Misuse of ambulances

[Lampshade7]

I work for one of the ambulance trusts. We have many, many people who phone up several times a day wanting ambulances. They are sent out but never need them. Obviously this is a vast waste of resources and time. If I had my way I would not send an ambulance no matter what the reason. One of my colleagues was horrified by this and said that they should be sent just in case. I think stuff them, you can cry wolf once too often. IABU?

If people were charged a nominal fee it would soon cut out the time wasters

@drpet49

If people were charged a nominal fee it would soon cut out the time wasters

And the poor.

@drpet49

If people were charged a nominal fee it would soon cut out the time wasters

It might in many cases.

However, what if those time wasters are actually GP's Surgeries like my mother's? Sending paramedics instead of ever actually seeing their patients at all, either in the surgery or on a home visit.

Perhaps it would force them to return to seeing patients face to face again, as they should be doing anyway.

And yes, it would also severely disadvantage poor people.

I know the staff always say “that’s what we are here for” or “you did the right thing calling us” … I do sometimes think they should also be educating people about what an ambulance is / isn’t for.

My DB was a paramedic.
He's incredibly good at educating people in this way but he's very good with words and I think it's a difficult thing to get across to people who are a bit hard of thinking

Hopefully given how stretched the ambulance service/nhs is, these people that do this will be left waiting 6hrs etc whilst genuine calls are prioritised. I do think after x amount of false call outs they should be referred to mental health team and calls redirected to them to assess instead. Absolute gross waste of money sending ambulances out to the type of people that do this, even if they made a specific job opening in mental health for an outreach worker, it’s got to be cheaper than sending ambulances each time.
I’ve watched ambulance programs and some times almost the whole programme is them going out to unneeded visits, some times multiple times a day to the same person!

I don't believe this for a second. 999 call handlers don't just send out ambulances to everyone who phones. They are trained to triage the calls.

I agree OP. If you keep abusing a service you can’t be surprised to have it withdrawn. I see no reason why others should suffer (in real life or death situations) in order to pander to the unreasonable whims of others who clearly don’t give a shit.

@drpet49

If people were charged a nominal fee it would soon cut out the time wasters

I agree. Privatising the NHS is the only way to go sadly.

@EgonSpengler2020

Your trust should have a frequent callers policy and an APP who deals with this group of service users.

The idea of the policy is to look into the reasons for the frequent calls (genuine or otherwise) which can be chronic illness, social needs, mental health/substance abuse and then work with the patient and/or their carers to find a more appropriate way to deal with their situation and to put in place services/equipment to facilitate this.

On occasions this will involve liaising with the police and very rarely might result in an ASBO, and then even rarer with a prison sentence for breech of asbo.

Your trust also presumably has a clinical desk manned by paramedics, nurses and APs who can "no send" to calls. So the days of everyone who calls getting an ambulance are long gone.

This.

My previous trust also had a policy of 3 attendances in 24 hours that were deemed unnecessary and they would not dispatch another ambulance for further calls for the next 24 hours.

There are numerous reasons why regular callers regularly call - these need evaluating on an individual basis and the cause of their dependence on the ambulance service needs mitigating, whether that be referral to additional services, education on appropriate access to healthcare or going down the criminal route.

It is completely unacceptable to adopt a blanket approach to any regular caller and demonstrates a real lack of understanding from you as a clinician. As annoying as it is, you need to be referring them through the correct pathway your trust advocates. Speak to a manager or clinician team lead if you have particular concerns and see what can be done about it.

I think the people complaining about GPs and other similar issues on this thread, are discussing a different issue all together and not understanding the meaning of what is considered a "frequent caller" within the ambulance service. This quote should give it some perspective.

"In 2017, the "top 10" most prolific callers accounted for 3,284 calls to the Welsh Ambulance Service...

...These types of calls account for between 4% and 5% of the service's 999 call volume each month."

I would now only use an ambulance for a situation where I did not dare move the patient. I might call one for a suspected heart attack but unless they could assure me they'd be there in 10 mins I would drive the person to hospital.

