Would you make a complaint about these paramedics?

[WatermelonWaveclub]

I went to my GP the other day as I kept fainting when coughing. The GP said my HR was sky high. Then I coughed and fainted in front of the GP. Afterwards I couldn't move my legs properly. She phoned the hospital who said I need an ambulance. The GP got someone to get me in a wheelchair and take me to the nurse's room where I was put on a bed in a cubicle.

Anyway a few minutes later the ambulance crew turn up (3 of them). They did an ECG - ok but tachycardic. I said my legs were feeling ok by then. They did a lying and standing BP and checked I could feel both sides of my face, could hold both arms up, checked pupils etc. So they say they need to take me to hospital. They start heading off and so I follow them on foot. They're all walking ahead of me, chatting away, not one seeing if I'm ok. So consequently we get into the car park - I have a coughing fit and next thing I know I'm waking up on the car park floor.

I can't stop thinking about it. Were they at fault? Should they have used a wheelchair or at least someone walked with me? At the hospital they wouldn't even let me go to my scans etc in a wheelchair, I had to be taken in my bed. So if GP and nurse wouldn't let me walk was it right that the paramedics did?

There is a really strong cultural bias against complaining (on mumsnet). It is seen as weak, as evading personal accountability, and as unhealthy and liable to harm the OP as it will prevent her from having the energy to heal. That would be my analysis of the cultural beliefs that underpin the “Don’t complain” posts. Within the context of the NHS complaints are seen as useless, or captious, or ungrateful. Many posters asserted that OP received more attention than she should have, received fast ambulance attendance when others didn’t, overegged her symptoms, did not listen to the paramedics, did not give the paramedics enough information, etc… in this version OP didn’t deserve as much attention as she got and should repay this favoritism by not criticizing the service.

Complaining is also seen as unnecessary (almost nagging or moaning) and hurtful to the EMTs who are understood to be hapless, charitable, everymen who aren’t paid to do a professional job.

Needless to say these are fairly weird biases.

If it makes you feel any better and helps you move on you should write the complaint, but if you're doing it because you think it's going to have some profound change in practice then I wouldn't be too bothered over the matter. As someone who works in the ambulance service at a senior level and has a hand in managing these types of complaints all that happens is you'll get a generic apology from the service. It's unlikely the crew involved would even be notified (we shield them from hearing about complaints like this since around covid time, this is because they only serve to cause stress/harm to the crew and there's no benefit or upside). Whilst it's certainly not ideal you fell, and I'm sure the crew felt badly about the incident, essentially you walked yourself into the GP surgery with the same symptoms, it was reasonable to assume that you could walk to the ambulance.

When the post started out I thought you were going to say that the paramedic discharged you/didn't take you to hospital as the GP had requested and there'd been a negative outcome. That's the kind of complaint the service would seek a response from the crew for.

@SleepyRich FGS no she didn’t walk into the GP surgery with the same symptoms she walked out with. She had a haemorrhagic stroke while in the GP surgery - of course the paramedics did not know that but hopefully there training covers FAST and someone with a collapse followed by facial weakness on one side and loss of power in legs and a GP and hospital suggesting she was very unwell should trigger them to consider she might not be the best candidate to walk unaccompanied. There may well be actual harm done if the fall has exacerbated the bleed and leads to ongoing neurological issues.

No wonder ambulance crews continue to dismiss symptoms if they never get feedback. How on earth do they improve if they are never told what the outcomes of the cases are? They may well think their actions are correct and so do something like this again. If sympathy for the patients and a desire to improve services doesn’t motivate you as a manager maybe think of similar scenarios where such a collapse causes an ongoing neurological deficit and disability putting the NHS on the line for substantial damages.

I would ask you that - you seem to be attacking me and calling me all sorts of names as if you won't encounter me again. All because I have a different point of view. How old are you honestly. Do you think I deserve being talked down at like that? I bet you wouldn't do that in real life. I am not going anywhere!

@Italianita But the crew wouldn't have seen that about the taxi driver, they were witness to an unaccompanied patient at a GP appointment without walking aids, it's a reasonable assumption that they'd be able to walk out. It was incorrect obviously given what's happened but this will have been apparent after the fact.

