To think most people who phone for an ambulance could make their own way to hospital?

[fillmeup]

Either by getting family or friends to drive them there or getting a taxi. Obviously if you’re on the floor with a broken hip etc and can’t be moved or had a severe stroke an ambulance is required but most people I’ve heard on the news recently talking about how long they have waited, I’ve seriously wondered why they waited 20 hours (or thereabouts) and didn’t just get a lift.

Some people genuinely have no money. We had a lovely person volunteering with us in work, but he was literally so skint we needed to give him bus fare in advance as he didn't have the money to pay for it upfront. He walked everywhere he could.

I suspect in the case of a broken nail that every ambulance sent would be diverted to an emergency while en route - unlikely that patient would be a high priority, unless the phone triage thought bleeding or nerve damage might be a thing.
A good triage system on the phone could direct people to get to hospital by other means, it's just hard for some patients who might be terrified in that moment to not think the worst and feel an ambulance is the only way.

@Pushkinia
But what you describe is what an ambulance is for! Accident - yes. Emergency - yes. What most people find difficult is using A&E for something that will clear up on its own. Hospital is not needed for antibiotics. This needs to be changed so a pharmacist can do it as doctors are not available. Even a community nurse should be able to do this. We don’t seem capable of saving our own services.

I work for Ambulance service and have seen this situation played out many times.

Very few paramedics have minor illness training, even fewer have a qualification that would give them credibility in diagnosing it. I'm 7 years in and only just done a minor illness course! Hence the need to speak to a doctor. Dealing with minor illness properly is actually far more complex then dealing with something like chest pain/heart attack - in terms of diagnosing and providing the correct treatment.

In a lot of instances paramedics would not be able to leave scene until spoken with a doctor. This is a medicolegal thing - if I see your child or elderly relative for example and say "well doesn't look that unwell, maybe you're right just needs some antibiotics, speak to a doctor when you can" , and leave - then the callback doesn't happen or takes too long, or something is missed and that patient dies x days or weeks later that's going to be on my head and also negative for the service.

Obviously this ties up crews for hours and reduces capacity to respond. However not having resources to respond to people is technically fine legally. Complaints come in all the time for "no one responded to my partner having a heart attack for 18hours then he died in surgery" - no one is even in a little bit of trouble for that as the delay was due to demand and nobody to send. Its just normal now. Last I heard 500 people a week were dieing in the UK due to delays in response and for treatment. This is why we are striking to get services changed and better supported so it stops overwhelming our ability to do provide any kind of proper emergency service.

We've got more ambulances and staff than at any point in history, but staff that become well qualified and experienced able to manage details effectively in a time efficient manner, having the knowledge to be able to confidently with standing tell the patient/family they can wait and try again with the gp or just don't actually need any treatment it's something that will get better itself - they get poached by private/other services who pay much better!

Whilst the rest of the staff are all being tied up dealing with minor illness, waiting to handover people who could have made own way, waiting for gp callbacks. I worked a night-shift last night on front line Ambulance responding to 999 calls. The only medication I used was patients own paracetamol they had in house but hadn't taken, not one person required any support to walk about the house, could have easily driven themselves to hospital or taken the bus actually if they actually felt they needed to go. But were calling 999 effictively because they wanted a checkup and it's more convienent to just call 999 knowing we eventually come and it avoids the difficulty of actually trying to see their gp. But we are not GPs, we don't not have anywhere close to their level of knowledge and experience in dealing with a minor illness presentation and differentiating it from something major, could very easily miss a diagnosis of cancer that would have been obvious to a GP. So 111 or similar keep sending us to check it out, but we are checking out things that we actually have no training in at all!

Often not actually. It's like you say they tend to code for something else that isn't really an actual risk for something that could happen. People call for stupid stuff tend to code the highest and you can be diverted from a stroke etc to attend to them.

The kind of person whom calls 999 for a broken nail, or simple nose bleed doesn't describe it as a simple broken nail, they say "the pain is agonising, there's blood pouring out, if someone doesn't help me I'm going to have to kill myself to stop the pain. .. ". The call taker isn't allowed to question the integrity of what the caller says so quite often these jobs code cat1 for something like catastrophic bleeding and bump to the top of the list over any heart attack, broken hip, stroke.

@Pushkinia you did the right thing. You had an accident, and the paramedics administered treatment whilst they were there with you.
You are right though, on MN you would have been told to hop all the way to the hospital.

So what is the solution if you have someone who needs A&E but you don’t have the means to to get them there?

I would post on social media. Hopefully a friend would offer a lift there.

I agree with you, but low priority calls are just that - low priority. They will have to wait for hours, if they get an ambulance at all.

My SM called an ambulance for my dad when he fell down the stairs and broke his collarbone and injured his back - he was told 4-8 hour wait so I went over, and between us we managed to pick him up and get him to the car. He was in a lot of pain but we made it in the end.

When my DS had sepsis, DH drove him the ten minutes to A&E. It would have taken longer to wait for an ambulance and he was grey with blue lips at this point.

And when I took my brother to A&E, he had to be transferred to a specialist neuro unit at a different hospital - but the staff wouldn’t let me take him. He had to wait for an ambulance transfer. It took ten hours, he was left on a bench with no food or water. I had to leave after four hours to pick up DC and he is autistic so not great at advocating for himself. If I’d driven him it would have taken 20 minutes.

We are lucky to live near a hospital though. If I lived 45 mins away then I’d 100% have called an ambulance for DS.

