to not understand why arriving at A+E in an ambulance gives you priority regardless to your injury?

[elfsmamma]

We had the pleasure of spending this afternoon in A+E, dp had dislocated his shoulder.

Dp was in lots of pain, he couldn't walk, his arm was hanging down and he was crying, shaking and almost loosing consciousness.

We had to wait for ages, first for an x-ray and then for a Dr to give pain relief and eventually attempt to put the shoulder back in.

People kept saying to me "oh you should have called an ambulance, you would have been seen right away" "poor guy go and tell them he needs to be seen now"

When we eventually went in the lady in the next cubicle had bruised her foot, she had come in by ambulance so been taken directly in. She was happy as could be, chatting to us asking dp ( who couldn't speak easily) what was wrong with him.

Aibu to think that all patients should be judged on pain and severity of injury rather than method of arrival to casualty.

Not sure where they prioritised her, but I think they got it wrong.

I don't think expecting to be seen swiftly makes you a wanker.

This time last year we were taken directly through with a blue baby with breathing difficulties, I absolutely agree that life threatening situations should take priority over pain but to have to wait hours in terrible pain with no effective pain relief is in my opinion unacceptable.

What country are you in op? Maybe ambulance arrivals are given priority there!

That is Britains NHS A & E. If you don't like it go private.

You can't. There is no private A and E.

Elfs did you ask someone for pain relief?

They have no choice but to treat in order of priority and that means sometimes a long wait for less urgent things. Just be pleased your not that more urgent case.

I am sure people were getting annoyed about waiting when 3 doctors spent an hour trying to (and thankfully succeeding) save the life of DS when he was 8 weeks. We had arrived by car too but he very quickly deteriorated.

Unfortunatly a and e departments never know what is going walk in next and they just have to cope as best as they can with the resources available and prioritise the most needy

We did go to something a few times; can't remember what it was called; Casualty Plus maybe- in Brentford I think?

DS1 split his head open while we were at Dm's. Went to her local A&E & were told to come back in 6 hours. Drove home & 4hrs later he was home in bed with a glued head (done by our local hosp). He did it again when we were at home & when I asked sister to sit with DS2 while I went to a&e she offered to drive us to the private a&e, look after DS2 while we waited & pay for it.
We were in, out & head glued in about 25mins.
DS2 then also cut his head open when we were at DM's (believe me, these accidents have had a major influence when planning my new kitchen) & we just put a clean towel in his head, drove to the private casualty place 45mins away & were home 45mins after that.

It did cost £35 ish each time so not an option for many, but I don't know why they're no longer around. It was like a private a&e but presumably would've taken some pressure from the NHS. Or maybe there just weren't enough children as accident-prone as mine to keep them afloat?

I'm not sure why people with minor injuries don't just get a taxi!

Don't be silly, OP...they would have to pay the taxi!! Here (Australia) you only really call an ambulance if you need it & have insurance, otherwise you will end up with a bill of $600+, so we don't have many cases of ambo abuse here, thankfully!

There are private A&E facilities in the UK! I have used the one at my local BMI hospital many times - it also has an intensive care department which I have (happily) not used.

I have lots of sympathy with the OP. Our expectations of healthcare in the UK are pretty low because most of us don't know any different. I have lived overseas for the last 2 years and the difference is incredible - I have never had to wait for more than 10 minutes. By contrast I went to A&E in the UK in screaming agony with pleurisy and was accused of "drug seeking" and then when I told a nurse I was allergic to the pain relief he was about to give me he hurled it across the room and stormed out . Envy of the world - not!

The problem is that they won't give you pain relief until a doctor says to. You could give some paracetamol yourself, though.

If the person does get worse while you wait, to the point of almost fainting, then do tell the triage nurse.

I've had two occasions. Once with a colleague I had gone to A&E with and another with my son, who had bronchiolitis.
They seemed fine on arrival.
He got worse as we waited for over 2 hours (!). They didn't think there was anything wrong with his breathing on arrival, but was seen within a couple of minutes when I went to tell them he was not alert enough. Then I had the pleasure of the doctor telling me that sometimes they don't recover - I could have punched him. But I digress...
She had lost a lot of blood and almost fainted. Still she was taken inside to be put in a bed and warmed, but still waited a long time for the actual doctor.

