The Fightin’ Nineties

I think that it's Ambulance Law #17 that states, 'In a fight with a 90 year old patient, the ambulance crew will always come off worse'.

Our call was to a ninety year old woman described as, “Not getting out of bed, not eating, not washing. Suffers from dementia”.

Now, this might not actually require an emergency ambulance but I'm getting soft in my old age and am more forgiving of certain types of 'non-emergency' calls.

It was the patient's daughter-in-law who had called us, normally her husband looked after his mother (our patient), but he'd had to go into work that day and had delegated the task to his wife.

The first thing that I noticed was that the daughter-in-law looked to be at the end of her tether, the patient was soaking in her own urine and was resisting all attempts to change her clothes. The daughter-in-law told us that the patient's dementia had become worse over the past few days. My highly trained nostrils suggested that the reason behind this sudden deterioration may well have been caused by a urinary infection.

Urinary infections can cause all sorts of symptoms and, especially in the elderly, can cause people to become confused. With the already demented patient it can increase their confusion.

As our patient was quite happy to sit in urine drenched clothes I wasn't hopeful that she would happily toddle off to the ambulance to go to hospital.

I wasn't wrong.

She refused *everything*, we tried persuasion, we tried reason, we tried bribery. None of it would work.

The daughter-in-law suggested that we leave and 'go help someone more deserving'. I let her know that this patient, and her, were our concern right now. I promised that we would get something 'sorted'.

I wanted to take the old woman to hospital for two reasons. The first, and most obvious was that if our patient did have a urine infection, and it was left untreated, then there were serious concerns for her health.

Secondly and thinking more long-term, I wanted her to go to hospital because then the hospital would help her. The patient's family were unable to care properly for her, so they were looking for a care home place for her. The social services had promised an assessment, but that it would take over a month to arrange. Then there would be the waiting while a suitable place was found, etc, etc…

It would take a long time.

By taking the patient to hospital, and hoping that they would admit her, we would be forcing the social services to deal with the patient a lot quicker than they otherwise would.

I imagine that the social services do their own prioritising. As this patient was 'safe' in her own home and is being looked after by her family she is a low priority. If she is 'bed blocking' in hospital then they will arrange the care she needs more urgently, probably because of some governmental target.

And why was I 'cheating' the system this way? It was because I could see the eyes of the daughter-in-law as she told me the strain that it was placing on her and her husband. It was because I could hear the tone of her voice as she explained the trouble they had in caring for the patient. And it was because I could see the bruises on the wrists of the patient where she had been restrained from attacking the people caring for her.

So taking her to hospital was the only real option. But how? We had already spent an hour trying to talk her into coming to hospital.

We'd have to kidnap her.

It is legal for us to forcibly remove someone to hospital if they are deemed 'not competent' to refuse and if they have a serious illness. As I mentioned earlier, a urine infection can become very serious in the elderly. In addition she was refusing to eat. This, in my view, means that her well-being was in danger. Her dementia was so far advanced that I considered her unable to understand the consequences of remaining at home.

So legally and ethically we were on safe ground.

I don't like forcibly removing people, it's a lot of aggravation and there is always the fear that someone will get hurt. Sometimes we will get the police to attend in order to help us remove the patient. In this case I didn't think that police would be able to do anything different to what we would do.

But…

Any confrontation would be rather one sided. Us, as an ambulance crew, are trying our best not to hurt the patient – it'd look bad if we broke her arm. Our patient on the other hand is more than happy to punch, bite, spit, claw and go for my testicles.

Which she did even though we had wrapped her in our blanket. Never underestimate the strength of a demented patient.

She managed to draw some blood from me (an inconsequential scratch on my arm), but at least we managed to safely get her downstairs into the ambulance. When she got in the vehicle she calmed down a little and she didn't seem hugely upset to be in the hospital.

The daughter-in-law couldn't thank us enough.

I knew that the patient would get medical care, I'm just hoping that she also got the social care that was desperately needed.


I've been a bit slack posting of late due to that nasty old 'black dog' that comes around in these shorter months. With a bit of luck I'll shake it off soon.

13 thoughts on “The Fightin’ Nineties”

  1. Sorry to hear about the black dog. You should seriously look into getting a light box and a dawn simulating alarm clock. Totally changed my winter experience. (Drop me a line off-blog and I can point you in the right direction- no I dont work for the manufacturer!)Love the blog, btw.

  2. It amazes me how social services work, once there is a hot poker proding them, they actually begin to give a damn about patients and their families.I have a patient on a ward who has been there for a long time (nearly a year) and needs unconcious nursing care at home, purely to support the family, who already provide all of the care. Yet due to legislations and a gap there is no way of resolving this problem!

    Ridiculous springs to mind!

    Hope you manage to cope with the black dog better than i do!

