Make ‘Em Wait

I've always said that we should aim to get to patients as quickly as possible. But sometimes, just sometimes, I wish I could make them wait.

Here's an example of a call that tends towards waiting a long time for an ambulance and really shouldn't – Doris falls over in a shop and breaks her hip. All she knows is that it hurts and she can't get up. The shop staff call an ambulance and the call is given the lowest priority.

Doris waits two hours on the shop floor until I turn up in my truck to look after her. I hate this – Doris should be seen *much* quicker. I'm guessing that it also frustrates those up in Control who are forced to follow daft computer scripts.

So why is Doris waiting – well, not enough ambulances and too many calls that don't require an ambulance. I've banged on about this enough.

We are driving back from dropping a patient off at hospital and we get an emergency call to “Male, 25, headache for an hour”. The priority of this call? One step down from a child having a fit, or a person who has stopped breathing.

The patient is only around the corner (and only 800 yards from the hospital), so we are there in seconds. Sure enough, the patient has a headache, but hasn't taken any painkillers for it. That's it. A simple headache.

The patient wants to go to hospital so, like trained monkeys, we take him to hospital.

Part of me wishes that he had been kept waiting, he's now going to expect rapid treatment like this should he, I don't know, scratch his face, suffer a papercut, or sneeze unexpectedly. Maybe he'll complain if he's kept waiting for an ambulance next time.

Meanwhile Doris is still on the floor.

22 thoughts on “Make ‘Em Wait”

  1. Couldn't agree more.I still find it mind-boggling how badly people know their own bodies, and how unwilling we are to self-diagnose.

    Hell, when I broke a bone in my foot I knew what it was without going to hospital… (I did, to get a cast so… yeah, that's a crap example).

    Headache wise I can remember the first migraine I had and wondering if I should go to A&E. Not once did I consider phoning an ambulance (I've never phoned one, although Louise was taken in one when her bile duct got blocked after gall bladder op).

    Anyway… where was I? Ohh yes, make 'em wait. Damn straight.

  2. “Control, control, this is ****””****, go ahead,” “Casualty has recently suffered from a minor head injury, brought about by abusing 999 call, over””Copy that **** – be advised that you can repeat same treatment for me. Out””Oi, bob – he said we can hit 'im again!” and thus, bob and his partner are able to have a rather good stress busting five minutes.

  3. You're absolutely right – drives us in Control mad!!I've said it before – I'll happily send my last amb to “Gran Down” (prob NOF gone, dehydrated, confused) Green 2 because she's been on the floor all bloody night, over the Red call to the twat who is “Not Alert” (because he's totally rat-arsed).

    This poxy American system of AMPDS is soley used because “Someone might die and we'll get sued”. It massively over-categorizes minor matters, and under-categorizes the “Doris” calls. It does little towards triaging calls, because certain people know how to play the system, and – effectively – lie to get an amb on immediate response. I use the word “lie”, because a person who has severe difficulty breathing and/or central crushing chest pains, tends to mention these matters immediately on calling 999, NOT as an afterthought, when they initially rang up with cold or flu symptoms.

  4. LOL @ “Oi, bob – he said we can hit 'im again!”!!On the topic of Doris and her kin, maybe you could set up guerilla courses in “how to lie” so they can get an ambulance when needed?

  5. I couldn't agree more with everyone…. It is such a stupid and frustrating system. We used to attend all calls on a “blue light” response, regardless of the nature (Green, Amber or Red) now someone has decided that it might be dangerous for us to respond on blue lights to a “green call” so instead we tootle along in the traffic until we get there. (but its ok for us to drive quickly to a drunk in the street at any time of day, or indeed a plonker in their own home)My first “green” job under the new system was as follows…. 90 yr male on floor, unable to get up, no apparent injury, wife on scene for access. It took us an hour through rush hour traffic, from one side of the patch to the other. We were greeted by wife with a “gosh, you must be so busy, its been a little while since i called” to which we couldn't really say, “no love, actually this is our first job of the day, some computer has decided that your hubby isn't a deserving cause for a quick response” so in we go, she explains she has been trying for 4 hours to get him up herself hurt her back in the process and decided it was best to call for us (so thats 5 hours or so total on the floor)

    We get to hubby, he is on the cold laminate floor, he is on top of his own legs and in quite a lot of pain, you try sitting on your legs for a few minutes and they start to get a bit painful….. he has chronic COPD and is on his own O2, 24hrs a day. He is stressed out and extremely grateful for us getting him up. Indeed he hadn't hurt himself at all, but then his generation wouldn't complain much even if he did. But the computer said that he wasn't a priority. I was tempted to tell them to do what the drunks and time wasters do, say he is having breathing problems or chest pains, then at least we would be there sooner. But no, I couldn't do that could I.

    I think Messrs Walliams and Lucas got it right in their travel agent/bank sketches in Little Britain…. ” computer says no”

  6. Hear hear !!!If “Little Brtitain” are reading this they could use heaps of examples (ironically funny ones – hopefully drunk, self inflicted ones) for their sketches !! Maybe they have more political persuasion than a FAB EMT's blog!

    “Compu'er says nooooo”

    Brilliant !

  7. I'm guessing that in very general terms if its chest or head it could be life threatening whereas a broken leg isn't. I wonder what percentage of these high category calls end up really being nothing more than a headache or gut ache?!When I broke my leg falling off a horse I waited I think about an hour for the ambulance (They did have a long walk) then I think about 30 mins for the helicopter (they didn't fancy the long rough walk carrying me). I did have concussion as well which I think was reported by the caller (a passing nurse and police officer!) so I'm suprised it was so long. I didn't really mind waiting as it didn't hurt too much so long as I didn't move, although I was getting pretty cold sat on damp grass.

