Leaving At Home

I often joke with parents that their children enjoy scaring them.

When they are a few weeks old, they hold their breath and go blue.

When they are a year old they get high temperatures and have febrile convulsions.

When they are two years old they fall over and cut their head.

When they are seven they fall and break a bone.

When they are fourteen they either get pregnant, or make someone pregnant.

One of our commonest calls for children is the 'traditional', two year old who has fallen over and cut their head on a wall/radiator/stone/passing dog. The mother is often panicking because 'it's a lot of blood!' (even though it isn't) and we pop them down the hospital for patching up.

Sometimes a child will fall over and get a bump on the head. I take them to hospital because it's an easy job and they get to sit there for a few hours before being sent home by the A&E doctor. Simple.

Sometimes however the parents just want the child 'checked out', they don't want to wait at the hospital so they will call an ambulance and not go to hospital.

Occasionally the ambulance crew will feel kind to the parents and child and suggest that they don't need to go to hospital.

I don't know what scenario played out in this story, but unfortunately the child died. Now the father is aiming to sue the service.

I have no details of this job, or what happened – but I can talk in generalities.

If, on examining a child, they are happy, alert and interested in what is going on around them and there is no history of a loss of consciousness, then they are almost certainly going to be fine. If you take them to hospital they will be sent home most likely without an x-ray or CT scan.

I can imagine that in this instance, even if the ambulance crew had taken the child to hospital the outcome would have been the same. Only the headline would be 'Hospital in probe over boy's death'. I don't think that the child would have been examined differently by a hospital doctor than by the ambulance crew.

There is a saying among those of us at the bottom of the medical hierarchy – 'always leave another medical professional between you and the patient', or 'don't be the last medical professional to see the patient alive'. If I take a patient to the hospital, then it's the hospital's fault if something goes wrong. If the patient wants to stay at home, then I'l try and arrange the GP – so if something goes wrong it's the GP's fault.

It's medical arse covering at it's worst.

In part it's due to the media – in this story above, do you imagine that the BBC would print a story following the investigation where the ambulance staff are found to be without fault? I doubt it.

We ambulance folk are being subtly encouraged to leave people at home, and most of us are blatantly ignoring this hinting for the exact reason above. We don't want to be the last people to see a patient alive.

If I go to a patient with a sore toe I'll still take them to hospital – because if they die of an unconnected heart attack, I'll be the one to blame.

And soon, with the 'front end' model, solo responders will be expected to leave patients at home, somewhere in the vicinity of 60% of patients should be left at home, or have 'alternate pathways' for care.

I can't see many ambulance people being happy doing that.

14 thoughts on “Leaving At Home”

  1. Every member of ambulance staff I have ever spoken to (for myself or for a person I was responsible for) has tended to include in their “okay, we don't need to take you to hospital” speech, advice to make a follow-up appointment with a GP, and instructions to keep an eye on things and call them again if any additional symptoms crop up before the GP has been consulted. I always figured this was pretty much a standard caveat?That said, I can't begin to imagine what that father is going through – his little boy dies, then he and his wife are arrested for murdering the kid, that's more than any person can be reasonably expected to cope with and remain completely calm. No wonder he wants to sue someone. I suspect the paramedics are just the most viable target.

  2. i can concur with the previous comment here in the west mids all children up to the age of 2 yrs are routinely taken to A & E no matter what the ailment,sniffly nose,sore ear,etc UNLESS the parent/guardian has made it their intention to convey themselves or has refused hospital treatment for this child in which case it is noted fully and accurately on the PRF and signed accordingly, as has been said in posts previously you cant make anybody do anything with out their consent

  3. As usual, a good thoughtful posting. It is interesting that ambulance staff are beginning to experience this problems that are faced regularly by Jobbing GPs. You take a history. You examine the patient. You make a judgement in good faith.You don't always get it right.

    If something goes wrong or you make a judgement that ends up with somebody being harmed, you might be hammered for it.