One issue is our hospital A and E has no parking immediately outside. You have to park in a multistory car park and walk 3-5 min. Not bad for standard appointments, but impossible with a person having a heart attack or a big child who can't walk. Once years ago I took a child to A and E and there was no parking available. I had to drive to another hospital. Fortunately we live in a large town with two hospitals. I often thought that he could in theory have died because of that lack of parking.

One of my kids developed bleeding from the nose and mouth and a petechial rash when we were staying in the middle of nowhere on a holiday. I drove him to hospital 45 mins rather than even attempt to wait for an ambulance. Once there we were seen at triage within 2 min and by a consultant in a private bay within 5 min. He had IV antibiotics running 15 min after we arrived at hospital. I think had I called an ambulance we would have waited several hours.

Wow, is that 4-5% of ALL ambulance use across the whole of Wales? Divided by 10, that's very nearly one call every day of the year - so the person at number 1 in the list almost certainly calls multiple times, every single day.

Considering that ambulances are intended for emergency cases - a high proportion of which will mean, sadly, that the patient will already be too ill to survive, in spite of the very best efforts of the paramedics and the hospital.... it does rather statistically suggest that they weren't genuine calls: I highly, highly doubt that, across the ambulance service as a whole, out of any random 365 admissions to hospital following an ambulance call-outs, every patient would survive.

It sounds like each trust needs a dedicated section to deal with these people and give them the help (or prosecute them if merited) that they need. When I worked in accounts, we had a general helpline number for about 99% of clients, but a separate team who looked after the rest - only 1% of the clients, but representing maybe 40% of all the business turnover.

If very frequent clients of Social Services have their own named case lead/contact to deal with their ongoing situation in an appropriate way, why shouldn't it be the same with constant ambulance-requesters?

The whole idea of 999 is that any one person will call them out very infrequently (if ever at all) - maybe moderately, depending on their personal circumstances; but the nature of a proper emergency is that they should be rare in any one person's life. Nobody has multiple genuine emergencies every single day of their life - if they believe that they do, they really need a dedicated case worker, who can refer them to the NHS help that they likely do need or, of course, send an ambulance if it is actually needed. It must be far cheaper and more helpful in the long run.

It's got to be a massive red flag that something isn't working properly when the most frequently-called number on a person's 'friends and family' list turns out to be the emergency services.

The South West Ambulance Service seem to have their heads screwed on in this regard:

www.swast.nhs.uk/welcome/hcps/frequent-callers-1

This woman called 97 times on Christmas Day - sometimes on two phones at the same time:

www.emas.nhs.uk/news/latest-news/2018-news/woman-told-to-pay-2000-after-calling-999-almost-100-times-on-christmas-day/

YABU, blatantly.

And this was a brilliant brainwave - very encouraging for everybody involved:

www.england.nhs.uk/2018/05/paramedics-brainwave-eases-ae-pressures-by-keeping-frequent-callers-away/

[quote BattenbergdowntheHatches]@Balcmange my good friend was a paramedic and the number of nuisance patients was the main reason why she isn’t any more. The ridiculousness and entitlement of the public drained her of compassion and she left after burnout. Before that, she had her own way of dealing with “frequent flyers”.

The woman who regularly feigned unconsciousness after fighting with her boyfriend got a precautionary cannula in the largest available size.

The drunks got their T-shirts necks pulled out just as they threw up so it went all over them. She used to tie their shoelaces together after they passed out.

She left after a week in which she retrieved her former teacher’s severed head from a field after a bike crash, had to wait a almost a whole shift for a morbidly obese man to be lifted out of his flat window using specialist equipment, and was then delayed getting to a gang-related stabbing in which a young teenage boy died while she was looking after him.

These people are human - and I couldn’t do the job. HCP’s aren’t saints but there is a horrible minority of the public who are basically illiterate, thoughtless twats.[/quote]
Bloody hell, I hope this is not true! Anyone incapable of treating all patients with dignity and respect should not be in the health service. Shame on your friend

@BattenbergdowntheHatches

Absolutely *@LifesABotch* but can you imagine how it feels when, shift after shift, you are called out to people who are taking the absolute piss? What do you think burnout in a hcp looks like?

