Should I Complain? NHS 111

[Lilwelshyrs]

I had a bit of a nasty fall off my horse yesterday. I hit my head, and skidded on my back. I honestly don't know exactly how I fell as no one saw it, but crucially, I was wearing a helmet, I didn't black out and there was no blood. I had to get up and get my horse - we were in a big field on our own.
I took the evening off of work and my DH was with me for the whole day.
This evening I went back to work and a few of my colleagues said I should probably go to A&E as I was complaining of a sore back and whip lash. As the end of work was only a few hours away and I managed to successfully commute into London, I figured I'd try NHS symptom checker. I would answer a few questions and then it would say the service was "currently unavailable".
So I thought, why not try 111?

I work in London but live in Sussex...
So I'm asked all the usual - home address, doc etc. Then the guy asked if I was safely at home to which I explained I was at work. He then asked me the usual questions - chest pain? No.
Hard of hearing? (Pardon?) No.
Loss of sight? No.
Then "have you had any neck pain?"... "Yes, and it's gotten worse since the fall".
He puts me on hold.
He asks me if my workplace is hard to access? I said no.
He puts me on hold.
He then comes back and tells me an "urgent ambulance" has been booked and is on its way...!

Eh?! What?! Why was I not asked? Am I about to be bundled into an ambulance like I'm some emergency case and then left in a London A&E which will have patients in far greater need of assistance than what I need?!
He never asked me about concussion or if I had blacked out upon impact of the fall, hadn't asked if I had felt nausous today and crucially hadn't asked if I was able to get myself to A&E (yet I had miraclously made it from Sussex to London without the need of assistance?!).
I thought 111 was to weedle out the non-emergency from the emergency? I felt he didn't ask me the right questions and I nearly wasted valuable ambulance services!

AIBU? Should I complain? Has anyone had this happen to them?!

FYI I am on the way to my local hospital which should be much quieter and will be assessed quickly with my DH in tow.

They do the same if you say you've had severe chest pains. I suppose it's in case you decide to drive yourself to a&e and get into trouble while you're driving, causing an accident.

I used to work for NHS direct but it was too expensive a service to maintain as it used only experienced nurses to do assessments. Before that I worked for years in A&E.

NHS 111 uses very few nurses and mostly call handlers with no medical training so that have to follow algorithms which end up in the absurd situation you describe.

An emergency ambulance is not appropriate in the circumstances you describe but I would have assessed you on my algorithm but add my A&E skills to the assessment. On what you have said I would have advised A&E because of the height involved. Riding accidents often have significant injuries, which we describe as the 'mechanism of injury'. There could have been fractures but cervical (neck) injuries involving the spinal cord are generally seen immediately.

Hats off to you for riding though, it's surprisingly dangerous!

Apparently not as dangerous as fishing I was told once by paramedics... :)

So again ive been caught out with semantics... Complain might be too much... The guy needed to talk more to me. Regardless of if I triggered specific panic stations on his flow chart, he still could have told me "we need to get you to a&e asap".

I thought I was doing the best thing by seeking advice to work out if I actually needed to bother them at my local hospital.

Again, had the guy said he felt that I needed to get to a&e quickly, I could have phoned my boss to sort some form of cover out for me... But as I was on hold for ages, I was unable to do this...!

You should complain as it's a way of the system learning by their mistakes. And you certainly should have been told an ambulance was being called.

If ambulances were called every time someone fell and had neck pain there would be none left for real emergencies, so some people on here are talking nonsense frankly!

In your case I would have advised going to hospital immediately following the fall as it's a significant height and the head/neck injury risk is high.

Yes we had something similar almost happen. DH had a crick in his neck which extended down his shoulders and arm. He was in a lot of pain so I wanted to get him into the out of hours Drs to get some stronger painkillers. We have to dial 111 for out of hours GP. As soon as they heard he's a 50 year old man with pain in his arm they wanted to call an ambulance saying he might be having a heart attack. We argued against it - I think it highly unlikely - he's slim, fit, no family history, no breathing difficulties - just a crick in his neck. Eventually they put him onto a nurse he spoke to at length and then a Dr he spoke to at length and decided he probably wasn't having a heart attack. We were completely unable to get him the painkillers he desperately needed and he lay around groaning all weekend in agony. I have got a customer satisfaction form here though so I will fill it in accordingly.

Really glad you're ok

No mistake made, he was doing his job. Nobody would criticise him for sending an ambulance in this scenario and it turning out to be nothing, with this mechanism of injury and history. Everyone would, had he ignored it.

Snotty. If she had been assessed by a medical professional rather than a call handler the advise would have been to get to A&E safely. Not an ambulance. If every fall, every fever, every head injury etc was called an ambulance there would be nothing on the road but ambulances.

Ambulances are for life threatening emergencies hence the title emergency ambulance!