My DS who is 33 years old was ill with D & V. He is type 1 diabetic and his sugar level was going up. I called the OOH service at 10.30 pm, a nurse called back 1 hour later. She said he is on the dr's list, she will ring within one hour. The nurse rang again after one hour, dr rang at 2.30 said my DS needs a paramedic straight away. ONE hour later OOH nurse told me to ring 999. I did and stayed on the line to controller until 5.45 when the ambulance arrived. Was told at hospital he should have been there last night as he was now hyper, i.e. sugar level really high and dehydrated. He was seen straight away by doctor. Next time I will call ambulance. No taxi would take him as he was too ill to walk. My DH and I are both disabled and walk with crutches so no chance of being any assistance. If I told you where I live in this country and what hospital he attended you would be amazed.

I fell on a kerb and the nearby shop called an ambulance as I had a suspected broken ankle and couldn't move. Had lovely gas and air in ambulance ... When got to a and e there was no room in cubicles so they took me off trolley, into a wheelchair with my leg up on a frame thingie, and parked me in the crowded waiting room, with no pain relief and people bumping into the wheelchair frame. Was not a happy bunny! Luckily my ankle wasn't broken but was a very nasty sprain. I was just annoyed that one minute I had pain relief, and the next as there was no room I had no pain relief.

Twice I have been admitted to A&E by ambulance for a life threatening allergic reaction and was taken immediately through to a bed and Dr quickly gave me an IV of steroids. Was also given an IV of antihistamines in the ambulance.
I was not in any pain but my tongue had swollen and was in danger of choking /suffocating me to death.

DizzyZebra sorry to hear about your ruptured ectopic. One of DMs ICU Nurses had suffered from one and she was extremely ill with it. :( hope you are recovered now. I'm a veteran with the whole 'my child should be seen before yours because I've been waiting here 20millions hours' whilst Dd is struggling to breathe and being rushed through by two paremedics despite being on oxygen. . I agree with the others maybe the lady had an underlying health issue? Hope your DPs shoulder is better soon.

They don't get seen any quicker. I was blue lighted to hospital in March with suspected meningitis and obviously was put straight into a cubicle and had bloods taken as they thought I had meningitis which is fatal if not treated in time. However once the blood cultures came back after an hour and there was no meningitis I was left waiting around for hours before they came to see me to find out what else it could be.
However there was other people in there at the same time who I heard having to wait a long time before a doctor even saw them despite going in by ambulance. My mum actually asked the paramedic if going in by ambulance gives you priority and they said no, people are treated by priority of illness regardless of how they got to A&E.

Sirzy me too! :( we was there only last week. I was hoping it was going to be a case of giving her another neb and sending us on our way. a & E doctor warned us she might be in over Christmas :( thankfully she wasn't ghostly ut would much rather be in the 'waiting' category.

It's so the ambulance crew can handover the patient and get back on the road to respond to more calls.

But not ut sorry and don't know where the ghostly came from.

"The problem is that they won't give you pain relief until a doctor says to. You could give some paracetamol yourself, though. "

Ah, there speaks someone who's never been in severe pain - paracetamol is a mild pain relief and doesn't touch things like broken bones, torn or ruptured ligaments, even severe sprains or bruising. I need to take prescription painkillers occasionally for a condition I have, and those wouldn't be a patch on anything the doctors or paramedics can give.

Also, I've always been told to avoid self-medication if likely to need professional treatment as you don't know whether what you've taken yourself may prevent the doctors from giving you something.

The triage nurse can, and do, get pain relief prescribed for you while you are waiting. If the pain gets worse then you need to tell the staff because unless you are telling them they can only go off the initial triage.

Elf

Unless you are a medic yourself you have no idea what is life threatening or not, so your point is moot and this thread is a bit pointless. iMO

Having literally just come off an A&E night shift I can promise you that calling an ambulance does not get you seen any quicker!! It annoys me how people come in by ambulance and expect to be seen straight away.. Oh and also get a free lift home.

Unfortunately it doesn't work like that...!