  3. I once worked as an aide with a very demented elderly man, very unsteady gait at the best of times, who once worked in a brickyard. His daughter told me they would crush bricks in their bare hands for entertainment. He later worked as a fireman. One night when there was a fire in the neighborhood, with sirens going for hours, he was in a bad way. I nearly had my forearm twisted to breaking while the nurse gave him a sedative. I could feel the bones bending.

  4. I remember a woman who shouted, loudly, 'help me' for 36 hours when I was in an open hospital ward just next to the doors to her room. She did occasionally stop to say how she was 96, which none of the medical staff contradicted so I assume it was true.Dementia is cruel indeed. And the fact it makes people overuse their bodies: horrible.

  5. One of our residents had a urine infection recently, and coupled with her new medication for her Parkinsons, she was very confused and paranoid. While I was in the duty room with my colleagues, we got a phonecall from the police, saying that the resident had phoned 999, claiming that we had locked her in her room and were refusing to feed her or to let her out. This was totally untrue, and once my colleague explained the paranoia/confusion, the police seemed to accept it, but for the rest of that shift I couldn't stop thinking about how awful it must have been to genuinely think that you were locked in your room without food, and that the only feasible option would be to phone 999.Urine infections don't sound anywhere near as serious or as complicated as they actually are!

  6. Demented patients can be very very difficult to deal with. During my time working in my folk's nursing home I've seen some sights and taken a fair few smacks. We had one who used to call you over and whisper “bend down, bend down, need to tell you a secret”. When you bent down she'd give you a right hook across the side of the head that'd knock you over. No one fell for it more than once. Then we had Mr B who if you tried to wash him would throw the bottle of pee that he'd stored especially for the event at you. Lovely.Social services are a mystery to anyone who works with the elderly. They are a giant, king sized pain in the arse and they really don't seem to see the elderly as people. They see them as 'demented' or 'stroke victim', never as 'Ronnie' or 'Jean' and if they ever pulled their head out of the rulebook for more than 5 minutes they'd see that individual personalities mean that some people don't fit into the neat little boxes that they refuse to deviate from. They are the most frustrating group of people ever.

  7. Had a similar experience yesterday.At 1700, I gave one of the crews on my sector what I assumed to be a lovely “Get you off on time” job. Drs take in to hospital half a mile from the patients house, littlle old lady with a UTI, for a local crew who were off at 1800. How wrong could I be?

    On arrival, the small, elderly, thing sitting in the armchair went absolutely ballistic when she was touched, and both crew ended up covered in scratches and bruises. Unfortunately, the doctor who booked the journey hadn't mentioned two salient facts in this case. 1. the patient didn't want to go to hospital and b. in her confused state she thought anyone who touched her was assaulting her (due – apparently – to some less than professional handling in another hospital a year or so back).

    As it turned out, we managed to contact the GP, and got him to arrange another visit. Oh and the crew didn't get stuck there, and got off on time 🙂

  8. Back in April, my mum who was late 60's had a UTI and this brought the same symptoms. She went from being totally self-caring and mentally alert to confused, agressive, violent (biting the A&E staff) and paranoid within about 4 hours. as she was admitted straight from home, it was hard for me 250 miles away to explain to the staff how abrupt and marked the change was as they assumed that she had some level of dementia already. Once I had explained that, more significant events like a CVA were explored but it turned out to be a simple UTI. Quite impressive and changed my view of them.

  9. I agree with A Reader – I take it he's referring to muzzles for the black dog. Mine's started whining and snapping a bit this last week or so. Darn seasons. Not that it was much better when I lived on the equator.

  10. I'm always delighted by people trying to prod social services into action. In case its ever useful, or of interest to you, I've provided the url to the criteria nearly all social services departments are now using to assess for care. Unless people fall into critical or substantial categories they won't be given any help.http://www.manchester.gov.uk/site/scripts/documents_info.php?documentID=2898&pageNumber=2

    You'd think your dementing old lady would certainly be critical, but if you check the eligibility page, one way SS depts are avoiding providing such services is this “A person is only eligible for social care services where needs are identified above the threshold line and where there is no-one else willing, able or appropriate to assist.”http://www.manchester.gov.uk/site/scripts/documents_info.php?documentID=2898&pageNumber=1

    (the emphasis is mine)

    They will go to ridiculous lengths to find anyone they deem appropriate to assist. A personal example was I'd happened to mention I'd started dating, although we'd only been on a couple of dates, the social worker was busy writing him up for my weekend care without knowing his name, age or location. It didn't matter what I wanted (and certainly not what he wanted!), she could write something down, save money and forget about it.

    I hope knowing the criteria used will be useful to you or someone else at some point, and that the black dog lifts a little soon, Bendy Girl

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