Some Questions (1)

I'm really interested in what people have to say about this post (I may be doing this all week – I'm on a run of twelve hour shifts).

Our patient is one of our recent 'new Europeans', he'd dialled 999 because he was feeling 'generally unwell'. His English is pretty poor, so it was a case of me asking questions and him saying 'yes' or 'no'.

His problem was that he had a headache, was a bit dizzy and his heartbeat was a bit fast. The reason?

He'd been drinking for two weeks.

He wasn't much fun, although I treated him with the same respect I treat all my patients, he complained that I was laughing at him.

It sits at the back of my mind that this was a completely self inflicted injury, he'd dialled 999 for an 800 yard journey and he complained the whole way.

So the questions I want answered are,

At what point does this become an abuse of the Ambulance/A&E system?

When am I able to point out that this might not be the best use for an ambulance?

What do I do when I get a complaint from the patient for 'being rude'?

What is the best way to stop this sort of call happening again?

41 thoughts on “Some Questions (1)”

  1. I think the only way will be some form of national identity card with proof of entitlement to the NHS but is that really what we are about. National Healthcare which includes all is going to give those at the sharp end exposure to less deserving cases but I really hope we don't have to do some form of means assessment prior to entitlement. If we start billing, we only need a whole raft of PCT people to monitor, assess, target, collect and fine non payers and when this happens …. Probably the sacastic approach is always going to be a winner.

  2. if you have to defend a complaint, I would suggest that your patient was perhaps unable to discern the cultural differences between concern and mirth, due to his “ill health”.

  3. given recent moves on smoking and rhetoric about drinking, I would be worried that they'd start putting anyone who had been out for a couple of drinks that they didn't like the look of in there or start breathalysing us on the street

  4. I believe West Mids Ambulance Control call takers are indeed taped – hence the routinely familiar “Hold whilst we check the tapes” response to not finding someone at the address when we arrive.

  5. No – I think he means that by and large they're scrounging bastards…if you dont like that simple assessment I suggest you stick it up your politically correct but practically useless anus

  6. If a patient is able to report you for 'being rude' why are you not allowed to report them for being stupid? These new Europeans seem to know how to milk the system for all it's worth. But we must remain mute. By law. Ever felt like we are being had?BTW you are a brave man moving intoBarking. I moved out 13 years ago but it's comforting to know you are there should my grandchildren ever need your services. Even if you don't, as you claim, like children.

  7. We have a patient who calls every other week for some fabricated emergency; I've been out twice, once because she had 'difficulty breathing' which was really 'I went on a bender after the cops took my boyfriend out of the apartment so the neighbors didn't have to listen to us fight and needed some attention' and once for a 'broken ankle' which she got whilst clopping around her flat in high heels drunk off her ass. (She walked to the ambulance and was home in half an hour.) We have seven nursing homes in our town and every time we go to deal with her they wait for us. (We're all volunteer. They get us when we can get there.) On one level I feel sorry for her because she is clearly an alcoholic, but on the other hand I resent the amount of legal propriety and paperwork involved in concluding a call to her home. We don't have anything like 'abuse of service' round these parts.

  8. Morons are a fact of life – some people are morons all the time and most people are morons some of the time. There is nothing that can be done at all short of killing everybody in the whole world for their own good. And that could be considered a little drastic.I daresay some of the problem could be improved by outreach programmes and information leaflets and so on – I think it becomes an abuse when people call an ambulance that they know is not strictly necessary.The biggest help would be if you guys were able to try to explain, politely, that ambulances are only for emergencies and this is not an emergency, without the risk of (1) being assaulted and/or (2) getting complained about to a management that won't back you up.

  9. Because he is probably from one of the ten new European coutries that joined recently, i.e Poland, Estonia, Lithuania etc

  10. You have to wonder though, would they do this if they were back in their 'home' countries? I don't know it for a fact, but I imagine we have a far better health system than many of the old eastern bloc countries do.I get the feeling we are too soft by far, sooner or later the system is simply going to implode.

  11. Because (and this was being debated on Radio Five late on Sunday night to GREAT public outrage), the culture appears to be that the more recent influx of Europeans from the areas opened up more by the extension of the EU are being labelled as more disruptive to our society than the older generation of immigrants. It appears that the newer immigrants are just out to fiddle the system and scam some money out of the UK. That's the way some people see it anyway. I am not suggesting that Mr Reynolds also feels this way.