I'm not sure why people with minor injuries don't just get a taxi!

Don't be silly, OP...they would have to pay the taxi!!

I don't know how it is where you live but round here the taxi companies won't take you if you're bleeding. I tried ringing one when DS, 2yo at the time, split his head open. As soon as I said "hospital" they asked was it A&E, when I said yes they asked "is anyone bleeding? We won't accept passengers who are bleeding". And that was three companies. No car, midday and midweek so everyone else at work (was a SAHM then), only other option was an ambulance. I did apologise to them and even they told me the best option was to ring them.

Not every ambulance patient who can still walk is a time waster.

Sympathies to OP. DH repeatedly dislocates his shoulder & describes it as agonising; he broke his leg very badly once and still says shoulder was worse. He has learnt to put it back himself, too, better than waiting for them to diagnose the bleeding obvious.

Gas & Air would only last until arrival, I think no one was suggesting anything longer lasting would be available?

Your A&E wait can very much depend on what is going on throughout the hospital.

A&E departments are often full of people waiting bed allocation on a specific ward.
If a patient is admitted with respiratory problems and needs a bed on a respiratory ward when there are none available, that patient will have to remain in A&E to be treated by the staff there. They cannot just leave that person to attend someone with a broken bone.

If someone arrives at A&E with an infectious disease, they are prioritised over the people already waiting for a bed on a ward.

Beds are like gold dust at the moment, due to social funding cuts and ward closures.

There is a much bigger picture to why A&E wait times are so long. It does irk me when the news stories focus on A&E and not what is going on in the hospital as a whole.

Community care and social care also play a huge part in what is going on.

Unfortunately, it seems to be getting worse. This government are hellbent on destroying all aspects of public funded care. Not just the NHS.

The first point of triage when someone calls an ambulance is the call taker. They ask a series of questions that catogerises the job as either needing a 999 response or an urgent job. Urgents can be taken in within a 4 hour window which may be extended if the service is busy. The ambulance that goes to an urgent job is often not a front line 999 ambulance. It is rare that people are told an ambulance will not be sent but it does happen.

Once we arrive at a job we again asses the patient and decide do they need to go to an A and E department or are there other options. The other options include taking the patient to an urgent care department, not too many of those about. Refering the patient to the local out of hours GP and requesting either a home visit or the patient goes to them. Refering to pats own GP if in hours. Finally we have what is called a self care pathway, this basically means the patient does not need to go to hospital. This is a very risk averse process and can only be used for certain things such as falls, diabetic problems, fitting, usually existing conditions. There is no self care for minor injuires so they get taken in.

The big advantage of a paramedic ambulance crew is the level of pain relief they can give without seeing a doctor, we have Paracetamol, Ibuprofen, Entenox, Codeine and Morphine. If we go to someone in pain we always try to give pain relief before getting them to hospital. Morphine is a very effective analgesic so someone may not appear to be in as much pain or as injured as they really are when they get to hospital.

If the job is serious we pre alert the A and E that we are bringing them in. There are two levels of pre alert, red and amber. Red is for Cardiac arrest, major trauma, reduced GCS, sever breathing problems, status epilepticus etc. A red pre alert gets all the relevant senior and specialised doctors waiting and the patient goes straigh into see them in the resus room. You don't ever want to be a red pre alert patient. The red therefore has a major effect on the rest of the department as the doctors stop what they are doing to work on the new patient. On a busy night this can cause long delays. An amber aler gets a nurse waiting in resus which has very little effect on the department. Amber alerts are often used for protocol driven alerts, chest pain, CVA etc.

When we take a non pre alert patient in we handover to a nuse. There will often be a number of waiting ambulances and there can be significant delays here. We give the nurse an account of the persons illness or injury, the person's past medical history, any treatment we have given and the nurse decides if they go in a cubicle or go to the waiting room. Some minor problems we can do rapid handover and leave the patient in the waiting room.

Calling an ambulance should not be a doorway to quick treatment as there is a multiple filter process before the patient gets to hospital. However there are patients who know what to say to get seen quicker, the exagerrate and often lie, they tell us they have chest pain, we pre alert and get them in then it becomes something far less serious once at A and E.