I know IABU, blatantly using this for traffic. Emergency situation, no ambulance still, and need advice

[TheChinkOfaGlass]

Hi everyone

My Auntie had a fall this morning and has seriously hurt her hip. Luckily she was close enough to the bed to get herself up on it.

999 said it is not an emergency and to contact 111, she was in severe agony and is 78 years old. I rang 111 who after assessing her, decided she did indeed need an ambulance.

I had originally offered to take her to the hospital but she lives on the top floor of a maisonette, and is unable to sit up (so a car journey would be no good and I would be unable to carry her to the car anyway. I did get help but she declined due to the inability to even sit up).

Her husband is disabled so isn't much use (I mean this in the nicest possible way, he is trying his best) other than keeping an eye on her.

So we could be waiting hours for an ambulance but in the meantime she is soaked through on the bed due to urinating on herself. I am going there in the next 30 minutes.

Is it safe to roll her to change the sheets to make her more comfortable? I don't like the idea of her lying in a soaking bed while she waits. I am also scared of causing more pain/damage by moving her. We do not know what's wrong, she thinks it may he her hip. I just don't know what to do. I have never experienced this kind of thing.

Her partner has managed to change her underwear but when the bed is so wet, it wouldn't really make a difference.

Also there was a typo in my original post, she is 89

If it’s OK to give her water, give her that also. (The reason not to is if she needs urgent surgery but it’s important she is hydrated)-

Realistically she will be waiting 3 times before an operation happens. This is the first wait, the second will be in the ambulance waiting to offload into the ED, the third will be waiting for a bed in the ward.

It will be a many more hours before an operation happens, in the short term it’s more important to ensure she doesn’t get dehydrated.

If you're still waiting then I would encourage you to move her carefully with as many people as possible to shift the pressure points, support the painful leg with pillows, give any pain relief she's prev prescribed or at least paracetamol if she can have it. If she did have a back injury or similar the damage has been done and beyond immobilisation now. Ultimately when the ambulance crew get there she's going to be transferred to a chair and carried out.

This is the kind of job we on the ambulance service absolutely really want to goto as we have the kit and training to actually make a difference. Unfortunately a 4-18hour wait is absolutely typical for this type of job. There's a lot of reasons - not enough staff, crews stuck at hospital, absolutely abused getting sent to people for checks ups when they're easily mobile and could have made their own way in taxi/family lift. The absolutely typical patient on an ambulance walks out and requires no treatment during transport. But because they've said they can't breath, sever pain, their child is floppy etc they get the ambulance in less than 2 hours (these reasons would be fine if true but when you get there it normally turns into "she's got a slight fever and coved once at playgroup today, bit fussy at dinner can you check her out").

Some others have mentioned to keep calling 999 hourly etc, this is bad for a lot of reasons but it's actually more likely to delay the response. Its not uncommon to close the initial call and its position in the queue and put a new job in, so now she's not been waiting 12 hours, now it's a brand new job at the back of the queue. Ice encountered this many times turning up on scene thinking not to bad only a few hours to find out close to 24hours, but on paper we made the time! Only call back if there is either a significant worsening, or ambulance is no longer required.

Social worker here

Calm the ambulance and I don't care how long it takes nobody try to move her if they haven't come out within 12 hours then ring again and state you think she may have broken her hip and you've been waiting 12 hours... and she's 89.
😡

Call not calm

I've read again

As she's on her bed.
I would get some inco pads, apply of bit of pressure to the bed to make putting the inco pad under easier (good side) and then feed it though carefully.
Wash and dry her the best you can.
Keep her warm and give her pain relief.

And don't move her unless you have people who know what they're doing.

Ignore other PPs
DO NOT move her!!
Mattresses and stuff can be replaced
Put towels underneath her
Give her sips of water
All of those things can be washed

And she won't be put in a chair with a suspecture hip fracture.
She will be placed on a trolley.

Putting a pillow under her good side is a good idea to try and relieve pressure.

Don't move her despite what others have said.

I don't think the British psyche is geared up for getting mad about situations like this. Keep calm and carry on, get on with it even if you're in bits with illness, get to work, don't keep the kids out of school. Don't complain. You get the picture.

Unless the population rises up and makes it clear to Government that it situations like this one are inhumane and (no offence intended) worse than some Third World countries. I know that might sound like an exaggeration, but is it anymore?

