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.