    I was interested in your 'putting another professional' between the patient and you. We get quite a few calls to ask us to check patients over, and I've often thought that this is a “covering your arse” tactic. You have confirmed this. I'm not angry or surprised. I have met loads of ambulance people and, by and large, you do a terrific job. But it makes more work for us.

    There is a culture of trying to find blame if something goes wrong. People sometimes forget that “shit happens”

    Have a nice day – its raining here.


  4. Well at least the ubiquitous time-keeping and logging will work on the side of the crew for once. They can prove they were on site for more than 'a couple of minutes' and had plenty of time to do a thorough exam – at least 3 times longer than the kid would have got at their GP's!

  5. Interesting comment in the second article, is that all the crew's paperwork [ie the LA4/PRF] was completed correctly. Does that then mean – I wonder – that the parents AGREED that the child need not be conveyed (or maybe did not WANT the child conveyed), and – indeed – signed the documentation to that effect.Obviously, one can only guess at what actually happened, but I find in these cases there is far more too it than has been reported by the media.

  6. That comment has made me really angry. It is likely that the parents did agree – because the experts were telling them that everything was ok.People on this site frequently slate patients who insist upon being taken to hospital against the recommendation of paramedics / EMTs – and now you're slating the ones who don't insist.

    Hopefully, nobody is to blame for this heart-breaking incident and it is, as someone else has eloquently described, just because “shit happens”. Hopefully, the paramedic did everything that was expected and couldn't possibly have forseen the outcome.

    Blaming the parents for concurring with an expert opinion is remarkably cruel – I'm sure they're blaming themselves enough already. With opinions such as yours, I think you should consider changing your nickname.

  7. I don't think that Saint is 'blaming' the parents, just suggesting that the crew have done everything according to the ambulance policy and that the circumstances of this child's death were just a result of terrible bad luck.

  8. It's not *just* a case of covering our arse so much – it's just that GPs and Drs have just a shade more training than us ambulance folk. So we want to be careful about not missing something.(That and I think it's people who call us for things but don't want to go to hospital or wait to see their own GP who are causing the work…)

    And you are completely right, sometimes you don't get it right – as an example would you order a CT scan for an unsymptomatic child? Which I would suspect would be the only thing that *may* have forseen the child's sudden decline.

    Sometimes people just die, and while the survivors look for someone to blame, there often isn't someone.

  9. Absolutely spot on TR – I was merely commenting on the ambulance trust stating that everything in the crew's paperwork was correct – ie they apparently [my italics] did their job.I'm not blaming anyone. I merely wondered if possibily the parents declined conveyance initially. It does happen. I've been involved – on the control side – in jobs where we have attended the same location/patient two or three times, due to an initial refusal to travel, then subsequently changing their mind for whatever reason. I do not know the circs, and I would not presume to second guess.

  10. At the end of the day as long as the patient was given all the information available, and they made an informed decision as to wether they wanted to go to hospital or not, that is up to them!If they based their decsision solely on an 'Experts Opinion' rather than medical facts of an evenly weighted argument, the next headline to be seen would be….

    “Paramedics Coherce patients to attend A&E in order to cover their butts!”

    I have to say that I record the final part of my “refusal forms” VERY accurately in case this ever happens to me!

  11. Without making a comment on the incident, quite recently a bulletin was issued in MRAS/NWAS reiterating it's policy that all children should be taken to hospital, regardless of any lack of apparent injury, unless their parents/guardians refuse.While it's common practice to 'persuade' an adult not to go to hospital, in my experience it's only on very rare occaisons that this happens with children.

  12. I can only echo what has been said in other replies to your post, the post wasn`t “slating ” anyone just voicing an opinion and as has been rightly said…we dont know the full facts due to the dis-jointed media coverage but what i will add is,it seems curious from this news item that it has now gone from a story of 2 parents and an unfortunate death of a child to the father wanting to sue the ambulance service BEFORE the coroners inquest…..now this may be a knee jerk reaction on his part due to his anger at the unfortunate loss of a child but there seems to be too much of this grief to greed culture before the facts are made public for my liking and i find it leaves a very bitter taste in the mouth

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