  12. > What is the best way to stop this sort of call happening again?Allow the people at the sharp-end to use their discretion to refuse to take a patient without getting into problems. Do the same as police speeding, i.e. two independent judgements, e.g. if two paramedics concur, then fine to refuse.

  13. These people are draining the NSH with their abuses, and taking an ambulance away from a potentially much more serious casualty. If they complain, tell it like it is!

  14. These people are not a new problem,they are the same old problem of inappropriate use of emergency services but from a different culture.I speak often with a doctor from eastern europe who used to be a paramedic there before becoming a doctor and where they operated a doctor accompanied the crew on a vehicle so they could assess the patient and refer them to the most appropriate health care provider not necessarily requiring hospital treatment/admission(serious face off now)BTW tom sounds like you need to widen the range on your Bullsh*t detector i have with mine so far it covers the west midlands LMAO you want to see the faces of my regulars that i go out to when i step out of the vehicle they go from GCS 3 to GCS 15 in a nano second and refuse hospital treatment….now i may come across as an uncaring/unsympathetic/uncompassionate kind of guy but i ,m not if like you they have a genuine illness,injury,problem then they get 100% of my knowledge and attention….i have been called out in the past and ended up making a cup of tea(for a partially sighted lady who,s fuse had tripped in the downstairs of her house and couldnt move around in the dark for fear of having an accident . sum total of help = reset switch )

  15. I would immediately take him to A&E (especially as it's quick) where he could be left waiting for hours then discharged and made to walk home.Preferably an A&E >800yards away 😉

  16. Well there are good common sense answers to those questions, which would all be totally politically incorrect, as common sense usually is.I'd like to see people charged a fee for using the ambulance service if the recieving hospital deems the condition doesn't warrant it. Might make people think twice before dialling 999.

  17. Re. the reporting people for being stupid. I wish. I work in Police Control, callers regularly, swear at us, shout at us and are sarcastic and abusive and are terminally stupid. I know Amb Control have the same problems. We are taped and they are not allowed to retaliate, in case they make a complaint. I have often said why is there not a system in place for us to complain about this type of caller and for them to be given warnings, when they get so many we are allowed to cut them off before they even speak. Ambulance crews currently are not taped when talking to a punter I suggest Tom makes sure there are no witnesses and tells the person exactly what he thinks.

  18. I would love to charge the time-wasters, the problem is it would not work for 2 reasons: -1, On the whole the time-wasters are also claiming benefits so would bound to be made exempt from paying.

    2, It's the people who actually do need us who will be discouraged from calling us. Their are already enough older people dying and suffering because they “didn't want to bother us”

    Best thing to do is be nice, take them to hospital, sit them in the waiting room and 'forget' to book them in.

  19. A few years back, when I started taking 999 calls in LAS Control, I was told the following by a member of the Language Line staff [the people the call goes thru when the caller does not speak English]. In many Eastern European countries, there is ONE single number which they dial for any and all “emergencies” (real or imagined). In other words; house on fire, heart attack, robbery, washing machine broken, electricity failure, one number is dialled, and the call dealt with/filtered accordingly.How true this is I don't know, but it would go a long way to explaining the number of unnecessary calls from persons of that extraction.

  20. My province started billing for non-essential ambulance services years ago. I know they still get crap calls, but having to pay a minimum charge of $75 to get to the hospital deters some. Cabs are much cheaper, and as long as you promise not to spill anything they're more than willing to take you. Not knowing you're going to be charged for a ride until weeks after you've used the system helps too. And instead of implementing a whole new department to follow up on the billing I think government workers in an obscure office were told to do actual work in between games of solitaire! There's plenty of people who have whined and complained about their bill in the media, none would win citizen of the year however. Why is it that people don't learn how to behave unless you hurt their wallet? Sigh, I miss photo-radar…

  21. While I'm sure that at some level you would like to be rushing from death-defying call to death-defying call all night, I think you'd admit that the stress from that would wear you out eventually.While these “attention seekers” do take up your time, what real percentage of that time is “wasted” on them? Have you ever done a real-time analysis? For example, have you taken a paper pad with you, jotted down the time you get a call, then after you are back in your motor and clear for another call, jotted down the time and a “W” for waster, or a “L” for legitimate, then tallied the times at the end of your shift for a week or so?

    I realize that will take some effort for you, but if these “waster” calls are really eating significant time, you'd have some facts and figures to back you up if you choose to bring the matter to higher authorities.

