What happens when rush into A&E with a life threatening illness?

[TrayBakers]

It seems silly to ask the question because presumably most people presenting at A&E are there because they feel they might have a life threatening problem, hence the word 'emergency' in the name of the department.

But I've always wondered how the reception staff deal with or spot genuinely time sensitive emergencies. I know it's not their job and that's what triage is for. But triage in my local hospital can take an hour, by which time anyone who is suffering a genuine medical emergency could be beyond help.

If someone were to run inside the department with a loved one and start calling out for help, would the reception staff immediately call for the doctors?

I remember one particular night that I found myself in A&E, a gentleman arrived crying out because of severe chest pain. They just asked him to wait in the waiting room. He continued crying out loudly whilst waiting to be triaged. He could've been in the throes of a heart attack.

Incidentally that same hospital has been named recently because someone died whilst waiting to be seen.

Does the TV version of bursting through the doors and being greeted by doctors thing ever happen? Or does that only really happen if you've called an ambulance to get there?

It's just something I've always wondered.

If patients need to go to resus then the team will phone ahead so we can get ready, exactly as you see on tv. Otherwise you don’t get seen quicker just because you call an ambulance, you’re still triaged the same. I’ve known colleagues when it’s busy take a walk round the waiting room to double check that sick children aren’t sitting waiting and have been missed.

I only have experience from our children’s hospital not adult a&e but we are regularly rushed through due to my daughters frequent severe and life-threatening asthma attacks. I usually run in with her in my arms, reception tell me to go straight through to the nurses in triage. I carry her through to the triage area and as she is very visibly in respiratory distress the nurses grab a doctor, bring us straight though to a cubicle and start her on oxygen and nebulisers while one of the reception staff come in and take her details from me while she is receiving treatment. This is a vey regular, frightening experience for us but dealt with immediately by the a&e staff who are wonderful.

I was whisked off the back of an ambulance straight into resus when my heart rate was sky high. It was very embarrassing as I was totally alert/ awake and I knew instinctively that there wasn't really anything wrong with me (but appreciate they can't take any risks with heart stuff).

I had three shots of some drug to try and slow down my heart rate but they didn't touch the sides (it was all very dramatic!), in the end it was lying patiently and recieving several litres of boring old fluids that got it down. It was only raised because I had a tummy bug and had been vomiting (which is what I had originally called 111 for).

I presented with suspected sepsis and a letter from the OOHs GP.

I was seen within 10 minutes.

When I was discharged, some 8 hours later, many were still waiting in the waiting room, including a man who had been sent at the same time by the same GP as me.

We (young DS) arrived by ambulance (head injury) and went straight through, they even detoured around a traumatic incident so my son wouldn't hear it.
Absolute wonderful care.

Dd had quite a complex break to the arm. We walked in, saw the receptionist, she came around the window to look at dd’s arm, made some notes and we were in x-ray and then a bed within 20 minutes. The entire family behind us also there with a ‘broken arm’ who were running around and eating McDonald’s and had been there 12 hours were left still waiting. It obviously wasn’t a life or death emergency, just a significant injury on an 8 year old, but the receptionist made sure we got seen quickly, which I assume is the case for lots of people when there is a genuine need, space dependent obviously.

When I went to reception with chest pain I was immediately sat down to do blood pressure and then a few minutes later an ecg in a side room next to the reception desk. Was then filtered off the ambulatory care rather than a&e for blood tests and a chest X-ray. Presumabably if the the ecg had shown something more severe I would have gone through to main emergency care.

My hospital has staff on the door triaging. If suspected seriously unwell they do obs before you get to waiting room. Sprained ankle for example will get sent straight in. It's a good system.

I’ve been sent to a&e by 111 with my son before. We weren’t sat in the waiting room long enough for the seat to get warm. My friends was sent with her child for suspected meningitis. She was told to go through the main hospital doors and someone would be waiting for her. They took her son from her and RAN down the corridor.

Generally speaking if you’re conscious and making a noise, you’re not in immediate danger.

I went in with a twisted cyst/ovary while pregnant and I was triaged almost immediately and before everyone else- I was crying in pain which might have been why or because I'd phoned ahead and it was an issue I'd had before.

My sister had a different experience though, she took her daughter in with a serious but non visible head injury and was told to wait even though she was hysterical, it was only a doctor that happened to be walking by that saw my sister in a state and had a quick look at my niece and got them rushed through.

I took a friend in who had pneumonia because he was barely conscious, clammy and struggling to breathe. He was so visibly unwell that people in the waiting area were staring and commenting. After 25 minutes of waiting (with me checking in at reception every 10 minutes to say I felt her really needed to be seen) I burst into tears and begged the receptionist to send someone to see him and told her he was the most unwell person I had ever seen, and I had watched my husband die. A doctor came out and they immediately took him through to resus – he had sepsis and ended up in the ICU.

Sadly sometimes people can present as quite well and really not be. My DH was having trouble breathing – it had been going on for a while but got really bad one night. We called an ambulance who checked him over and said he was fine as far as they could see but as it was an ongoing issue they’d take him in if we wanted. He walked out to the ambulance with his slippers and Kindle, preparing for a wait. Three hours later he was in the ICU in an induced coma with severe heart failure and later died. It’s terrifying how quickly things can happen and unfortunately our A&Es are desperately understaffed and underfunded, just like the rest of the NHS.