She said there were multiple cases a day where she would go to a house, load a (stable) patient, then have the car follow the bloody ambulance to hospital. Often with flasks and snacks. If the soaps are shit, let’s have a night in A&E!

“Uncontrolled bleeding” was a snapped acrylic nail that had taken off a bit of nail bed.

A man with a cough for 3 weeks who decides at 6pm on Friday he “needs to be seen”.

A pregnant woman who, despite being perfectly healthy, has not managed to save the taxi fare to hospital in 40 weeks, or arrange a lift. Demands an ambulance.

People who have a minor fender bender and think that summoning an ambulance will help them claim £££ for whiplash.

The person dating a chemo patient who swallowed semen during sex and called 999 after having a panic attack because she thought her hair would fall out?

It’s lovely that MN can’t imagine how someone can be so hardened to this that they no longer give AF. It harms us all when hcp’s are so jaded with the public that they expect a shout to be a waste of time that potentially harms another patient.

Yes I do see your point, and everyone has their limits. But that does not always, and should never, translate as taking it out on your patients. That is what I found most disturbing about your post. I do get that you were using your friend's inappropriate (and probably illegal) actions to illustrate the terrible state of the nhs, and the unmanageable pressure that paramedics can be under. Other than a mass recruitment drive, and immediate improvement of conditions, how is this ever going to change?! With GP surgeries calling for ambulances to deal with their patients (who presumably are more unwell than they might have been because of the difficulty in accessing a GP appointment the last 2 years) it is a worry for all of us that we might not be able to access help when we most need it. And you have to wonder how much more of it the ambulance service can take.

If you work for an ambulance trust then you know you have regular callers, you know there is a process to follow for them. You know that many have MH issues

So stop being so nasty

[quote WeBuiltThisBuffetOnSausageRoll]And this was a brilliant brainwave - very encouraging for everybody involved:

www.england.nhs.uk/2018/05/paramedics-brainwave-eases-ae-pressures-by-keeping-frequent-callers-away/[/quote]
The police ran a similar scheme aimed at people with mental health issues called the High Intensity Network/Serenity Integrated Mentoring. It was scrapped, as it was criminalising people in crisis, and there was safeguarding concerns.
I am ashamed to say, I was a service user under it.

Most ambulances that are sent are not for emergencies. It’s costs about £300 just to send one. What a waste of money. Most of the time they need to go to a&e and will most likely be quicker. Even if the ambulance takes them to hospital, they could still be waiting hours in the hospital. There needs to be more education at school on what to do if we cut ourselves, when to call 999, when to speak to a pharmacist or gp. There needs to be more gp surgeries, and walk in centres. But of course this costs money.

@Traumdeuter
In my experience, if a caller has a history of abuse Ambo won't attend without police.
They literally wait outside until we get there. We then get there, establish that there is no risk, and the Ambo deal and take them to hospital, if necessary. Our problem is that we would usually be required to go with the person to hospital, because this sort of patient will often leave hospital requiring another unit or more trying to attend to locate the now missing person.
Security staff at hospitals are normally instructed to not intervene and will follow a vulnerable person off site then call us to come and get them.

It's all such a waste of everyone's time. The police are the worst people to deal with MH crises. We seriously need to invest way more in MH services.

[quote WeBuiltThisBuffetOnSausageRoll]And this was a brilliant brainwave - very encouraging for everybody involved:

www.england.nhs.uk/2018/05/paramedics-brainwave-eases-ae-pressures-by-keeping-frequent-callers-away/[/quote]
Really brilliant idea. Quite shocking to read the numbers though. Around 5,000 “frequent fliers” nationally who cost the NHS £53 million in 2016.

@BattenbergdowntheHatches what happens in eg the “uncontrolled bleeding” patient that actually had a snapped fingernail? Do the ambulance crew have to actually take the patient to hospital as they’ve had an ambulance sent out, or can they just stick a plaster on her finger and leave?