Oh my goodness some of the suggestions on here.

Do not put a pillow under her injured leg.
An unstable hip fracture is serious stuff.
And until you know otherwise that is what I would treat it as.

If her foot on the injured leg falls out to the side rather than pointing straight up then it’s probably fractured at neck of femur (hip). If she has fractured something could there be a risk of blood clots? I’m not a doctor but I would think if you described her leg as flopping out to the side they’d send an am ulance.

Broken hip unfortunately is cat3, the call taker will absolutely sympathise and genuinely wish someone could be sent straight away, the dispatcher will desperately want to send but are tied by the categories so can't. They need to prioritise the 40yr old male with a 3 month history of back pain (which the triage tool thinks is cardiac but everyone including the patient knows full well its just normal back pain but he's called since gp won't give anymore codeine).

The cat3 reponse is normally the lowest level of response an emergency ambulance would be sent to. Cat4 would be a routine admission, take home, an expected death, a non injury fall just needing help up.

Don't you think the categories need to be adjusted? It seems crazy to me that a broken hip in an elderly patient is only category 3

@TheChinkOfaGlass don't overlook your aunts regular meds if she's on any .She may need to take them regularly .
And have them ready in a bag and a list of them for paramedics and hospital.
And another vote for keeping her hydrated .

Sorry op. This is so awful. We are not a civilised nation if this is the best care we can offer our elders who worked all their lives, fought for us and raised us. I am ashamed that the government who represents me delivers this and I would pay my taxes not to feel this shame in my country.

Only if she's downstairs and straight access through to where she is in the house - they don't bend around corners.

It's rarely possible so we normally use a carry chair. Although if signs of a hip fracture I would give a decent dose of morphine before doing so!

They can't really be adjusted further

You've got stuff like
Hanging, drowning, cardiac arrest, choking

Then
Breathing difficulties, chest pain, actively fitting, unconscious

Broken bones are below all that

The problem is you've got say 10 ambulances all on calls. One comes free and a cardiac arrest comes in. Another comes free and of course they need to go to the unconscious person. Then the third comes free and another cardiac arrest comes in. So the category 3 is constantly waiting until the others are cleared

We’ll say she has a bad hip and chest pain - she needs to be taken in.

Looking at how the categories are defined its actually a sensible catogery for it to be in. The problem comes because absolutely tonnes and tonnes of stuff is coded cat 1 and 2 which is absolutely not requiring of any emergency treatment or transport. For example in my trust cat1 is either cardiac arrest, seizure or some one who's breathing is described as so poor they are about to be in cardiac arrest, yet 40% of these calls are discharged on scene without even needing to call a gp, just people exaggerating their symptoms or not being able to describe someone whom just has a cough.

@Pelo22 thanks for explaining. I see the admissions coming in and we quite often get people ringing for out of hours gp eg to get an inhaler as they've run out and are then told to wait for an ambulance as they have breathing difficulties. They come in chatting away feeling embarrassed. For example. I realise triaging is always going to have its flaws, it just feels like hip fractures should be bumped up. Could there be a cat 2.5 so at least they are ahead of the other cat 3 calls?

OP I hope so much a gp can get some pain relief to her. So sorry you're gong through this, must be agony seeing her like this.

This is making me so angry. And this is before the nursing or ambulance strike!

Not the place on this thread really but I think we should all be bloody striking!

Sleepy "They need to prioritise the 40yr old male with a 3 month history of back pain (which the triage tool thinks is cardiac but everyone including the patient knows full well its just normal back pain but he's called since gp won't give anymore codeine)."

oh my word, I had no idea that was a thing.

I am so angry at the ageism. No one would tolerate a 5yo waiting this long in the same situation and it is no more acceltable for a 80yo or more. I am so so angry on your families behalf op. I will vote against this and lobby as much as I can. It is a disgrace. Please write to your mp afterwards about it we need to voice how bad it is.

Considering that an ambulance may yet take several hours, log roll her and change sheet. Times are different from when we has a proper health service and the time intervals were much shorter. Phone Gp and tell him that she needs string pain relief NOW

Once again, amazed that some people have GPs they can contact out of hours, where do you guys live? London and Essex don't have this provision at all.