An Idea

I have a theory, possibly saving the ambulance service from crashing and burning at some point in the future.

There are a large number of patients that I go to where they essentially want a free taxi to hospital, sometimes they call an ambulance because they think that they will be seen quicker than if they arrive under their own power.

I've lost count of the number of times someone a relative has 'followed up the ambulance' in their own car when our patient has an incredibly minor illness is in the back of my van.

It'd be a fairly simple system to set up, all you'd need is a copy of the Yellow pages.

It would start in Control, the calltaker would take the patient's name and address, they would then determine if the patient has anything seriously wrong with them, like they aren't breathing or a leg has suddenly dropped off.

The calltaker would then read out the following bit of text.

“By getting an ambulance you will not be seen any quicker in A&E. All our ambulances are busy dealing with emergency cases at the moment, would you be happy with a free taxicab? You will likely get a taxi quicker than you will an ambulance.”

If the patient agrees then the calltaker, or a newly delegated (and even more poorly paid) role, then looks for the closest minicab firm in the Yellow Pages and arranges it for them.

There are various figures for the cost of running an ambulance to a job, it's normally pegged around £400. Wouldn't paying for a minicab save the NHS a lot of money?

And if we start supplying minicabs with disposable seat covers they could also deal with the vast majority of our Friday night clientele.

Of course, this is somewhat similar with what we are trying to do with the fleet at the moment – reduce the number of 'proper' ambulances and replace them with single-personed people carriers who can take the walking wounded to hospital. Of course, that costs a lot more money…

I, however, am not mad.

A perhaps more sensible suggestion would be to team up a paramedic with a police officer and have them assess all assaults that don't obviously need an ambulance – things like simple cuts and the like because at the moment we send an ambulance to these. Actually we often also send a FRU because the call gets categorised as 'Possible Serious Bleeding”.

47 thoughts on “An Idea”

  1. I would love to be able to do this to those luurrvly weekend called who are erhummm slightly the worse for drink :).I always have a smile on my face when the ECP in Control requests that I hand over a call and starts the conversation with “I am aware that you may think that XXX requires us to send you one of our Ambulances that are highly in demand by people who are actually incapable of getting to the hospital or require treatment for a serious injury…”

  2. Which is why the waiting time targets should be different for different triage results: head injury / heart attack wait times should average below x; simple stitches should average below y. Any one-size-fits-all approach is clearly insane.I'd fight for that change alongside… but you prolly already are.

  3. We have 12million smokers despite the terrifying message brandished on the pack.What does it say, smoking can kill you, no honestlY it really can, wouldn't you be better off avoiding lung cancer, emphysema and ischaemic heart disease………..NO [WTF].

    Not to mention all the doctors and nurses who continue to smoke even though they witness *first-hand* the effects of smoking.

    Ditto with excessive alcohol use and the much more hidden problem of illicit drug using NHS staff…

  4. If it's a offence to hoax a Fire Brigade call, and it's and offence to waste Police time, why can't it be made an offence to waste Ambulance time?Above all, Govt. need to lose the “customer satisfaction” or whatever target. If an EMT is sarky to you when you've phoned up for a free taxi to take you to have your verucca looked at, then good!

  5. Brilliant! This would have saved me trying to find the phone book to call a cab to take myself to hospital when I cut my finger with a pair of secateurs while trying not to bleed everywhere/faint/throw up a couple of weeks ago. Its actually quite hard to do pressure and elevate when you're looking in the phone book!!

  6. People go skiing knowing it can be dangerous, people drive knowing accidents can happen that they didn't even cause, people have babies knowing they may need emergency help – so the guy was irresponsible this time round – so what?If people were all perfect, we could close 80% of hospitals and disband the police: sadly they – we, you and me included – occasionally do dangerous things, or just plain screw up.

    The alternative is that grim “health and safety gone crazy” world where egg and spoon races and conkers are banned in case someone damages themselves!

    Kat's mentioned they'd not seen him in this state before, so I can't see that under the circs he deserves any harsher judgement than any skier, driver or mum who ended up getting out of their depth.

  7. It is a brilliant idea – chances of making it to reality are less than 1% in this pessimist's view, but still, nice thinking. Anyone who can do the wording fancy setting up one of those petitions on http://petitions.pm.gov.uk/ or something? Might not make a blind bit of difference, but at least that way you tried?