    You might also find that while the wasters irritate you (rightly!), they aren't really as much of a drain on your time as you percieve. Relativity and all that. I'm not saying that they aren't a drain, or that you aren't justified in being miffed at them – just that your aggravation at their time-wasting may be coloring your perception of the severity of the problem.

  22. Time wasters take up time that other patients need. People who clearly don't need an ambulance shoud be made to pay for it and it should be on an increasing scale eg one call 100 pounds, 2nd call 150 etc.I completely agree with the person who suggested the idea that if 2 paramedics decide that the call doesn't not merit an ambulance, then they should not get one.

  23. I would say that, however little time they waste, they may be taking Tom, or any other ambo, away from a job that needs them NOW. And, with my A&E Doc hat on, I can tell you they waste an awful lot of A&E time, with very inexperienced A&E docs mucking about for hours wondering what to do with them… We need to crack down on these, and find a way of not transporting them.

  24. EDUCATE THE PUBLIC what ambulances are for!!!! and when to ring 999. We are not a free taxi service as some people think – maybe start charging people if they've rung in with something stupidly trivial and the a&e doctor thinks that transportation by ambulance was unnecessary ??

  25. Unfortunately, we live under the yoke of Idiot Blair's Human Rights Act: Every tosser of whichever nationality, creed , colour, religion, sexual persuasion, hobby, [I could go on] believes it is their RIGHT to have an ambulance.You may be interested to know this: LAS have Clinical Telephone Advisors who re-triage green (ie low priority calls) over the phone. They ring the caller back (can be a family member or the patient – but they MUST be able to speak to the patient), and attempt to initially get more info, then either: a. ask sector to send an amb, b. arrange other transport (such as PTS), c. arrange a GP visit, d. give “home care” advice or e. institute the much-vaunted “No Send Policy”. This is a policy whereby the CTAs explain to the person calling that there is NO clinical need for an ambulance, and one WILL NOT be sent.

    During the period 2nd – 9th September (one week) the No Send rule was brought into play……… ONCE.

    LAS gets around 4000 calls a day these days, thats 28,000 calls in the week I mentioned. No Send instituted ONCE.

    That is why people having heart attacks, epileptic fits; little old ladies on the floor for 12 hours, people having CVAs etc wait ages for ambs.

    Rant Over

  26. There'll always be stupid and unreasonable people unfortunately my friend! I'm in the coastguard and some of the jobs we get called to leave you thinking “why did you not think this was going to happen?”. I'm dead against levying any form of charge though even for the stupid ones/time wasters. The problem being that when people know that there may be a charge for rescue/ambulance response it puts people off calling when the situation may be genuine, or waiting til it's too late for fear of having to pay.However, i do think it's perfectly reasonable to point out to a person if a call has been inappropriate in the hope that it may educate them, we call it giving “advice”. Although I suppose it's a bit easier to speak your mind when you're a volunteer and don't rely on what you're doing to pay the bills…but you should be able to and there should be the support from on high if you do point out to someone what a numpty they are. As Long as you stick to facts and aren't abusive what can they complain about (I know…not how it happens!), but it makes it hard for them to substantiate that complaint.

    I do have an awesome amount of respect for you guys and the crap you put up with though!

  27. While I understand your frustration, RapidResponseDoc, I still think that the severity of the issue will determine what the “higher forces” will do to help alleviate the situation. Any additional “data” that can be brought forward to support your case would be a GOOD thing.And the same applies in A&E with the whingers (time-wasting-non-patients) there. Very inexperienced A&E Docs need to learn to triage better if they are spending hours wondering what to do with a drunk and ignoring folks who's lives are hanging by a thread. As for taking the ambo away from a job that needs them NOW – yes, that may well be an issue and that may well equally be no more than a “perception”. Will it happen? Certainly. Does it happen every time that someone calls inappropriately? Probably not. How often does it happen and how much time does it really waste? That's the question. Yes, even one person who dies because of a whinger is bad – but there's no telling the ambo could have gotten there sooner either – it could well have also been out transporting someone from one hospital to another or some other non-emergency.

    Why would you be so adverse to having a simple bit of unofficial research done to determine the true scope and quantity of the problem? Sometimes that “unoffical” research is the straw that breaks the back of the establishment and its refusal to look into something.

  28. Current research carried out by the ambulance service shows the number of people who need/don't need to go to hospital.(This is if I remember my numbers right, but it's somewhere in the ballpark).

    10% of calls are life threatening.

    20% need hospital treatment.

    70% would be better served by other 'care pathways' (GPs, Walk-in centres, etc…) and don't need an ambulance.

