Afraid Of The Dark

As I've mentioned many, many time before it would seem that the world of healthcare just stops once the sun goes down leaving just us ambulance folks and the A&E departments to deal with everything. The weekends are the same.

We had a perfect example earlier this week, while my regular crewmate was off watching the Foo Fighters at Wembley (lucky cow…) I was working with another EMT chasing around the Hackney area.

We were called by the district nurse service to attend to a woman who had been cannulated, but the cannula had come out.

Our patient was being treated for a long running infection, no-one really wanted her in hospital because it is really easy for her to catch another infection there, so she was being treated at home. A splendid idea.

She needed a small needle (cannula) in her vein so that she could be given antibiotics straight into the bloodstream, and the district nurse service came around twice a day to administer this.

Unfortunately this cannula had started to fail on the Saturday night. Unfortunately for the patient the service who inserts them in the community doesn't work on a weekend, or after the sun goes down. The district nurses couldn't resite it, they don't have that training in this area.

So they call an ambulance and expect us to put a cannula in the patient and leave them at home.

Unfortunately neither me or my guest-star crewmate are paramdics, so we aren't allowed to put in cannulas either (despite me doing it regularly in my previous life as a nurse). Meanwhile the patient really didn't want to go to hospital.

“How do you think I got this infection in the first place?”, she said to me, and I couldn't really disagree with her.

The family were lovely, so it wasn't a hardship to go that extra mile for them. We called up our control and asked them to send us a paramedic who soon arrived. I was glad to see that it was one of my mates and I knew he'd be happy to do it.

However… Are we legally covered to cannulate someone and leave them at home, normally when we stick a needle in someone we take them to hospital. So my paramedic friend phoned up our control and asked for the 24 hour clinical advice desk.

He was on a break.

So we chatted to the family of the patient, not a great hardship as they were your classic, traditional, East-end family while we waited for the clinical advice desk to phone us back.

He did so and gave us the go-ahead to pop that needle in and leave the patient at home.

Which we did.

And the patient and her family were extremely grateful.

This is just one more example of how the ambulance service and the A&E departments pick up the slack for the other agencies that have decided not to work after dark, or on weekends, or on bank holidays.

Part of us being run ragged at night is due to people expecting treatment when they want it, when it is most convenient for them. When 80% of our jobs can be treated by GPs or walk in centres, why do these patients wait until most of these services have closed? Because it's most convenient for them. The health service then expects us accident and emergency services to pick up this slack.

“I want treatment for my sore throat now“, said the great unwashed public at 2 a.m. in the morning and phones 999 for an emergency ambulance. Then they moan when they have to wait at the A&E department while they deal with real emergency cases.

And so what happens? The ambulance services start reconfiguring to meet this demand for trivial work, we train and employ ECPs who do the GP scut-work, and we start converting the fleet to cars, all the better for taking the minor illnesses to hospital.

We aren't an accident and emergency service any more, we are the “coughs, colds, bumps and grazes” service, open 24 hours a day we will bring the hospital to your door – free of charge and no waiting needed. Meanwhile the seriously ill can go waiting because we are so busy dealing with your minor case at a time of your choosing.

10 thoughts on “Afraid Of The Dark”

  1. It's the same here in the US. We often get called to people who, when asked “How long have you been having this pain?”, say “Well, it started about a week ago”. Oh good, so you decide to call for an ambulance now, at 10pm on a Saturday night.However, just recently someone told us that he's been having chest pain for about two or three days and it turns out, according to his 12 lead EKG, that he was having the “big one” today. So I guess it's not always a good indicator of how serious it is.

  2. ok, not trying to be a “devil's advocate” here, but maybe a thought:I spend all day chasing down elusive invoices, my throat hurts, but there's no time to think about it, as I have a boss yelling in one ear and an upset customer screaming over the phone in the other. I go home, take a hot shower, which helps the throat a bit, then have some dinner and go to bed. At 2 a.m., all the adrenaline has finally burned off, and now my throat hurts like someone has shoved a red-hot poker down it.

