have to try and drag him out.  This is also something that I don’t like doing.  It’s night-time, there is no-one else around besides the police at this time of night.  I really hate getting them out in order to help us get a sixty-five year old, five foot nothing tall man out of a house.

(That and they’d probably send two five foot nothing female police officers to assist us – which damages my ego even if I do know that either of them could kick my arse without breaking a sweat).

So we drag, pull and try to get him to let go of the door handle – he finds that just by sitting down we are unable to move him.  We get to the point where I’m considering doing painful things to him out of spite.  Then the FRU (who was first on scene and had left to do his paperwork) returns.  I explain what we are trying to do.

“Mr Smith”, the FRU says, “come downstairs into the ambulance”.

And of course he does.

So then he sits happily in the back of the ambulance, still ignoring us and we take him to hospital.

We tell the nurse we handover to about the situation at home, we tell the nurse in charge of the department – I advise them that he’ll need some sort of input from the Social Services before he gets discharged.  You know, the sort of thing that I would do as a nurse.

So when we see him being wheeled out to the private ambulance to go home without any apparent social service input we fill in the LAS ‘Vulnerable adult’ form detailing the self neglect and the fire hazard.  We’ll make sure that he gets help.

14 thoughts on “FIlth”

  1. Yeah the Vulnerable Adult/Concern for Welfare becomes somewhat of a mockery when the receiveing hospital takes no notice – unless THEY feel something isn't quite right.But what I will say Tom, is that other than fill out the Vulnerable Person form, you cannot do anymore for that chap.

    With any luck reporting it at your end will produce the result needed.

    Bless the little love, he sounds like Mr. Trebus from the TV programme

  2. What Herts Ambo Bloke said about patients getting better is so true, but as frustating are the ones who complain of Central Chest Pain but declare they have no previous cardiac history, until you hand over to the A + E staff when they casually mention the 3 M.I.s they had last year! Or the old chap, being admitted for something like a UTI who categorically states that he hasn't had a days sickness in his life but when he takes his shirt off in the A + E Dept, you ask him what that big scar going all the way his abdomen is and he cheerfully mentions his Triple A from a few months ago. And it is always in front of the grumpiest, non-ambo friendly nurse the world has ever seen.

  3. Depends on the person – but in my experience I've never had a problem with them (except that they sometimes like to 'stay and play' when I'd much rather 'scoop and run' (to a proper operating theatre.The doc who runs HEMS is very ambulance friendly.

  4. Its a tricky situation isn't it. I know exactly how you feel, helpless and annoyed that someone else hasn't taken on board your concerns. I know everyone is busy with their own work, but it doesn't take too much effort to make a phone call or two.I don't have an answer for this case, however, do you not have ECPs that can make visits in cases like these, and then make the necessary calls to try and organise social services. I know I have gone round to people on “green” calls that have not required hospital treatment, but I have not been happy just leaving them, one case in point was a lady in her 90s that was not going to leave her home for anyone, a call to the ECPs had a home visit penciled in for the following morning, and then they could assess her at home and try to work out a solution that was good for her and everyone else.

    I know it sounds like passing the buck, but they have the contacts and resources that we don't so it comes in handy when you get that odd job that just doesn't feel right.

    As for the FRU managing to get the person out of the house with one sentence, its a pain when that happens isn't it, just like the patients that are really poorly, and you put a pre alert into the hospital enroute, but when you get there, there is nothing wrong with them and they are sitting up chatting with the entire team in resus, and the team are looking at you, their eyes saying… why? and you feel the need to say, well they were dying five minutes ago, honestly, I was bagging them all the way in. I don't know how I fixed them, it just happened….

  5. I don't know how it works in London, but up here in the midlands if a patient is admitted with little wrong with them besides their housing/living situation, we have to keen them in until they have been assessed by everybody under the sun.I am in the middle of doing an assignment using the SAP documents, and I am having to refer my little old lady to some local services that provide hair dressing for the elderly, all part of the holistic care and all that. It does annoy me that when I am on placement, I work my ass of to make sure discharges are liaised correctly and that the patient isn't discharged until they are ready to be discharged, yet some staff nurses/sisters/matrons/bed managers just drop kick them out the door……

  6. Ahh…bless him!But yet another reason that people call for an ambulance before anything else because they know we will do something and we will be there straight away to do something!

  7. for an even more extreme example look at may 5 entry

  8. Is it a problem with the system, or individuals working at the hospital that let this man go home without assessment on his safety at home?

  9. I would really like to know what your FRU people do for thier wages. In my last four shifts I have only called for one ambulance (I do not get back up unless I ask for it),I deal on average with 86% of calls on my own. If the job is not life threatening and I know a crew would sit them in the ambulance, they come with me .(1) It's more comfortable and (2) it keeps my colleagues free to deal with thing that I can't.Bloody hard work but rewarding!

  10. Our FRU people are there to stop the clock – there is still (or was until *very* recently) instruction not to transport patients. Mainly for our safety (I'd like to think). This is all to change, and is the basis of an upcoming 'political' post.

  11. Where does this right for you to forceably remove someone for medical treatemnt come from?? Amulance staff are not qualified to make the legal decision as to wether a person has the mental capacity to make the choice to refuse treatment?? Such a patient would need to be sectioned under mental health act and this is not an ambulance skil.Seems a risky practise…..

  12. It is tricky, and one that I'm going to do a long post about in the near future.Basically we have guidelines that we can follow that conform to common law. But to be honest if someone wanted to sue us then we'd be buggered…

Leave a Reply

Your email address will not be published. Required fields are marked *