My inlaws called an ambulance because MIL had a nosebleed that wouldn't stop. They have a car and can drive. They then didn't even bother going to the hospital because of the wait in A&E. Absolute madness.

A taxi, a neighbour, a friend, local FB group. Theres plenty options available. I dont know many of my neighbours but I wouldn't hesitate to run them to hospital if needed. I'm sure most people would be the same.

If I needed A and E there's no way I'd post online and wait for someone to reply.

I can’t get my head round my son getting an appointment with a paramedic tomorrow for a cough he has had for over 5 weeks. I can only get an on-the-day appointment with the Doctors. I have to phone when he has already left for college and then you get what you are given regardless of my working day or his college class times.

so, we have been given a choice of appointment time tomorrow to see a paramedic instead. I can’t get my head round it - surely they are needed to be out in an ambulance dealing with people who need or (idiots who have requested, but don’t need an ambulance)

I haven't read the whole thread but can anyone in the know tell me if someone calls for an ambulance and its the broken nail variety of reasons can the handler under absolutely no circumstances refuse to send an ambulance? I suppose they can say there'll be a veerrrry long wait but they can't just say "nope, you don't need one"?

And when you think that 40% of the people who get a c1 or c2 response (ie high priority calls) don't go to hospital at all it seems reasonable to deduce that quite a few of those didn’t need an ambulance response in the first place.

How many of those didn’t survive to make the trip?

The paramedic will work at the GP surgery, not on an ambulance. Not all nurses work in hospitals; not all paramedics work on ambulances any more.

My very "extensive research " into this is what I have seen on the various emergency service programs on the BBC etc. A lot of callers were told they did not actually need an ambulance at that time. And sometimes, when an ambulance does attend, they treat on site and either the issue is dealt with, or the patient is told to make their own way to hospital.

If there are people who are ringing 999 and getting sent an ambulance, and taken to hospital for a stubbed toe or broken fingernail... I wonder what work of fiction that is actually happening in.

Thank you. I wasn’t aware of that. 👍

It'll be what's known as a specialist Paramedic in urgent care. There are similar schemes now to progress paramedics which additional training and they work along side GPs and nurses in primary care. Very much like the nurse practitioner/ACP role.

Broadly speaking these roles come about since the demand for GPs vastly outstrips supply. Paramedics are cheaper to employ and train. Downside is not as skilled as GPs/possible more likely to miss a subtle or more unusual diagnosis but it helps meet demand.

Sounds like a good outcome to review your son.

They are not taken to hospital, but they have taken an emergency ambulance crew off the road for a period of time. Paramedics will tell you that up to 90% of emergency calls do not require any emergency response

If there are people who are ringing 999 and getting sent an ambulance, and taken to hospital for a stubbed toe or broken fingernail... I wonder what work of fiction that is actually happening in.

Precisely! What discussion like this does do is actually instil a fear in people to not call for fear of 'wasting' resources. Those who call over a broken nail I presume will continue to call but there's a huge grey area, I'd even say most people who call fall in the grey area.

Thank you. That all makes sense.

Strictly speaking is the triage tool computer that would tell the call taker to inform them that no Ambulance will be sent, call takers aren't allowed to make decisions its to input what the caller says as accurately as possible to the questions the computer tells them to say. It's fairly common for people to be told that their complaint does not warrent an ambulance to be sent.

The triage tool is adjusted throughout the day depending on demand/resources availiable - so very quiet itll have a low threshold to send an ambulance, but at the opposite end of the scale and we stop sending for all but the most immediately life threatening calls.

In terms of the calling for a broken nail, if the caller sensibly answered all the questions sensibly - my breathing is fine, not any serious bleeding, just a little bit sore, I'm calling because I'm sad about my nail - then the triage tool would always say no Ambulance and it wouldn't mater a jot if the caller demanded one/threatened to sue, it would nt be sent.

The trouble is the kind of person who makes such a silly call on hearing they won't be getting their ambulance then often says "oh well actually I've got chest pain too" and the call taker has to start the triage tool again for chest pain which will probably lead to Ambulance being sent. The call taker will know the patient is lieing, be sure that the only outcome if the crew arrives will be a lecture on not wasting emergency service time, but they still have to follow the script.

Another thing that happens is that whilst calls are on the stack waiting for an ambulance clinical staff will be looking through them, might see one that they suspect could be managed over the phone and call them back to see if they can deal with it or book a taxi/tell them to make own way. They don't have to stick to a script as they're clinically qualified.

@SleepyRich Thank you, that's very interesting! I always thought I'd hate to be a call handler for the very reason of being put in a position to make a judgement call so I'm glad to hear they're not implicated in the decision-making.

Very very few people that call 'need' an ambulance, its vanishingly rare actually. Its really common for patients coding cat1 or 2 to actually turn out to be a minor ailment that's been occurring for months or years, already diagnosed and they just need to self care. You can easily work a week of shifts without ever seeing a single patient that needed any treatment beyond telling them to take paracetamol. It's not uncommon for people to need to be seen in a&e to work out what's going on, but in terms of it being an instance when hours matter or the injury/illness has caused them to be physically incapable of making own way just make such a tiny fraction of the work we do - so much that some students are now coming through their training without ever attending a cardiac arrest, stroke, major trauma, child birth - so the first time they do attend one of these events, possibly as the only qualified member of staff, will be the time they're responsible to manage it and make the decisions. Having only ever role played it in the classroom! It's a real baptism of fire!! Can anyone imagine the same for a newly qualified doctor to be let loose in the first week to see and treat a trauma job with no oversight?!?