  8. I think one of your greatest ideas was around setting up “materna-taxis”. I'm 6 months pregnant, and living in central London have no friends or relatives local to me who could drive me to hospital when I'm in labour.. Apparently, most of the local cab firms won't take women in labour in case they make a mess of their seats, so my only option might end up being geting the bus! (as long as its not the middle of the night!)I won't call an ambulance unless I'm about to actually gve birth there and then.. but, it is a worry that us pregnant ladies don't need.

    Oh, and the advise given by moth the hospital (a dedicated maternity hospital), and the “NHS Guide to Pregnancy” book we're all given? Call an ambulance!!!

  9. The only problem I can see with this is that once people know they are entitled to a free taxi to hospital, all those decent people who were previously quite happy to pay for one will now be ringing up…

  10. Can we add to the little read-out card…”If you call an ambulance and don't need it, A&E will put you right at the back of the queue. Repeatedly. You will be seen when we get round to it, and not as a matter of any urgency whatsoever.”

  11. I think it's an excellent idea. I called an ambulance for a friend who'd had a seizure and bumped his head quite badly on the way down, and this wasn't a million miles away from what happened. I got a call back to see if he was recovering OK, which is was, and they gave me a few numbers I could call for a cab.BUT you see, I had to pay, so I want this to be instigated so that next time I get a FREE cab (joking).

  12. Tricky isn't it? In the old days of doctor's deputising services it took no time at all before the public cottoned on to the fact that, if they asked for a doctor to call, they got one.How about a big bouncer-man driving?

    I wonder if it would help if these people had to be interviewed by one of the NHS suits whilst waiting and questioned as to why they thought their case warranted free transport? There are some people who just don't think before they pick up the phone.

    I once managed to persuade someone who wanted a doctor to visit at Christmas because it was difficult for them to come to the surgery that the service was for medical cases, not social. Eventually he got the idea and was quite reasonable.

    This is a subject that should be aired very soon, as it seems to me that we are now in a position where there are fast responders, ENPs, EMTs and paramedics all being sent to people who know the buzz words- difficulty breathing, bleeding, choking etc and no-one dares to refuse to go because of the danger of being sued right left and centre.

  13. To be honest TR, some of us on the sector desks have been doing something similar for ages.A lot of our customers actually ring LAS on 999 NOT because they have no money for a cab, but frequently have no credit on their mobile phone to CALL a cab, and can only dial 999. So – once we have established this – we often will call a cab on their behalf, which said customer is perfectly happy to pay for.

    As for the “back of the queue” thing in CAS, one brilliant sister at a west London hospital (sadly she's moved elsewhere) usee to say to the patient in front of everyone “You called an ambulance for THAT???? Waiting room – and be prepared for a very long wait!!”

  14. Good idea, although of course the press will pick up on this as “Ambulance service admits 'even taxis are quicker than us'” or similar negative coverage.However, doesn't arriving in an ambulance mean you bypass triage at A&E?

    Sometimes you can be waiting 30 minutes to be triaged, so surely this would save some time?

    I'm not condoning getting an ambulance unneccessarily – just pointing out that it MIGHT save you some time in A&E to arrive that way, even though how soon you are actually treated won't change.

    That said, when I went to A&E with a suspected broken wrist, my GP gave me a letter with her assessment so I could bypass triage that way too?

  15. One fatal flaw ………since the Ambo's won't be so busy, you will be sitting in the station more often and therefore subject to cuts.Your station loses one Ambulance, the RRV is replaced by Community Responders, and Abdullah's taxi's gradually increase the rate to NHS due to rising oil prices, which leads to more admin overhead to count the beans, which leads to a shortage to fund the Ambulance service !

    Tongue in cheek, of course 🙂

  16. After just coming off 4 nightshifts over the the weekend and dealing with a very high ratio of bullshit jobs to proper ones i am backing any suggestion which may remedy the misuse of ambos.E.g Called to 50y/o female for a fall. Get to her (large posh) house to find a woman coming out the door to meet us. As i approach i ask her if the patient is inside although my answer is confirmed as she turns and locks the door and walks towards the ambulance

    “No dear, i had a fall in supermarket car park and i've hurt my knee a bit (5 hours previously and drove home). I didnt want to waste your time so i tried to call a friend to take me to hospital as my husband is at work”

    Me (calmly) “Did you think about calling a taxi?”

