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.

Really hope they come soon, I’d be worried you’ll still be waiting tomorrow though.

All those saying call out of hours gp, a week ago we waited 12 hrs for a non medical call handler to call back our 111 call for my I ill elderly MIL, then another 6 hours for a gp to call after that. Unfortunately 111 isn't coping any better than the ambulance service at the moment.

The pain is actually manageable with paracetamol as long as she isn't moving. I'm not going to move her through fear of making things worse. She is dry for now, thanks to hair dryer and managing a snooze. She's on the top floor of a maisonette with narrow corridors so anxious how they will get her out without causing pain

They'll have good ways to move her and might give morphine. Try to not to worry about that bit

Doesn't need to be a cat2.5 we all regard the cat 3s to be the most likely of requiring an ambulanc, generally the sickest requiring the most treatment and support to get to hospital.

In terms of the category problem (which is only a part of the problem) there needs to be a paradime shift amongst the public. Do not call 999 or accept an ambulance from 111 unless you have no other option to get to hospital and looking at the situation is clearly an emergency.

As an example chest pain is a typical cat 2. Both of the following examples will code the same, either could actually be having a significant heart problem but clearly one of the patients could manage to hospital without taking up an extremely scarce resource (plus getting themselves to hospital much sooner than waiting for the cat2):
a) 50yr female, sudden onset of crushing chest pain, looks grey and clammy, vomiting, feels dizzy, weak, is short of breath)
b) 32yr male, coughing for 3 weeks now, over the last 3 days he's started to have pains in chest when coughing and would describe himself as short of breath, couldn't go see a gp as can't take the time off work so called 111 after getting home since not getting better and thinks might need abx.

Now I agree b) could be unwell, need abx or a PE rule out etc, but very likely make his own way to oogp, wic, or a&e. Yet its really really normal to see b) on the ambulance as a blue light response.

What’s going to happen in situations like this when the ambulances are on strike? Genuine question, will we have to just try to move people to a car?

WAST are currently in Business Continuity Plan. They will be unable to respond to any but red calls as 60% of their vehicles are outside Emergency Departments. The situation is appalling and I don't know what to suggest to you OP. I would personally change the sheet underneath if I could. There is a risk of pressure damage with the wet sheets. This is not something usually suggested but these are disparate times.

According to the guardian people with broken hips will probably have to wait till the next day or the day after for an ambulance and might have dies of hypothermia or get pneumonia by then

Just trying to think of practical things now. I've already done her hospital bag, I've taken her dog to my daughters house. Can't think of anything else.

How does someone get an ambulance because they can't get time off work etc as per (b). That's strange.

Desperate even

@SleepyRich definitely
I took myself to OOH with what I thought was a chest infection. Being nosy I looked around as they came out with a nebuliser at who was sick
Me that's who. Turns out continuously coughing means you can't breathe very well and I had pneumonia

I think there's still an expectation of "I don't have any money/can't drive/pay my taxes/want an ambulance right now" which means people like the OP are left looking after the ones who really need the ambulance

Because it’s triaged as “chest pain”. Just the same as the a) (hypothetical) patient who is probably having a heart attack

She will be there an extremely long time unless there is anything additional that would change the algorithm and move her up the queue.

Is there any bleeding at all, is she on any blood thinners such as warfarin?

A 111 clinician wouldn't advise you on manoeuvring her if she has already been queued for an ambulance due to safety. It just wouldn't be worth it for them if something were to go wrong.

I would gather all the help you can and get her to A and E yourself in all honesty.

But that's a huge category, I think I could describe some of pneumonia symptoms as chest pain!

How would you get someone with a broken hip to A&E?

Dd had bad crushing chest pain at the weekend and struggling to breath, she has an underlying condition which makes heart attacks more likely and I genuinely thought she was having one. I drove her to the hospital myself as it’s only 15 mins away and knew I’d get there quicker than an ambulance. People need to use their common sense a bit more. I’m sure if I’d rung 999 we’d have Been sent a fairly high priority ambulance but she was mobile.

Exactly!

which is what @SleepyRich is saying, that, when they get there, a great number of the supposed cat 1/2s are lower acuity than that.

It really is, Dd has rung 111 before and as soon as she says chest pain (even the times it’s been mild and I’m not worrying she’s having a heart attack) they say oh you need an ambulance. At which point I start shouting she does not and that I’ll take her myself.

It's just the state of affairs with the ambulance service at the moment. You need to be realistic. If there is any way of getting her there, get her there. She could be in that position for days.

This isn’t the first post I’ve read today, on another forum someone in north wales was in the same situation.
its totally shit and this is why people are striking, everywhere needs more staff. The staff are doing their best, but are so exhausted nurses/paramedics/doctors are quitting.

If she’s comfortable now waiting for the ambulance is the best thing, prepare that she might be waiting a long time in an ambulance or stretcher at teh hospital. Sounds crazy but buy some pouches of baby food, the meal types, they’re actually ok. She can have food herself and lying down if stuck not getting anywhere and allowed to eat.

Of if you know of someone with a van, or 7 seater car you can lie the boot flat or a motorhome, I’d see if you can get help to move her and take her in.

@EmmaAgain22

That's the rub, the not being able to take time off work was why he called 111, but he got the ambulance because the person taking the call isn't medical and is just putting the details into the computer in a similar way to when you use 111 online. So the computer picks up a patient with chest pain and shortness of breath, then panics putting them into the same category as a). If the call taker is switched on and the stars align they can put their hand up and flag a clinical supervisor to say they disagree, but if it takes too long, or they don't input exactly what the patient answered they'll fail the audit.

@TrimTheTree this was an option earlier but the severe agonising pain will not allow her to sit up to get her to the vehicle

If you’re in mid Wales don’t suppose you know anyone in a mountain rescue team? You need a spinal board and someone with knowledge of how to get someone on it, etc.