  8. Yeah I know how you feel, someone -undoubtedly a 'Doris'- will die one of these days because of the pissed plonkers who abuse the system!

  9. Lol, I love it! I think this should be standard procedure in treating timewasters! And for drunks; the alcohol version of narcan, with the unpleasant side effect of a hangover 20x worse than usual!!

  10. It's the old problem though and that is, how do control know if it's the minor headache ,no painkillers taken, headache or the meningitis headache? It is extremely difficult to triage patients over the 'phone because they either exaggerate +++ or they underplay their symptoms.When you can see them face to face you can see if they look ill. Maybe in the not too distant future there will be a tele-consultation of some sort.

    Hope foot improving

  11. Bill them. Make them pay for the treatment, ambulance time, EMT time, hospital time, doctor's time, nurse's time and any other resources that were used. Then add 10% as a donation to the Home For Stressed Out Medical Personnel Fund.

  12. I hate sending the falls to the PSIAM desk, especially when I have to explain to the poor patient who's in pain and stuck between the toilet and the wall that we'll call them within the hour – they could have been helped up in ten minutes!!

  13. I can understand your frustration. Personally, I'd go along with billing people who are timewasters – except that there is always the risk that the prospect of a bill would put off some genuine and needy patients. It's a really tough call.

  14. A couple of years ago our lot (UK Trust) recategorised ?#NOFs as Amber B's, after concerns were raised by roadstaff about them being treated as Green C's. I think this was during the time when we weren't responding to C's on lights (we are again now). Just shows that ******* ******* AMPDS can be modified if the powers that be can be arsed to do it.

  15. Three tick boxes on the patient report form, one from the crew to say whether they think it is deserving of an ambo, one from the triage nurse and one from the doc. All boxes ticked, no probs, no boxes ticked, bills in the post…… Would it work though? Or would it just frighten the already petrified “older generation” who don't want to bother us into leaving it until possibly too late?

  16. I had been suffering severe abdominal pains (more than my usual gut ache i suffer) and decided to pop some painkilers and try to sleep (this was on the saturday), By monday morning i was still in pain and decided to go to see my GP (same day appointmetn what a lucky day)I got poked and prodded by the doc who then takes on a look of concern on his face, asks me to wait outside, i go out then get called back in and given a letter for the surgical assessment unit at my local Hospital, then told to make my way there

    by this point is am bit worried…Severe gut pain, referral to surgery and told to go to hospital… do i panic and call an ambulance?

    nah do i hell, I go home, have a shower (stupidly had some breakfast) then got the bus to the hospital, and go to A+E desk, within 5 mins i am in the assessment unit strapped to lots of machines with 2 (very attractive) female doctors poking and prodding me,

    Because i was stupid enough to eat no operation, have to wait….and wait….and wait…. 6 hours later (no painkillers nothing) then teh doctor comes back and goes through the Post Op and consent form as they want to whip my appendix out, some guy in a green PJ set up takes a look at me for 2 mins bounces all over my stomach, says its nothing serious then sends me home, I was in and out of that unit for 4 days before the pain finally went

    I spoke to the doctor and was told, if i had called the ambulance the night it had happened they would have taken my appendix out there adn tehn instead of me suffering with it for 6 days afterwards

  17. Knowing my elderly rellies, yes, many still remember the doctor being unaffordable.The answer isn't to make us like rats squabbling over a shrinking number of resources, it's to accept that humans make errors, and an inevitable minority are just plain tossers at times, and have enough ambulances and crews to cater for that.

    Multiple redundancy works in the brain, because it's a pro-survival characteristic, ditto with ambulances and healthcare IMO.

    But any system that doesn't allow for the possibility of wilful or accidental error is always going to be at breaking point.

  18. The thing is I'm sure, the Not Alert “twat” might die and then sue, taking more money out of the system, whilst the “don't want to make a fuss Doris” lying on the floor all night will just die quietly without making any further calls on the resources of the ambulance service.Surely the answer is less reliance upon technology, more training and an increase in status / pay for all ambulance staff allowing them to make judgment calls and a more robust stance against the “compensation culture” by their employers so that they feel secure to make those judgments.

  19. the guy who didn't take painkillers for a headache reminded me of one of our patients…i'm secretary for a couple of colorectal surgeons, & one day a patient phoned. he'd had a haemorrhoidectomy a couple of days earlier & had been discharged home. now, i've never had a haemorrhoid op but i'm told it's very painful. therefore my bosses always send patients home with plenty of painkillers, instructions, etc etc etc.

    so anyway, this guy phones & the conversation went something like this:

    him “i need to speak to the doctor! it's urgent! i'm in terrible pain!”

    me “i'm sorry to hear that but, well, yes, you had your piles operated on 2 days ago, it is a painful thing”

    him “but i'm in terrible pain! i must speak to him!”

    me “didn't the doctor give you painkillers or a prescription for them when he discharged you? he always does, i'm surprised you haven't got anything for your pain”

    him “yes, he gave me painkillers”

    me “are they not working? perhaps he can prescribe something else if they're not strong enough”

    him “i didn't take them. i'm in terrible pain! i want to speak to the doctor!”

    me (did i really hear correctly???) “ah — oh — well — so you've not taken anything for the pain?”

    him “no i haven't taken anything. i'm in terrible pain!”

    me (maybe i did hear correctly — best make sure…) “nothing at all?”

    him “no, nothing, the pain is terrible!”

    me “ok, well, why don't you take the painkillers the doctor gave you, and call us a bit later if you're still in trouble”

    later that day he called again….

    him “i took the painkillers”

    me “oh, ok, how are you feeling?”

    him “the pain has gone”

    talk about a miraculous recovery.

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