to complain to the ambulance service?

[lurcherlover]

I genuinely don't know if IAMBU here, so all thoughts welcome...

I was out walking DDog today with DS (7 months) in his back carrier when my mobile goes. It's DH, who is round at my parents' house as my dad has phoned our house. Dad's had an accident and I need to get there straight away (luckily they only live 5 mins from ours and I hadn't walked far). I get there and find my Dad in absolute agony with what is clearly a dislocated shoulder (the deformity was obvious). He'd tripped and fallen in the garden. My mum was at work (Dad's retired) so he'd phoned our house. He was in shock, grey and clammy, and in unbearable pain. Naturally, we phoned 999 for an ambulance. We were told that as it wasn't a "life threatening injury" an ambulance wouldn't be sent out and we would have to get him to A&E ourselves. If we didn't have our own transport, a "non-emergency ambulance" (ie the minibuses they send out for little old ladies to go to the chiropodist in) would be sent in approximately 2-4 hours' time. So we had to virtually carry my Dad to our car between us and drive him to hospital, with him groaning in pain.

I was fuming - my Dad was in agony, and paramedics would've been able to give him morphine (which the dr did as soon as we got there). Plus, I was worried the injury wasn't stable, and putting him in the car to drive to hospital might do more damage. Added to this the fact that luckily DH wasn't working today - if he had been, I would have had to somehow get my Dad in the car by myself, then get him and DS out at the other end. So I'm thinking of complaining and saying an ambulance should have been sent. Opinions please?

FOrgot to say OP I think you were right to call 999 however depending on the circumstances ie locations of ambulances and other calls waiting it may have been correct that it would be quicker driving him.

Well, I'm going to go against the grain and say YANBU. If I found an elderly person who'd had a fall in excruciating pain, grey and clammy and with an obviously damaged shoulder then I would call 999 and expect a response. I'm not a medic, but have worked with the ambulance service in the past in another role and I know the paramedics would see this as entirely reasonable and potentially a lot more serious situation than many they get sent to. As you say, you're not medically trained and there could have been an underlying reason for the fall or other injury on top of what was assessed as a dislocation by a 3rd party over the phone. That said, I can understand that your call might not have top priority and that you might have to wait. I hope all's mending now, it sounds like the experience was v unpleasant all round .

I phoned for an ambulance after my dad ( who has severe mobility problems) had a fall. We couldn't tell from looking if the ankle was broken or not. Dad lives one floor up and there was no way we could safely get him downstairs and outside.

The ambulance dispatcher said no and told me to call out the GP...so phoned the GP who said to call the ambulance back. Went round and round in circles trying to determine who should come out.

I eventually rounded up some blokes to give me a hand to get dad down the stairs ourselves...we managed it - but it was by no means safe and very distressing for my dad who couldn't co-operate with what we were trying to get him to do with arms and legs etc. His illness causes poor balance and limited understanding/awareness.

We manhandled a confused, fragile, disabled man down a flight of stairs...had we lost our grasp we could have caused so much more damage which would have been a bigger drain on the NHS.
Had the ambulance control said they would send an ambulance but it might be a longish wait that would have been reasonable...but passing the buck to the GP seemed daft when the GP would probably have had to send dad to hospital anyway!

yes your being unreasonable. Your DH was home today, so thats fine. I fell down the stairs the other week, seriously painful ankle, thought I was going to be sick, and pass out and seriously thought it was broken.
I was alone with DD2 who is three and in bed. What did I do??
I called DH, who came back, then called my cousin to come and pick me up. DH stayed with DDs, cousin dropped me at A&E.
Its not life threatening and while seeing to your dads sholder they could well have been delayed in getting to a heart attack, ashma attack, seriously accident.

agree with others that you really cannot compare this situation to a child or young adult dislocating a shoulder

when dd fell down the stairs and broke her foot, I picked her up and put her in a taxi- getting an ambulance wouldn't have occurred

if the same had happened to 86yo MIL I would jolly well have wanted an ambulance- because you simply can't know how badly they will be affected or if there is an underlying cause for the fall

elderly people often die shortly after breaking a leg- because they can't cope with the shock; rarely happens to 10yos

This very similar to an earlier thread about DR receptionist asking medical/ symptonal questions to decide if nurse or gp needed. I got jumped on was surprised many thought my concern for the fact receptionist who isn't medically trained could make a decision based on a phonecall - not knowing or seeing the patient - just with a list of basic symptons - could make that decision. And before I get jumped on non smedically trained MNer diagnosed my DS correctly - which is why I made the appointment as it made sense but when I gave symptom was told no appointments. Turns out MNer were right and he was about a day off needing some minor surgery.

