Still can't quite believe the ambulance service said 'we can't help you' :-O

[mineofuselessinformation]

DC2 (young adult) woke me at 6.30 this morning in severe abdominal pain. I ran through the usual things: painkillers, constipation etc.
By 7.30 it had escalated (pain score 8), so I called 111. They advised that DC needed to have help: they would call back within the hour or send a non-urgent ambulance. Advised if pain worsened to call 999. Happy with that although not good to see DC so unwell.
30 mins later pain had increased - DC slapping themselves on the leg to try to distract from the pain and in clear distress, so called 999. Ran through symptoms with them, told them 111 had advised to call.
Their response after asking questions: 'we can't help you'.
Luckily 111 called back five minutes later so I told them what had happened. They sent an ambulance which attended. Advised to take DC straight to A&E as symptoms weren't giving a clear picture as to what was wrong, clearly needed to be seen, but not at death's door just yet. (I don't have an issue with this but did tell them I was concerned at driving quite a distance with someone so unwell in the car in my own.)
We duly attended and the upshot was that DC has what used to be called a 'grumbling appendix'. We were told symptoms may well recur and to attend A&E if they do. (By this point the pain had settled a lot due to codeine.)

I've never experienced this before - the 999 call handler had no way of knowing nothing serious was wrong with DC, yet still gave me a flat no - and I was told to ring by 111. (And DC could have had a ruptured appendix, given their pain and symptoms.)
I don't know why I'm posting except to get it off my chest, but I am wondering if the call handler needs to have a bit more training?

To be fair to you i blame television more in this case. Before I started my training I assumed that appendicitis was a 999 emergency and that you arrived and were pretty much in theatre within the hour.

It is 99/100 not like that. Its usually a referral to a surgical assessment clinic where you are triaged (so they can instantly tell you how poorly you are by vital signs) then bloods taken to see the level of infection, then you would see a junior doctor and then a more senior doctor. You would have some scan in between and most likely started on fluids and antibiotics but to be honest the quickest cases I have seen are where the bloods are particularly off or vital signs not good (which would suggest a perf or particularly mucky appendix), or if it just happens that the surgeon doing the ward round that morning has a free slot and can fit you in. Some people wait a few days with a more stable appendicitis.

In fact we used to joke about driving to the nearest hospital (1.5 hours away) with a ?appendicitis rather than be admitted by our colleagues.

The call handler does have a way of knowing the severity of the callers condition though- they use a triage algorithm, the questions they ask rule out life threats and then get gradually less time critical. This sometimes cuts off at certain points if there are calls waiting (have ruled out x,y,z on the caller on the phone but none of the above on the call waiting to be answered- which could be a cardiac arrest and need immediate advice on how to give CPR)
The call handlers are also audited extremely rigorously in their compliance in this system.
I’m aware my post sounds a bit abrupt, it’s not meant to and I’m so sorry to hear about your experience. Glad your DC had nothing serious and is on the mend

Thank you to everyone that has been supportive.
I'm off to bed now, after a very long day in which I totally forgot to take my own medication (until tonight) so I need my bed!
DC is in much less pain now, and is under strict instructions to wake me if they are back in any kind of significant pain.
I'm not looking forward to a repeat performance but suspect there may well be one. But at least this time I will be armed and ready to go (washing up bowl ready for the vomit and all)!

Sleep well, OP! Fingers crossed for an uneventful night

Thanks, @NorthEastLass.

Sleep well OP. I’ve just downloaded that app, so thanks for that.

Oh and in an emergency most taxi companies would come if you offer to pay a bit more i reckon.

Hope your night is uneventful.

@mineofuselessinformation

For those asking, it's over 30 minutes drive. Having been advised to do it, I did. But I think anyone in my position would have felt concerned about driving someone clearly in extreme pain, alone (so no-one to help) and not knowing if there could be a life-threatening emergency on the way.

Oh FGS really ?

Sorry but that is not a case requiring an ambulance, there was no reason not to find your own way to hospital.

OP you are always advised to call back if things get worse. This doesn't mean they anticipate that it will for future. Its just a catch all thing as people don't always describe their symptoms accurately.

Years ago I used to read a paramedic's anonymous blog. I remember him saying you would turn up to breathing difficulties call and find the person laughing away and with a light asthma reaction. Then you would turn up to a man complaining of indigestion like pains, and find someone sweating, red-faced, struggling to breathe and in a lot of pain.