    Her “No, i drive everywhere and didnt think about that. I hope im not wasting your time”

  17. ..”team up a paramedic with a police officer and have them assess all assaults that don't obviously need an ambulance”Been there. We tried that last Xmas. Worked OK but staff got fed up lugging the para-bag about and getting wet. Also caused the usual headache for Control coz the assult calls all came in via the police so ambulance Control rather lost track of what the paramedic was actually doing. Still, quite a few of the Fri/Sat night regulars at least learned how to get to A&E on foot.

  18. I worked on an A&E reception and everyone, regardless of how they arrived, had to go through triage first. Obviously if you were criticially/seriously ill it was done as they assessed you, but *most* ambulance patients either wait in cubicles for an hour or so for a Dr to see them, or get put in the waiting room to wait their turn.And where I worked, if you came in 9-5 on a weekday from your GP with an xray request for a ?# arm then you went straight to xray and were only sent to A&E if the xray showed a fracture.

  19. Unfortunately, by the mere fact that this is a brilliant and sensible idea means there is no way the ambulance service will use it!Our service is currently trying to find a way around loan worker policy for the RRU. We have had new RRU's supplied so as we can carry patients who do not need an ambulance to A&E, but its not used because RRU tech's/paramedic's are not allow to transport patients on their own…………….. you would think the service will have thought of this before spending lots of money on shiny new RRU's!

  20. Really?! Well I didn't know that…That's bloody awful. Shame you can't tack a 'fine' on their mobile phone bill.

  21. Nope – the ambulance crew hands over to the nurse and the nurse then will send people to the right place, which is often the waiting room for further triage.Of course, the Royal London Hospital doesn't do this, but they have always been a bit strange…

  22. Here is the thing, we are supposed to be an emergency service, so why are calls waiting for ambulances rather than us waiting for calls to come in and whizz around there.

  23. I dont understand how people call an ambulance for minor things. I felt so guilty calling for a severe asthma attack as after 4 nebs & a epipen I could walk a few steps. The paramedic kept saying I'd done the right thing though despite my arguments. I have home nebs & epipen.

  24. Some of us will convey in RRV/U's depending on the individual case as appropriately risk assessed (our service's policy supprts this) although some staff will refuse to convey regardless.Regardless of this, is the principle of RRV/U's not to merely achieve sub 8 minute Cat A targets???

  25. It seems to be the way; people who are on deaths door reluctantly call an ambulance whereas others who are perhaps a little too quick to call dont need one.

  26. Education, Education, Education.Thats what we need to do. Along with all the adverts for safer driving/drinking/stop smoking and other sundry public information films we should have 30 second adverts showing what happens when we are tied up with a nonsense call and someone elsewhere needs an ambulance in a life threatening situation.

    The fire brigade bang on about hoax and inappropriate calls and get lots of airtime to inform us of the consequences…us?…we just turn up for work and do the same crap jobs day in, day out, night in, night out. And the more serious jobs struggle to get the appropriate response.

    Which brings me onto 'Call Connect'!….Who the hell thought up this ridiculous scheme? So now when someone dials 999 they are not even asked at the start why they want an ambulance, just 'Where to?' And so if an ambulance is available they are dispatched on 'Blues & Twos' regardless of the severity of the callers injury/illness. Just to shave a few seconds of the great god 'ORCON'!!!

    What happened to 'Right response to the right patient at the right time'?

    We have operated a 'Foxtrot Oscar' unit comprising a Paramedic and a Police officer to attend all drink related or public order jobs for the past few years and it saves a hell of a lot of unneccessary ambulance journies to A/E. Over the years we have made sure that both ambulance and police controls work in conjunction with each other so everybody knows what everybody else is doing.

    A national TV/radio campaign to educate the public on the proper use of ambulances and a discretionary charging system by the receiving A/E to deter the regular punters! (I would have liked to gone into depth on equipping all ambulance crews with 'bolt guns' or 'Tasers' for regular callers but I dont think management would wear it?)

  27. I'm not even sure education is the answer, Kingmagic.We have 12million smokers despite the terrifying message brandished on the pack.

    What does it say, smoking can kill you, no honestlY it really can, wouldn't you be better off avoiding lung cancer, emphysema and ischaemic heart disease………..NO [WTF].