My DD had chicken pox and Dr refused to see us even though she was so unwell..

6 days later, her spots were infected, she was struggling to breathe, and the spots were tracking slightly.

I called the Dr who said he would send us cream for the spots. We only lived 5 mins from the Dr and said I was bringing her in.... We turned up, the receptionist took one look at her, went straight in to one of the Doctors who came out, looked and her and said to drive straight to A&E and he would call ahead....

We were told to go straight to Paeds and we were admitted within 5 minutes of arriving. She had sepsis, pneumonia and was very unwell. They told us that had we not have brought her to the Doctors, she may not have made it. She was only 11 months old at the time.

Just remembered another story.

2 weeks after my C Section, I was still feeling so unwell. I was deteriorating but thought it was just normal.

My DH thought something was seriously wrong as I wouldn't wake up properly, it was Sept and 25c and I was freezing in loads of layers.

To placate him, I said I would get the bus to hospital. All I remember was walking in and saying "I don't feel very well". 12 hours later, I woke up and remember nothing else. I had retained placenta and was in septic shock. I was in hospital for 4 days.

I always think about how many women came before me that would have died without a D&C and antibiotics. Jane Seymore was one of them.

Actually I can't fault the last time I was in a&e. Had to wait to book in and about 15 minutes for triage but after that they sprang into motion.
Actually whenever I've turned up to any a&e with an actual emergency in the last decade I've been seen very quickly.

I used to work at an ED reception and we always called doctors/nurses out to the front of someone looked particularly terrible.

I have seen a child carried in a blanket rushed straight through, but it was a long time ago.

When DS2 threw up whilst I was waiting to check him in, after a head injury, we were triaged very quickly.

Of course there should be a basic standard of care but A&E is always going to be running on a complex set of variables.

If there’s one member of medical staff free and two people arrive at the same time, the one who appears to have the most serious issue will be seen first…but medics aren’t magicians, they can’t see what’s going on inside our bodies as soon as we arrive and sometimes something that’s not obvious will end up being more serious.

What I’m trying to say is that there’s no one size fits all answer to your question.

It also sounds like you might be suffering with some post partum anxiety which is totally normal and understandable. Might be work speaking to your HV about that but also how about looking into doing an infant first aid course which might be a practical way to make you feel more positive.

I walked in clutching my chest, early pregnant, bleeding and with very significant chest pain and looking very poorly and was whisked right into resus bypassing triage and put on an ekg. Once that was fine I was ignored and then eventually brushed off and sent home with a chest infection. 3 hours later I was back in a much worse state - ruptured ectopic. So the receptionist was actually the one who took me most seriously and got me seen very fast. This was in 2013 so might not be the same today.

I went in with a facial injury and was triaged and sent to xray within minutes

@TrayBakers was that QMC?

I was once brought in by DH for a haemorrhage which was part of a miscarriage. The receptionist told him to take a seat me in a hospital wheelchair beside him. The porter who had got him said wheelchair at the door when he pulled up in a panic said "what will we leave her here in that pool of blood or move her there for another one?" Receptionist went pale, team of nurses were hastily summoned and I was rushed into surgery very very quickly

It's funny you ask that as it's only since my experience that I wondered the same thing. I went to AE with an AV malformation and was waiting in AE for so long said to the nurse I thought i was going to pass but nobody came to see me, ended up sitting on the floor in the toilet. I was discharged 2 days later after a blood transfusion. 2 weeks later the same symptoms at home, called an ambulance this time and was bought in, although not seen immediately the paramedics have to stay with you until you are seen and I felt much less scared and cared for ended up in for 10 days and had a hysterectomy. It's made me slightly nervous about going to A&E in future tbh.

When my son had breathing problems at 10 weeks we didn't go to the A&E waiting room at all - he went from the ambulance to the pediatric area of the hospital and we were straight into a private examination/waiting room with a bed. We were in there 24 hours and then moved to a ward.

OP, it sounds like you're struggling with anxiety and intrusive thoughts around your baby. I've been there, it's horrible. Please talk to your midwife and ask for help - you don't need to keep feeling like this. They should be able to arrange someone you can talk to quite quickly.

My son had a few health problems when he was tiny, and we were always looked after and taken seriously. I've had no concerns about his treatment and safety in the NHS - they take sick children very seriously indeed. (Case in point - he got prescribed antibiotics immediately for strep throat. I couldn't talk or swallow without bracing myself for the pain with the same illness, and was told I'd just have to wait until it got better... while caring for him.)

People screaming in pain have a patent airway. It's the quiet ones you need to worry about.

My late DH was blue lighted to A&E and met at the door, straight into resuscitation. He had a chest infection set up by a previously undiagnosed tumour and died a few days later.

The medical attention he received in A&E, and subsequently in ITU was second to none. But far too late. More problematic were the numerous visits to GP and walk in clinics in the months before, where the shoulder pain was blithely diagnosed as a trapped nerve and he was sent home with pain killers. No-one thought to Xray him, despite his many requests, and the only time the GP examined him with a stethoscope was two days before he collapsed with what one of the A&E doctors described as one of the worst chest infections he’d ever seen. Yet the GP didn’t find anything wrong.

The circumstances gave us access to top quality secondary medical expertise via A&E. The problem was, and still is, the quality of the gatekeeping allowing timely access to those services.