    Granted, it's inconvenient for y'all – and yes, it's not technically an “emergency” in medical terms – but I'm going to have to pull on my pantyhose and go face the music again in a few hours, my throat feels like it is on fire, I can't sleep and my powers of rational thought have compressed to the size of a shrivveled pea – and I NEED DRUGS.. NOW!!

    My point is that maybe sometimes pain that can be accomodated during hectic busy lives becomes unbearable at 2 a.m. when all the good telly programmes are over – and so you get called?

  3. Do you drive? Drive to the hospital?You have a phone to call 999, call a taxi?

    You can take the day off work and go see a GP?

    There are always diffrent options.

    I've been called to someone whos washing machine had broken down yet according to control she was having “chest pains”. Thats when I got shouty. Complaint number 3 and counting

  4. I had a similar experience recently with my PEG button – normally it's changed by the DNs…but unfortunately it fell out some time between 10-midnight…cue me frantically getting a friend to ring the DNs, who could do nothing about it as they didn't have the same training as the daytime ones.Result: almost two days in hospital 🙁 (spending Friday night in A&E in a big city is not a good plan…)

  5. Banging head and brick wall come to mind ! As you are on the inside is there a way to change things and how can you get that job! Hope your bruises on the inside and outside get better soon and that you can find a way to switch off on your break ! regards to you from C .

  6. P. S . how does the fuel increases affect your vehicles ? especially the ones on waste of time trips ?

  7. As a sore throat is not technically life threatening or even life changing, why call for an emergency ambulance?? Supermarkets do paracetamol, throat lozenges often with trained pharmacists behind the counter. They stay open late or 24 hours. If you can call 999, you're capable of calling a cab, if you have a car maybe driving may be a good idea. Powers of rational thought don't really come into it, common sense and a sense of perspective do.If you do call for a sore throat please don't be offended if we turn up 3 -4 hours after your call (without any other symptoms that are life threatening you will be the lowest priority) Of course you could ring back and say you have DIB or chest pain in which case someone will be with you in instant, please try not to be miffed if the ambulance crew are slightly 'off' with you when it transpires your DIB is none existent. Apologies for the rant, I've had a week of nights featuring many calls that didn't require anything more than a plaster. The only one where I was required was a status ep, we arrived 17 mins after the call after driving 7 miles from someone with a verruca!

  8. The sore throat example was given as an example, not a training exercise. Sorry for being vague on that.Where I live (Chicago suburbs), there aren't pharmacies open 24/7 – most keep the same hours as all other stores and close around 9 or 10 pm.

    No, I wouldn't call an ambulance for a sore throat, even one verging on Strep, (for which Acetominphen is essentially useless) but the post mentions using A&E departments, not just ambulances, as evening/weekend clinics. My point wasn't to call an ambulance at 2 a.m. for a sore throat or bad back, etc – but that sometimes the pain doesn't really hit you as being severe enough to require medical intervention UNTIL it is late, there are no distractions, and it is just you and the pain.

    And at times like that – the only available medical services are frequently emergency services which are also dealing with the stabbings/gunshots/RTA traumas, etc. of the night.

  9. Unfortunately for the patient the service who inserts them in the community doesn't work on a weekend, or after the sun goes down.I think the government should solve this by passing a law that no-one must fall ill outside the 9-5 daytime period. No? They believe laws solve everything else.

  10. I spent a week in hospital with my then one year old son last autumn. Part of his treatment was intravenous antibiotics and most of the reason that we were there for a whole week was because the cannula kept failing and it repeatedly took them hours to find a doctor to put another one in. The longest wait was 12 hours meaning that he was behind 2 doses of antib's but there were several other times, once when a doctor couldn't manage it, asked a nurse – who wasn't allowed to do it, then wait several hours for another doctor. I could go on and on.

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