    Then there are the 200,000 abortions and over 300,000 sexually transmitted infections despite masses of info about safe sex/contraception, etc.

    Rates of obesity rise inexorably, especially amongst youngsters.

    Heroin addiction has sky-rocketed since the 1970's.

    Piss-heads rampage round the city centre each night.

    How much was spent on the poster campaign “only one of these is a taxi” – our department displayed the poster at the ambulance triage area, well, it brought a knowing grin from one, or two rather smug, and self-satisfied customers.

    As long as there are enough people to pick up the pieces [courtesy of the 100 billion NHS tab] there are plenty who will not give a toss about the efforts of ambulance crews, or any of the other other front line staff, I'm afraid.

    http://www.marketoracle.co.uk/Article197.html

  28. A great idea…….but we are forgetting one very important point. It is very difficult to triage someone over the phone…particularly if you are talking to a friend who is p***ed. At some stage, although a rare occurance, at sometime, someone is going to make the wrong decision about not sending anm ambulance. Now I can understand this being a very rare occurance and of course measures wikll be put in place to try to ensure it doesn't happen, however, think of the poor call taker who it does happen to. They will be instantly backed up by the usual management decision of being suspended pending an investigation and then the service in question will spend the remaining time trying to protect itself from legal redress. The poor call taker will invariably be disciplined/sacked/demoted or whatever the service decides in order to be seen to be “taking appropriatte action” Once the 999 call is made then everyone who deals with the call/patient is acutley aware of “covering their arse” no matter how trivial the call sounds.

  29. I was thinking about something along the similar idea after what happened to me last friday night.A guy i knew had drunk a vast amount of whiskey and was falling in and out of consciousness and was being very very sick, i know youre probably thinking thats nothing out the ordinary of being drunk, but the problem was this guy had been known to have been taking medication for autism as well as anti depressants, and no one had even seen alcohol effect him this badly before.

    So we thought as none of us were able to legally drive at that point we called an ambulence, who were quite rude to me once i mentioned he had been drinking a lot but as soon as i explained that we just wished for someone to check him over and make sure he was alright and we will club together and get a taxi home for him. I know youre probabaly thinking why didnt we get a taxi to the hospital but the problem is that we couldnt afford a taxi to the hospital as well as one to get us back home.

    After reading Tom's book and several posts on here i know how many people waste the NHS's time and i was really reluctant to call the ambulance in the first place, but i thought it was better to be safe than sorry as we had no idea how the mixture of this guys medication and alcohol could effect him.

    I just wished that there had been an alternative service we could have called or a local place in town we could go just to check that this person didnt require a trip to the hospital thus not preventing the ambulance from getting to somewhere more important.

    Although i am still in two minds about that night, all i know is how bad the rest of us would have felt if we just left him be and something did actually happen.

    Kat xx

  30. Ah – it was the Royal London I attended where a note from my doctor skipped triage.I don't think I was triaged when I was brought in with a dislocated knee as a kid, but then again it was 20 years ago.

    Glad that everyone is equal, then!

  31. Do you not have NHS walk in centres?Although I thought we had a GP walk in clinic at Whipps Cross, but it seems that everyone goes to A&E now, whether they are wanting a GP, are a Minor Injury, or actually need to attend Casualty. I went there with a cut finger that wouldn't stop bleeding (I'd sliced it down to the muscle) and I thought maybe I'd get seen by a separate minor injuries department rather than having to join the A&E four hour queue and compete with children and broken limbs. I'm quite confused about NHS provision in that regard now!

  32. A perhaps more sensible suggestion would be to team up a paramedic with a police officer and have them assess all assaults that don't obviously need an ambulance – things like simple cuts and the like because at the moment we send an ambulance to these.We have this set up already, works a treat on Fri/Sat nights, frees up ambulances for the “real” jobs who actually need us as opposed to the daft gits who reckon they need to go to hospital for that 1cm cut on their hand. The Para and the copper triage the calls in a certain area and advise if a crew is needed or not. They also do minor wound dressings and tell the patient to make their own way to hospital, do neuro obs and act accordingly.

    Top bit of kit.

  33. Not to mention all the doctors and nurses who continue to smokeHey! I'm supporting the Health Service.

    Can't you triage on arrival and, in minor cases, recommend taxi travel when an ambulance is not required – thus saving on the travel to hospital; being able to be back on the next job immediately and not having to strip down and clean the vehicles?