So they say if it gets worse to ring 999 as some people, especially older people, really underplay their symptoms to 999. So people need to know they have to ring back. But for people who would ring back anyway, they can ring 999 and be told no the ambulance will still be six-plus hours. Because it is still a low priority.

And the level of pain does not equate to the emergency level. I know we can't always judge that and it needs to be checked out. But my DD was in incredible pain and it turned out to be wind. Literally, all I had to do was burp her as if she was a baby. My fathers slight chest pain was a heart issue though that kept him in hospital for a few weeks alongside an operation.
I know we cant always know if it is serious or not, so it does need checked out. But it helps to remind ourselves that awful pain does not automatically an awful medical issue.

this is unfortunately not a result of covid. 2 years ago (pre covid) my sis was taken on one side by the gp, told to drive my mum to A&E and if it looked like she was unable to breathe then stop and ring 999 on the way, but don't bother waiting for an ambulance as she probably wouldn't be able to survive that long. It's years of chronically underfunding A&E and people need to understand that. (she survived btw)

I had covid in January at 31 weeks pregnant. I had been in hospital for 6 days. Had been home less than 24 hours and really wasn't doing good. 111 sent urgent ambulance.
They arrived, didn't even come in the house, didn't see me at all as I was upstairs, told my parents they refuse to even see me 'just because she has pregnancy symptoms'
Rang 999, the man was furious but lovely, sent another ambulance out. I was in A&E less than 5 mins before I was oxygen and drips, my oxygen level was at 85

@aliceca very true
Changed slightly for anonymous reasons but a call was for say a cut to the arm. Crew dispatched not at any great speed, I didn't think anything until an hour later when I got "why didn't you say he had been gored by a bull?"
Me er well.. they never mentioned it?!

It's like when you ask what the emergency is and get "in 1993 he had shingles, and he got up for breakfast and said he felt a bit weird but he had his toast and then a coffee but he only has one coffee then.."
Ok, what's wrong with him right now?"
"Now? Oh. He isn't breathing"

I'd never have called an ambulance for this though. Not when you could just drive there.

So sorry OP. My dh took our 12 year-old to a and e in the car after he took an overdose and was losing conciousness. Absolutely terrifying but quicker than an ambulance. Thank goodness we only live 10 minutes from the hospital. When they got to the hospital he went straight to resus.

@NMC2022 yes sounds like exactly the kind of thing this paramedic saw all the time.

I also think people not used to being ill can overreact. I took a friend to A and E a few weeks ago - she rang me and I picked her up. I was pretty sure it was gallstones and did not need a trip to A and E at all. I have them and am waiting for an operation, they are rarely an emergency. But she was insistent it must be really serious. Turned out to be yes gallstones. She was upset as she said a nurse in A and E treated her like a time waster. I was sympathetic, but yes I think she was.

DS recently had nausea in the evening before and then rapidly escalating abdominal pain from 6.00 the next morning. A series of calls to 111 resulted in an ambulance arriving (very quickly - minutes) at 8.00 to take him in to hospital with suspected appendicitis. It seems very likely that his appendix burst shortly after the first call to 111 so abdominal pain absolutely can be an indication of a serious problem. For what it's worth I had appendicitis several years ago and although it was absolute agony, the pain didn't develop anything like a quickly his did. So yes, you were absolutely right to take it very seriously.

I am a 999 call handler and something seems way off here. There is no way they would say they just can't help you. No way. Perhaps based on the assessment they reached a non ambulance disposition? In which case it is not in call handlers remit to upgrade to an ambulance. Perhaps you disagreed with the outcome and the call handler said they personally cannot upgrade to an ambulance? In which case the call would have been sent to a clinician for callback to discuss the most appropriate course of action. Whether an ambulance is sent or not is not down to the call assessor, it would have been based on the answers to the questions they asked you. I'm sorry your child is poorly but something is way off here, and it's terrible to read this sort of misinformation.
If there is some miniscule chance that this is what really happened then please do complain rather than putting it all over mumsnet.

And to add, the paramedics were able to give him gas and air, and codeine so that the pain was reasonably controlled, and he was properly admitted quickly, neither of which would have happened if I had driven him to A&E myself.

I understand it was scary for you as their mum, but a young adult can be taken in a car, and probably should be. I'm glad they are ok, and hope you get some sleep, but I don't think the call handler needs reeducation- you had the capability to take them, and they advised you should.

[quote NMC2022]@aliceca very true
Changed slightly for anonymous reasons but a call was for say a cut to the arm. Crew dispatched not at any great speed, I didn't think anything until an hour later when I got "why didn't you say he had been gored by a bull?"
Me er well.. they never mentioned it?!