    This research is the justification behind the push to have ambulance cars rather than big 'carry the patient to hospital' ambulances.

    …and I think i've moaned about *that* idea a fair bit.

    As for inexperienced doctors…Well – you have to rule out all the nasty things that can cause someone to appear to be drunk, or which can be masked by being drunk (head injuries are a favourite).

    I think there was a recent death like that.

    Here is my idea – That the *government* funds a 'drunk tank' where we can take people who are drunk. They can be checked by a nurse practitioner and charged when they sober up. There should be 24 police there to deal with the violent drunks and maybe fine them for being 'drunk and incapable'

    This will stop (a) drunks dying in police custody, and (b) drunks clogging up valuable A&E beds.

    It'll also give the government some idea about the number of alcohol related calls, and will give them something else to set targets on.

  29. Thanks Saint – you have just justified the impression that I've got from the CTA desk. It's a good idea, but it just doesn't work as well as we would like.Not when we are sending FRU and ambulance on a 'CAT A' 18 year old with a sore throat (with…difficulty in breathing, or as I like to call it, pain on swallowing). While 90 year old Doris who has been on the floor for 16 hours gets a Green response.

  30. Here in La La Land , the charge for the emergency is astronomical for those that have no insurance, even then it be along wait, and some have been known to die. Even with Insurance, I [ an AOP+ some] have to pay 100 Dollars [ 15% of of the mth ly pension] for 10 $ cab fare. { it is good to have a credit card }So many of those Ambo's on call get the chance to watch our homeless begging or or others jay walking and the sunny wench advertising her wares.So I stay healthy.Re: slander and verbarge. Each Ambo should have a camera and mike and the taped, be handed in at the end of shift.

  31. It's refreshing to see that the work you get is no different to what we get on the other side of the world. We have our regular patients, so regular I can write up half the paper work (Name, date of birth, past medical Hx, Meds, Allergies, What his normal ECG looks like) before I even get there. Today a crew went to him expecting the same but this time was in SVT of 250 and ended up requiring adenosine. Just goes to show we never can be to careful with our regular's no matter how many times they cry wolf.

  32. Such public education exercises have been run, many with AS's helping along the education process. The public, for their part, are often as not horrified by the types of call that are made.Doesn't really explain the huge albeit temporary hike in calls that frequently follows such an exercise though.

  33. This country and it's emergency services need to get a backbone.Emergency responses from ANY quarter should not become an automatic right just because the government of the day decides such a promise will be a vote winner.Ambulance Services in particular, in my experience, need to be able to protect themselves from abuses of the 999 system and should be able to refuse to provide it's services where it suspects that it is being abused – ie: regular callers or 26 y/o males at 3am with a sore throat.As someone has mentioned, public education is sorely lacking. As is education that some form of penalty would result if users abuse the system. Gawd if only THAT were true. But I reckon public education needs to be furthered on beyond telling them when they should phone for an ambulance, as I firmly believe abusers of the system do not care one iota either way whether they abuse it or not.It is, IMHO, increasingly apparent that those who live and work in this country (in addition to those who are allowed to apply for residency here) are becoming unable, much less unwilling, to look after themselves. And it seems it is those, in increasing numbers, who are providing the emergency services with the bulk of their wasted time, efforts and provisions of aid. It is costing us taxpayers money and costing this country and it's useful inhabitants an ability to provide sensible timely solutions to emergency situations as and when they will unfortunately arrive on someone's doorstep.

  34. If they have done research already – good. Then I do like your “drunk tank” idea, although I also agree with the “needs to be thought through carefully to avoid problems with abuse” also.Oh, and just to be clear – I live in the US, where EVERY ambulance ride is at least a $75 charge, no matter WHO calls for the ambulance. And I drive myself to the hospital, have done while having a gall-bladder attack when pregnant, for a cardiac event that required a 3-day hospital stay, and when I had the pulmonary embolism and deep veinous thrombosis. Because I couldn't afford the ambulance bill on top of the hospital and doctor bills.

  35. The only trouble is, a patient who is drunk and belligerent and can't speak much English can't be adequately assessed on the phone. So they'd have to visit the patient in person. And two paramedics on a truck equals an ambulance. And once the ambulance is there, they might as well just take him to hospital…

  36. I think Claire meant the we are not (yet) recorded while speaking to “patients” in the back of a truck. The problem seems to be that ambulance service management countrywide will take the word of a complainant over the word of the crew, so I will still bite my tongue rather that offer appropriate advice in the privacy of my ambo.

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