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?

You don't know it's a straight dislocation until you XR it (assuming not a recurrent dislocator)

May well be a fracture associated with the dislocation. There often is.

Either a fracture or dislocation can compress or damage the main nerves and arteries to the whole arm (so unless someone has assessed the rest of the arm it may be Limb threatening - ie emergency)

Why did he fall in the first place - how does the ambulance controller know he didn't collapse rather than trip?

TBH I'm amazed that elderly gent, grey, clammy, shoulder pain didn't score a first responder - there's plenty of life threatening things that could be, and how does the call centre person know you know what a dislocated shoulder looks like - what if he'd had a heart attack and fallen and you'd noticed he had a lumpy shoulder?!

YANBU - Speak to PALS service at your hospital. They can only improve the service if they get feedback.

COI: Orthopaedic doctor
PS - hope he's doing ok now

I don't know which ambulance service you are covered by so I can't say on their response. However I am an emergency medical dispatcher. Fall, with dislocated shoulder offers a Category C response in the service that I work for. Unfortunately we are always taught the amount of pain doesn't always correspond with the severity of the injury. So when we triage, there isn't an option for how much pain the patient is in. With our service, you would have either received a call back within an hour from a health care professional (paramedic/nurse) or an ambulance would have been sent (without lights/sirens - unless hcp had triaged and deemed necessary)
We ask why the patient fell as well, whether it was a trip/faint/fit
Hope this helps, sorry about your Dad and hope he has a quick recovery

I think you were entirely reasonable to dial 999.

Dislocation even in a younger patient can be serious and can result in no pulse in the hand causing longterm damage. Dh was literally screaming when he dislocated his elbow. Your poor dad.

The ambulance service were probably engaged in picking up folk who were worse for drink which based on opinion on a recent MN thread are perfectly worthy of the attention despite the fact they put extensive pressure on the service.

I'm sorry to hear about your Dad, (hope he's feeling better) but I don't think either an ambulance or a complaint are necessary.

We don't ask people on scene to diagnose. We ask what happened so op would have said he tripped and fell. we then ask questions like is he awake? Is there bleeding? Is he alert? In order to send the best response. A shoulder will always be a cat c unless the patient is unconscious or not alert. Shoulder pain is totally different, if he had been sat in a chair got sudden pain in his shoulder and was grey and clammy, but he tripped so this was a traumatic injury rather than medical. Sorry for grammar as I am on my phone

I think it depends how busy they are. I got to A&E with dd 2. We sat in casualty for 6.5 hrs(friday night). I was then told at 6am that 2 RTA's had come in and they were transfering me to a different hospital via taxi. She was in pain so i couldnt take her home and they advised me i would have to go to the other hospital. It took 35 mins to get there. I didnt realise till i was discharged from the other hospital 24 hours later that the 1st hospital had put me in a taxi without a car seat. The 2nd hospital would only discharge me in my own transport or a hospital taxi with a car seat. They said normally i would have been sent via hospitals in an ambulance and had they known they would have sent one of theirs for me and dd.

I got seen to eventually and no harm done. I think it just depends how busy they are and they obviously see to whoever needs help first.

I think YABU - I've no doubt that your Dad needed to be seen in a hospital and was in pain - but you were able to get him there in your car?? It didn't need an ambulance to get him there? You don't say how long it took you to get him to A&E? An ambulance isn't always the quickest answer.

I find it shocking that people are having a dig at the ambulance service for this.

Yes its quite painful I think everyone agrees with that, but its not as serious as a heart attack, a road crash, breathing problems etc.

The person that stated that Despatchers have to go through longer training than ambulance crews, what HAVE you been smoking, despatchers do not go through a 3 year Uni Course as a paramedic.

I think you are being more than unreasonable in complaining about that, yeah ok we would love to be in a country where we could have an ambulance on every street corner, but at the same time look at NHS systems around the world, ours is amazing compared to most! You should have just jumped in the car and driven down to A&E yourself, it might have been quicker for you, and less painful for him.