It's like when you ask what the emergency is and get "in 1993 he had shingles, and he got up for breakfast and said he felt a bit weird but he had his toast and then a coffee but he only has one coffee then.."
Ok, what's wrong with him right now?"
"Now? Oh. He isn't breathing"
[/quote]
😆 You have clearly met some of my patients. For every ‘Why TF did you call an ambulance for your sprained toe?’, there’s a ‘Didn’t it occur to you to seek help before it turned black/swelled to the size of a balloon/dropped off?’

Just thought I would add that I don't think you were wrong to call 999- people call for all sorts of reasons and that's down to them. We have people call for lots of minor things but what the public need to understand is its not an ambulance ordering service, they're not pizzas. You will be assessed and referred appropriately.

@lemoncrisp

Had a situation recently where customer died (expected death). Rang 999, as instructed, for paramedics to come and confirm death. Was told the expected wait would be 10 hours. They then called back to say no ambulance would attend. Don't know who eventually confirmed the death, maybe the GP.?

How bizarre. If someone died I'd phone the surgery or the out of hours doctor service, not 999. They can't do aything for someone who's already dead. Seems a strange instruction to me!

@mineofuselessinformation

Well, I'm feeling a little more relaxed now, and that's despite the nest of vipers handing me my arse on a plate... Not to drip-feed, but it was the combination of being told to call 999 if pain worsened, which it did, the call handler not giving any advice (no idea if they are allowed to), and being left to deal with a very distressed young adult who, (sorry if this is a drip feed) suffers from anxiety, which is why I was trying to hold it together. (This DC is also severely visually impaired although I didn't find it necessary or relevant to post in my OP, but maybe it is). I was neither trying to use an ambulance as a taxi (I have already posted about this), nor trying to jump a queue. I have been in more than a few medical 'incidents' if you want to call them that, including fighting for my older DC to get seen earlier for a life-threatening condition which a GP brushed off, holding my DF's hand while he vomited up his own blood, eventually bleeding to death into his gut, and trying to cope with my DMum's advancing COPD, which results in frequent hospital visits and stays. I have no-one here to help. No partner, no neighbours that are able to step in and no family nearby. Maybe now those that are enjoying giving me a good kicking might try to understand why I panicked. Or, maybe they will now accuse me of drip-feeding. Maybe I'm a weak person. But, I'm a human being, genuinely concerned for their child, however grown, and needing some help and guidance as to what to do.

I see life is tricky for you OP, but as just about everyone has said, if you think your child needs to be at A and E, put them in the car and drive them there. Anxiety and visual impairment don't have anything to do with whether or not he needed an ambulance. In the current climate where ambulances are waiting in queues outside hospitals, if you can drive someone there, then do it. You waited over 90 minutes to get an ambulance when you could have been there by 7am if you took him straight away, or by 8am if you'd taken him when the pain worsened. It must have been coming up to 9am at least by the time the ambulance had come and taken him there.

As for complaining because the handler said no to you, the whole NHS is crumbling under covid, please give them a break.

@Wheelsofdeath

I am a 999 call handler and something seems way off here. There is no way they would say they just can't help you. No way. Perhaps based on the assessment they reached a non ambulance disposition? In which case it is not in call handlers remit to upgrade to an ambulance. Perhaps you disagreed with the outcome and the call handler said they personally cannot upgrade to an ambulance? In which case the call would have been sent to a clinician for callback to discuss the most appropriate course of action. Whether an ambulance is sent or not is not down to the call assessor, it would have been based on the answers to the questions they asked you. I'm sorry your child is poorly but something is way off here, and it's terrible to read this sort of misinformation. If there is some miniscule chance that this is what really happened then please do complain rather than putting it all over mumsnet.

THIS! This is exactly what I said, one of first replies on this thread. I advised OP that if this really did happen she can make a formal complaint to the ambulances Patient Experience department and they will conduct a full and thorough investigation with feedback. I also explained the remit (or lack of) of call handlers and how it would not have been the CH personally, they're were purely doing their job following the pathways script. I don't think my reply was what OP wanted to hear as I just got a sarky blunt reply. I was only trying to be helpful and informative!

Thank YOU for everything you do. It is a challenging job at the best of times, and you guys on the end of the phone don't get anywhere near the amount of credit and appreciation you deserve xxx

Why on earth didn't you put him in the car and drive him yourself? FFS, OP, show a bit of common sense.