Today I called an ambulance.... and was put on hold

[Crunchymum]

About 4pm today I called an ambulance as my disabled almost 2yo had a severe allergic reaction (first time its happened)

I dialled 999, asked for ambulance, and got a recorded message telling me I was in a queue.

Hung up, called a cab instead.

Firstly, I was called back (approx 5 minutes later at most) and secondly whilst it was a severe reaction, breathing wasn't compromised. But what if it had been?

Maybe I'm part of the problem? I did make my own way to A&E (weren't admitted but needed steroids and more antihistamine) so should I have not called an ambulance to begin with?

A&E was as you would imagine. We were seen relatively quickly but took ages for meds and then discharge etc.

@Crunchymum I could probably bore you to tears with all my thoughts tbh 😂

The NHS as a whole needs its services bringing in line. The patients bed blocking because of no appropriate discharge care is a huge issue that has a knock on effect to the beds available on wards, patients are then bottle necked in a&e meaning we cannot offload patients from ambulances. We regularly have crews cohorting at hospital for hours on end, meaning they are caring for patients in hospital corridors rather than patients awaiting our help in the community. Funding is part of the answer, but clear care plans, well thought out safety nets as well as education of the use of different services is the key (to me, anyway)

111 is a tricky subject. Historically I have seen some rather dubious ambulance requests sent over (sore throat, tooth ache, refusing to make own way with a cut finger for example) but if an ambulance is deemed necessary, then an ambulance is what they get. 111 staff have a lower level of training than 999 staff although in our area we use the same triage system and many times a day a caller will call 999, we triage the case, advise them to call 111 for a GP appointment for example, you then sit and watch as the address reappears as needing an emergency ambulance as a direct request from 111 after they've gone through the same triage process but came to a different conclusion. Its frustrating for us and for the patient.

Now (this may give away which service I work for) but we have taken over 111 in our area recently and it is back under ambulance service management. The call assessors are getting additional training, there has been a large investment in additional staff and extra support in terms of more GPs, more nurses just generally more clinicians available. It won't remove all frustrations, and it won't be an overnight fix, but already I can see the cases hitting my screen on first appearance have a genuine need for an ambulance disposition. I hope this joined up working continues as I think patients will see a real benefit.

I would love to see more alternative pathways opened up in terms of falls teams, mental health teams and GPs responding with our paramedics. All have these have been initiatives in years gone by that have lost their funding sadly.

My DS is anaphylactic to certain things... his consultant said to shout anaphylaxis down the phone as soon as 999 answer.

When DD was a year old we couldn't wake her up one morning. She was breathing but stone cold (turned out that she was hypoglycaemic and had pneumonia). We called 111 because we stupidly thought "well, she's alive so it's not really an emergency let's not waste ambulance resources... they'll probably just send us to a&e". 111 dispatched an ambulance immediately. The paramedics gave us a stern talking to about calling 999... it's hard to judge especially when you don't want to be a timer waster.

@3littlemonkeys82 the falls team are desperately needed I think, falls often made up such a massive amount of calls
When I first started, a stabbing would have people around your desk, looking at the job. When I left, stabbings were almost routine you would get 2 or 3 a night rather than 2 or 3 a month/year
The actual volume of calls had gone up massively too, not helped by people ringing back 2/3/4 times for an ETA

As I say, this is so insightful @3littlemonkeys82 (I personally find it fascinating) however I don't want you having to "talk shop" on a Sunday night

Suffice to say I think you do an absolutely awesome job, and I have huge respect for your thoughts on things like 111. Its eye opening.

@ClientListQueen I've never known it happen, but I suppose it could be possible. Although I must say our duty managers phone is constantly ringing so even if the operator had access to call that number it wouldn't necessarily be answered before the 999 line was ifswim?

As I say though, thankfully over 2 minutes delays are relatively rare in our service so maybe we just don't have the need to force calls through.

By the way, hows life on the outside? Are you enjoying it or do you feel a little institutionalised? We've had a spate of folk retiring only to come back shortly after!

@3littlemonkeys82 I can't remember whether it was something like NYE, but it only happened twice in the time I was there (I remember because it was so unusual)
I started in 2007 and it was totally different then

Honestly? I'm glad I'm out. I have a contact centre job with v little stress, no audits and similar pay. I work hours from 8am - 6.30pm only and one in every 4th Saturday. No Sunday's, no Christmas... no uniform
My new manager says I watch the board and process calls faster than anyone he's known 😂

@clairethewitch70.