Clemetteatelea it takes 6 weeks to train as a dispatcher- how is that longer than training for ambulance crew?

On tv now there is an ambulance attending a dislocated shoulder

The call handler (emd) takes what information the caller gives, they ask a series of questions based on that information (computerised triage) and a response catagory is determined automatically. This was a traumatic injury so was catagorised correctly. In our ambulance service we'd have a clinician call the patient back. They are medically trained to telephone triage and would arrange any help if necessary. So they might send an ambulance they might not. If the service is busy and all the ambulances are dealing with breathing problemS and cardiac arrests then they may advise that getting a taxi might be quicker than waiting for an available ambulance.

The emergency medical dispatcher (call taker) certainly wasn't negligent.

Op YANBU to call 999 in this instance though.

Call takers are not dispatchers...

Or, at least they are not in EMAS.

YANBU

Am amazed at the number of people telling you to get a grip as if you called an ambulance for a grazed knee

And the Emergency Care Assistants (ie ambulance crew) receive 6 weeks training.
Irrelevant to the OP but I am not keen on being told I am wrong. I resigned from the ambulance service last week but that is also not relevant (I am just happy about it)

Yanbu.

A dislocated shoulder should take priority over a heart attack or a stroke. After all, those people may not survive, so sending emergency crew out to them is pretty pointless, dont you think?

I think the ambulance should be privatized and rebranded Free cab to hospital Service.com

Why did your dad ring your house and not 999 himself? And then when your dh got there why did he not feel the need to ring 999 and instead rang you?

I get a dislocated jaw quite often. I drive myself to a&e. Couldn't ring 999 obviously.

YANBU.

I would have called an ambulance for something that looked like a dislocated shoulder, and there is some muscle that can get ripped in a situations like that that can never be repaired. the something or other cuff. And that is v v serious because it removes useful mobility of the arm. My Mum who lives in an isolated rural area can now no longer drive or conduct many household tasks because of this muscle being ripped in a fall, and it not being sorted out quickly enough, and damage being done after the fall itself.

Also any official First Aid course will tell you to call fo medical help fo accidents at work rather than driving a patient to hospital - driving someone in agony, who may not be able to out a seat belt on, is not an easy thing to do.

However I would expect the ambulance to prioritise those with immediate health-threat injuries and illnesses, so would expect a wait.

Ambulances give G&A, not morphine, don't they?

Clemetatree- in many smaller ambulance services the call takers and dispatchers role in done by the sane person at the same desk. Our large ambulance service has all staff trained in both roles. So our call takers are our dispatchers.

Quintessional- I nearly had a cva myself reading your post, until I realisEd it was tongue in cheek! :)

clement- what country or part of uk are you? Our emergency ambulance crew are paramedics with at least 3 years training. Or technicians withat least a year training.

A&e support staff drive non urgent ambulances and they have less training.

I am in EMAS. do you not use Emergency Care Assistants on ambulances in your trust?
And are your dispatchers not required to be certified by the academy?
Ambulances here (and most places AFAIK) are crewed by ECAs (or equivalent) with 6 weeks training, probationary technicians (here called AECS) with 13 weeks training, technicians (who have completed the 13 week course and have done at least a year on the road), paramedics (various routes, some university educated with 2 or 3 year courses, some worked up from AECS/technician with an extra 13 weeks training). I have worked on emergency ambulances crewed only by 2 ECAs, backing up a qualified paramedic in a car, worked with technicians, or with paramedics, but it is not the norm to have a paramedic on every emergency ambulance. This is pretty standard from my reading of the blogs, NHS website, meeting people on courses and at different hospitals around the country.

oh most definitely tongue in cheek.....

YADNBU.

Your dad is elderly, and the fall was not witnessed - thus he could have had and neck injuries. The fact that he was cold and clammy would indicate he was in shock.

Complain.