    Date (?and time) stamped vouchers for free taxi to a named hospital only within one or two hours.

  34. I think the difficulty someone might have with this sort of use of an ambulance is called – acting irresponsibly.If he was on medication that says “Don't drink alcohol” (and all anti-d's do as well as just about every psychotropic medication) then to go drinking and become a bit dodgy… is not a health emergency – “no one had even seen alcohol effect him this badly before” … it's a lack of responsibility. If he wants to get pissed – stay home or make sure he has enough money for taxi to A&E at least… then you're only wasting A&E time instead of an Ambulance aswell.

  35. I've taken to advising people that they won't jump the queue at A&E just because they show up in an ambulance. I'll no doubt get a telling off soon but if it saves a few wasted journeys and frustrated crews then I don't mind. People really need to learn to distinguish between Real Life and Casualty…

  36. I'm 6 months pregnant, and living in central London have no friends or relatives local to me who could drive me to hospital when I'm in labour..“That would be me if I got up the duff.

    Good luck, and look for the iwantmymum.com forum, if you want progressive parenting news!

  37. No unfortunately we dont (i guess my town is too small) but it would be ideal considering ive lost count of how many times i myself or ive heard of someone taking a trip up to A+E (either by bus or car) just to be told their perfectly fine after just having something cleaned up etc after waiting a few hours, a walk in centre would most likely save time at both ends to be honest. And i can almost imagine that it would be a good way to start off people interested in going into a job to do with medicine and give them much needed experience.Kat x

  38. i agree with smoochie to be honest, and it can be quite easy to loose track of things especially when you have a lot on your mind im not saying this excuses him at all and he knows that he made a huge mistake and i doubt he would ever do it again, but if we had enough money we would have done that ill be certain to to keep in mind of what happened in future though, i was mainly just curious about what other action i could have taken other than just leave him be and hope for the bestKat x

  39. Here in LaLa Land, I be charge a minimum of 100 dollars for gurney transportation, the taxi fare be 10 Dollars, so when I go for an amble to test out shanks pony I see many a parked ambulance enjoying the view , but if I needed the bottled air and/or the needle then I could get the added excitement of getting the ladder company and its crew as they be part of the fire service [ medical Paras or EmTs???]. so when any of my neighbours request service, I get to see four/five fully rigged firemen with the monitors and shocking gear then along comes the gurney drivers when requested, Often I see two ambulances on scene and they be the ones that get the fun of using noise and lights and turn all the traffic lights to their advantage., We also have the advantage of reserving the center strip for bypassing drivers that be from Mars or Venus, noticeable withe their antenas poking out of port holes situated on the side of the head.Every time I needed quick service for losing the use of my legs or havin tongue swollen so that I have to breathe thru my nose I use the cheaper Service., then I am very fortunate I have a very good Emergency room group 20 minutes walk away. Never timed Nee Naw but they be active.answer : free you have plenty of work , charge , and Dole may be applicable or more blogging time..

  40. what's wrong with that though? It wouldn't cost an enourmous amount to give everyone a free taxi to hospital as part of the NHS if they want one. Maybe it would be cheaper than sending ambulances to all the assholes who try to get a free taxi by ringing 999.

  41. I'm a member of St. John ambulance, and a short while ago we were running a first aid post in the centre of Kingston-Upon-Thames to take some of the pressure off the LAS. We were there on a friday, and saturday night until the early hours dealing with the drunks and alike coming out of clubs and bars.This was an experiment tried out for a month to see how things went… i was just one of the minions so i don't get any feedback but its no longer running and there is no news of it starting up again in the future. maybe its due to the fact that we were there voluntarily and occasionally there wouldn't be the ideal number of us there covering the duty.

    I'm not sure who booked us out to set up the post, and who was giving the “donation” possibly the NHS, or the local council… but maybe if they offered the St John members a small incentive then they would get a better turn out.

    the post was very effective… we dealt with the “drunken barely conscious” and the drunken brawls to diabetics and asthma attacks victims. i found that we were indeed very helpful and took many of the “waste of time” calls away from LAS as we also carted the none emergency calls off to A&E.

    possibly another good and practical idea thrown out of the window!

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