Cornetto capacity should always be presumed to be present unless you have reason to suspect otherwise. Or you could argue everyone calling needs to go to hospital in case they've missed the potential life threatening problem .

I'm noT arguing against the ambulance by the way. Just about the call handler phoning for one without doing to op the courtesy of telling /asking her first.

sqibble I had the exact same situation. Had bad shoulder pain on the weekend. I'd had it before and I knew what I needed was more then over the counter pain killers.

GPs was closed and they only gave us the option to ring 111. The person on the phone told me I was possibly having a heart attack and told me I had to go to A&E. They wouldn't arrange an appointment with a GP for me.

I ended up ignoring this. There was no way I was going to go and sit in A&E and waste everyones time. So I had to go to the 'local' walk in centre which is miles and miles away. Even getting to see a GP there was a struggle but I eventually got my pain killers.

All because I feel ill on a Saturday, if it had happened on a Mon-Fri I could probably have got my GP to see me.

In my opinion 111 suffers because there are not enough walk in centres anymore and there isn't enough provision to cover the weekends. There are plenty of situations where you or your children are not ill enough for A&E but too ill for it to wait until Monday.

My aunt fell down the stairs to her flat. She was very shaken afterwards and a neighbour took her in an made her a cup of tea and she was chatting just fine. A couple of hours later my cousin arrived to take her to the hospital as she said her arm was hurting her. She walked downstairs to the car park and she didn't know which car was his. That was the first inkling they had that anything might be badly wrong. She died an hour later of a catastrophic brain bleed. She would have refused an ambulance too

YABU OP - they did the right thing.

It's ridiculous to say one serious incident should affect how everyone is treated.

If everyone who fell down the stairs called an ambulance despite appearing fine where would we be?

Also if your aunt had spoken to 111 they would have advised her to be checked over in A&E they wouldn't have called an ambulance unless there had been serious neck/back pain, loss of consciousness or other life threatening injury. She would have been better to go to A&E immediately but until she showed signs of the inter cranial bleed (as in confusion) they wouldn't have scanned her anyway, just done neuro obs, and observed her for a while.

Rjae that's not what I'm saying. I'm demonstrating that it is perfectly possible to think you are fine, and to appear fine, after a fall and yet not be fine at all.

Secondly, given that the OP had one of the danger symptoms - severe and increasing neck pain, then they were correct to call an ambulance.

As for my aunt - I would hope that a 74 year old falling down 14 stone steps onto her head and being rendered (briefly) unconcious would have triggered an ambulance from 111 or any other medical service. Even if the person involved 'didn't want a fuss'. Having said that, the extent of the brain injury and the location (brainstem) meant that she was unlikely to have survived regardless.

Scales - isn't it frustrating. Especially if it's something you've had before, you know you need medication for it but you can't get it.

Increasing neck pain is normal with whiplash. It is also often excruciating and should be looked at in A&E. I said that.

And of course most people think they are fine after an accident because the vast majority of people are fine after an accident.

Well of course your aunt would have been called an ambulance if she had been knocked unconscious! You didn't say that, or how many stairs, or that they were stone, just that she had a cup of tea and appeared fine! If you are going to quote an example please put in all the details.

I didn't say people should ignore injury. Nhs111 should assess. What I'm saying is that they are crap at it because they have no medical training or experience. I have 12 years A&E and nhs direct experience so I know what I'm talking about. They are not even allowed to use common sense and a man with toothache turned up in an ambulance because he had jaw pain which is one of the symptoms of a heart attack. Of course it was toothache!

When 111 was going to take over from NHS direct the trials they did showed a vast increase in the number of ambulance call outs because they are not medically trained.

I've sat at an A&E triage desk more hours than I care to remember so the algorithms are pretty fixed in my brain. If barbarian had given the full info re her aunt including her age it would have been a different outcome. I've fallen down a few stairs a couple of times, had a cup of tea and been fine, just like thousands of people.

Assessing the OP I would have reached the conclusion to go to A&E immediately following the accident. That is the correct outcome in the circumstances because of the mechanism of injury.

I suggest you keep your opinions to yourself. I am also speaking from 12 years emergency experience.

The only anecdotes I've quoted are true.
I would also say the OP should have attended A&E on the day and if I had know the full fact re the poor aunt then I would have said an ambulance is appropriate.

111 service is great for out of hours advice but when it comes to assessing individual patients algorithms are not appropriate.

Rae, if you want other people to keep their opinions to themselves, internet forums are not for you.

Then they shouldn't rubbish my opinions either!

internet forums are not for you.

Well you clearly are the one who must be obeyed so I'd better not post anything ever again!

Controlling or what?

ha ha!

nobody obeys me

But you are complaining that people disagree with you. No point.

I'm not complaining that people disagree with me only that telling me they have far more experience than me and therefore implying my opinions are anecdotal and meaningless, pees me off a little

No one obeys me either