I think the same here - dislocated shoulder - bad but ok not serious serious iyswim.

Elderly man whos grey and clammy and hardly able to move whos had a fall and dislocated shoulder = potentially serious.

I think OP the dispatcher just worded it badly re time limits and wait etc. Perhaps its easier to say 'no' knowing you have an alternative than say it will be a wait and sending an ambulance crew to an angry family whos been waiting 4 hours.

I think that a shoulder dislocation in an elderly man is a very different matter to a similar injury in a young, fit rugby player. It sounds like your dad was very shocked by the injury and the pain and, as a nurse, I would have called an ambulance for him, and would have thought he definitely needed one.

Just to slightly lighten the thread - my dad used to play rugby, and dislocated his shoulder during a match against one of the London medical schools. The student medics clustered gleefully round him, whilst the most senior demonstrated how to reduce a shoulder dislocation, right there on the pitch, and then said "Ok - that's you sorted - off you go X!"

I disagree with most respondants on here. If you man-handle someone into a car or taxi, you could cause further injury. Also, if you are not medically qualified, how do you definately know it is a dislocated shoulder, or that no further injury has occurred?

I belive the ambulance service is negligent in refusing to send out an ambulance, as they have left someone in extreme pain and suffering. I would call the police and have them arrested for neglect - after all, there cannot be a lot of difference in causing pain and suffering in a care home, or refusing to help someone who is suffering?

If you and others do not complain, then the ambulance service will think it is okay to continue providing this level of sub-service. Did A&E turn you away as well, claiming it is not life threatening and tell you to book an appointment at the GP?

The call takers don't do the assessment: they feed information into a computer where a very effective and well tested system tells them what questions to ask next. The computer then makes the decision about what resource is the most sensible one. I know this sounds a bit heartless/'computer says no' but it works: they even have systems to listen to breathing quality, instructions to teach you how to do cpr and deliver a baby and so forth.

All the calls are recorded. If you are dissatisfied then contact your ambulance trust, they will pull up the recording of the call and the information put into the system and review the decision.

I believe a dislocation would normally be a category C call - low priority. You get an ambulance but not if there are more high-priority calls going on out there. High priority are things that might be time-critical like a heart attack or serious asthma attack. With a mobile patient and a low-priority call if you are close to a hospital then you may well get quicker treatment by taking yourself there. Everyone who arrives -whether by their own means or by ambulance - is triaged the same way and going in by ambulance won't get you treated quicker or taken more seriously when you are at the hospital.

A basic first aid course - or first aid manual - will show you how to support and stabilise a dislocated shoulder to reduce the strain and pain, and lots of other useful things.

I appreciate that this was a really shocking event for you. Sometimes the Professionals forget just how distressed patients and families can be by something they see as relatively minor, and don't realise how what they are saying is coming across.

PS - OP, who is your ambulance trust?

I would call the police and have them arrested for neglect

erm sorry, who would you have arrested? The Chief Executive? The Dispatcher? The unknown ambulance driver?

That has to be the daftest post this week - and thats some going, LOL!!

YANBU to be upset but I am not sure I'd complain about it. I'd have expected an ambulance, and been irritated but I'd have probably assumed it was a busy time. Hope he is feeling better - sounds very upsetting all round.

he could have gone in to shock or had a heartattack due to the pain,awful they should have sent an ambulance for him.
we had this many years ago with my mum,she had collasaped and couldnt get up,i was home ill and my nan was there,no way my little nan could lift my mum up and i was about 5 at the time,lucky my dad & older bro came home for lunch,called 999 told to call gp,so he came round and called 999 himself,they still refused,he gave them a right mouthful and they sent one,turned out my mums kidneys had failed and nearly died.