I agree.

People need to think "is this serious enough to warrant 999?".

I used to work in care and so have called 111 or 999 a fair few times. I'd say of all the times an ambulance attended, 50% of the time it wasn't needed. The other 50% it was either family members demanding an ambulance (and in one case they called it themselves despite being told by a trained nurse it was inappropriate) or sent through 111, or sadly for end of life patients where all the paperwork for a DNAR wasn't completed correctly or in time. It's extremely frustrating for all involved when you call the OOH service to request a Dr to confirm death, or a DN to administer more pain relief and as the paperwork hasn't been done, they send an ambulance and instruct you to start CPR - on someone who's been dying for weeks. I have had to do this twice, been talked through CPR by a call handler on a patient who essentially had a DNAR isn't official yet. I've also had a quick response paramedic arrive in response to a DN for breakthrough pain relief in a terminal patient, because what I described was life threatening (obviously) but they only had my word for the fact the patient was end of life, nothing on any sort of system. I understand that they are acting on the information available to them, and that's the procedure, but it's undignified for all concerned and a waste of an emergency resource.
I also think people are too scared of getting the blame these days to not call an ambulance, I work in hospitality now, and have seen ambulances called when in my opinion, they didn't need to be. And some were the result of alcohol and very avoidable, but when people are drunk, they tend to be dramatic and they're not thinking straight, and again the handler can only go on what they're told. Hell, I've been yelled at that someone is 'dying' when an ambulance has taken hours to arrive, so I can only imagine the abuse the call staff and actual crews are receiving re waiting times.

I've only been in an ambulance twice for myself (escorted several patients) and once was obviously life threatening and the other turned out to be, but I didn't think it was - I'm grateful to the 111 handler for sending an emergency ambulance because I may not be here without it.
I think in those situations it boils down to what do you prefer, people dying because they don't think it's serious enough, or people essentially wasting resources because they think it might be serious enough.
The ones that need to be stopped though are the ones who call an ambulance for things that aren't, and can't be categorised as an emergency. I saw a post on Facebook that went
"A&E stands for Accident and Emergency, not Anything and Everything"
I think that message needs to extend to the ambulance service too.

And yes then there's cuts to services too. From my simplistic POV, if demand is going up and the actual available resources going down, then it's a recipe for disaster. I think that's probably the biggest issue really, but frustrations at time wasters are more apparent. I can't imagine how frustrating it must be to be fighting to actually save a life with all your knowledge and skill, knowing if you'd not had to attend a time waster the call before, it may not be as bad as it now presents. Or to lose a patient because you couldn't get there fast enough and the next call is not an emergency, while working under massive shortages. Who wouldn't be frustrated with that?

I don’t think I would vote labour. Can’t vote for an antisemite.
Besides it’s not about the total funds per say. But the misuse of funds in other sectors. I doubt Corbyn is intelligent enough to deal with that. If people knew how much money is pissed down the drain in certain sectors whilst the NHS is like this they would be furious.

*doodoobear. We had this with my dad who was terminally ill and on palliative care at home. I was desperately trying to get the dnar completed and kept hitting brick walls. I had to warn my mother on no account to let a paramedic through the door when they sent an ambulance. I knew they’d start cpr.

I agree DNAR paperwork is a minefield, and am hopeful that in the future all DNARs will have some kind of database that is accessible NHS wide. We have a system where if we are notified we add a flag to the address but this can take some time to do so If the paperwork is not physically presented to the crew, in date, not out of exceptions (so if the patient has a DNAR related to cancer, but they've suffered a head injury following a fall) the crew would still have to initiate CPR. The call assessors still have to offer to give CPR advice to the caller as they obviously cannot physically see the paperwork to confirm the details. But in the grand scheme of things it might only occur a few times a day.

Ambulance misuse by other services is a far bigger concern. Sorry I know it's a very debatable issue. We have a policy in place where if police or fire request our attendance for any reason at all, we must respond under emergency conditions so lights and sirens. Yet it doesn't work back the same way. We can request police or fire for any given reason and they have the right to refuse to attend.

Each and every emergency service is under pressure. We have all generally had funding cut. We are all expected to do more with less. But we absolutely must resolve to not pass our commitment on to another service in order to ease our own pressures.

Apologies, it's your daughter, not your son.

I hope she is feeling better now.