I have driven my DH to hospital quite a few times with a dislocated shoulder (and various other injuries ). I think though, that 4 hours is too bloody long to wait for transport with a dislocated shoulder should a driver not be available. In fact, I think it would be quite cruel to leave someone in so much pain for so long. Would they have sent a GP to provide pain relief?

It is all in the telling though isn't it.

"My father has collapsed in the garden, is grey and clammy and appears to have a shoulder injury" would have a different response to "My father has a dislocated shoulder".

I often hear stories on MN where people are not listened to by their GPs or HCPs when I can see there is a potentially urgent problem (the most recent being the lady who couldn't pee and is now in a wheelchair). I do wonder what they have said to the GP and if they down play their symptoms. They do not know what the problem is so are unable to stress the symptoms that would jump out to a HCP as being urgent. Of course a good HCP will ask the right question to get the answers, but not all HCPs are good.

In this case I would have expected the dispatcher to ask questions about the man's health and what caused his to fall before deciding to say no to an ambulance.

The lack of compassion here is quite shocking. Elderly man in excruciating pain, grey and clammy. Family don't know extent of injury. Calling an ambulance is very reasonable.

i would ask for a written response as to why he was denied an ambulance. Then write a letter to the Trust enclosing the response along with treatment, diagnosis etc and ask the Trust whether their policies are being implemented correctly and whether this was a reasonable decision made by the Dispatcher. See how you feel from there.

You are right though Callow in that people often down play symptoms (too british?) and perhaps that was a factor but not an excuse.

I think a lot of the posters here who are saying "it's not a priority, it's just a dislocated shoulder" are missing a few things that would tip the balance into me calling an ambulance too.

1. Going grey / into shock? big

2. The history and age of the patient - my dad's had a heart attack before - I'm assuming the OP knows the rough medical history of the poor man

3. Not seeing the fall or knowing what a dislocated shoulder looks like - there's the potential for the injury/injuries(?) to be far more serious than a random guess can determine

.. at the very least I think the OP did the right thing to call 999, however, I'm surpised that he was assessed as being a very low priority based on point 1 above in particular... that makes me uncomfortable, really.

callow, I think you've really hit the nail on the head in your post Fri 03-Jun-11 11:40:53 - that's exactly what was concerning me here.

I feel quite sorry for the ambulance service here. No-one knows what was said in the phone call but the OP describes the injury as an "obviously dislocated shoulder". So the phone call to 999 might have described just that. Everyone I have ever seen with a dislocated shoulder has gone that awful grey colour. Why not just get him to the hospital in your car asap?

Surely also the ambulance service has enough to do without dealing with complaints, where no-one has actually suffered any harm?

I think the fact that he was able to move and then ring your DH meant that he wasn't in a life threatening situation tbh.

I would've called 999 too. OK, a dislocated shoulder is not in the same league as a heart attack, or someone being cut out of a crashed car, but it's still not a misuse of the service.

If you read any blogs written by paramedics/ambulance drivers, they seem to spend most of their time dealing with non-essential calls. Drunkeness, drug taking and care-in-the-community patients seem to account for a huge number of calls. Not to mention people who call an ambulance every time their child spikes a temperature, or vomits.

I would definitely be writing a letter of complaint.

i know its hard to see a loved one in pain and a dislocated shoulder would be really painful but it isnt an emergency situation, he wouldnt have died from it and that is ultimately how they must tier these things. if he had been on his own and managed to get to a phone and called them they prob would have sent someone but because he had someone with him with a car it would have seemed a bit redundant.

It's a tricky one - shock can be nasty especially for an older person, but if he was otherwise stable I think YAB slightly U to complain as you did at least have a car to get your Dad to hospital that day. If he had bumped his head in the fall or had any other underlying health condition, or if anything adverse happened as a result of them not sending an ambulance then it would have been different. I am shocked at the suggestion that they would potentially leave your Dad for up to 4 hours if he had no transport though - dislocated limbs can impair circulation or pinch nerves, so I do hope that the ambulance service dispatch asked about this (any colour change/change in sensation in the arm)?

I have had to take my 8 year old dd to A&E by car myself in the last month after she dislocated her shoulder at school, and she went that same grey colour. It didn't even cross my mind to call for an ambulance, but she dislocates very frequently and easily due to her having a connective tissue disorder.

YANBU I was taught in first aid training that shock itself can kill.

A letter of complaint is required I feel.