@Skycrawler we stopped passing complaints on in most instances since there wasn't any positive outcomes from doing so. Take this case, I wouldn't pass it on to a crew as is since they are obviously aware that the OP fell, and no doubt presume she wasn't happy about having fallen. Knowledge of the complaint doesn't add anything. They wouldn't wish for someone to fall and they will have reflected on it/consider making a different choice next time. If they don't/didn't care that she fell they they're pretty awful people and if that were the case a complaint certainly wont change practice for the better!!!

It's a benefit to pass on patient feedback if it's something the crew would not have been aware of, i.e. "we just had a complaint from the patient who you discharged at scene with a diagnosis of soft tissue injury, they went to the hospital the next day and it was actually fractured and they're not happy you missed it" for example would allow for the crew to reflect on the assessment they performed/was there anything additional they could have done.

We get more datix's/complaints about people getting dropped/falling using the little carry chairs on the ambulances then we do from people falling on their way to the ambulance so it was a point a few years back now that practice changed and staff are encouraged to keep patients walking/use the chair in the ambulance as opposed to stretcher and then avoid hospital bed if possible - the catchphrase was "fit to sit". The norm now is that the majority of patients do walk to the ambulances and don't require a stretcher, I've not seen an audit recently but it is data we gather through the epr system and it's only something like 20% need assistance to the ambulance - and most of these will be hospital transfers/patients from care homes that couldn't have made the walk on a good day!

I'm not saying the crew were write to make her walk, it was a mistake clearly. But the crew would be well aware of what happened, they reassessed her, they will have documented the event themselves/written a datix would be the normal practice.

You've been really unpleasant to me on this thread and tried to suggest the salient information wasn't in the OP which it was and continued your attack even after I'd clarified to you that I was too unwell to make my own risk assessment. You've even suggested I'm drip feeding when I've just had a brain injury and I'm trying to remember things and piece them together which I have been clear about. I'd appreciate it if you didn't continue to derail.

That's utter nonsense, I did not 'walk into the surgery with the same symptoms'. Firstly I was supported to walk into the GPs. Something the ambulance crew did not do. Once in with the GP I had a brain bleed. So additional symptoms. But yes, of course it is reasonable to expect stroke patients to walk to an ambulance unaided and unsupervised. Even putting the stroke aside and assuming it was just a vagus nerve faint as I had been experiencing - I walked into the GP and fainted. So based on those circumstances I'd walked into the surgery with the symptom of passing out. How does that symptom suggest I can walk unaided? The fall could have killed me. But you are going to 'protect' the ambulance crew from that fact?

The patient has been moved to a bed via wheelchair. The patient is highly likely to faint again if they walk. How on earth is this only obvious to them after I passed out AGAIN? Do they not take a history into account atall? They purely just say did the patient walk in? Oh they can walk out then! But take nothing into account that happened after the patient walked in? That this caused them to have symptoms of a stroke? They would take none of this into account? It starts to make sense if senior leadership think this is fine.

It's not about if they care about someone falling! It's about procedure. It's about a risk assessment when someone is having symptoms of a stroke. Is it really good practice to allow a stroke patients to walk to an ambulance unaided and unsupervised? Surely the crew need to reflect on if it is sensible to get a stroke patient to walk to an ambulance in this manner?

It's not protecting the ambulance from any 'facts', it's just unnecessary to involve them further, we'd issue you a response on their behalf. You said the crew assessed you before with sitting and standing BPs and your symptoms had resolved, so I wouldn't consider there to be negligence in what you describe. That you fell is unfortunate obviously, but they are aware you fell already and will have documented as such. It sounds like you just want them to be told off/wrists slapped which is something we just wouldn't do for an event like you describe here.

Absolutely I agree it sounds like you would have been better taken to the ambulance in a chair +It sounds like it'll help you to receive some kind of apology for what happened so I'd urge you to write to the service involved, they'll have a form to fill in on their website to do so.

Ambulance crews making countless assessments of risk during a shift, not all of them will be correct, they are already aware that you've fallen so they don't need to be told again and I wouldn't take them off the road to write a response to you, it's the job of management/patient relations team to write the response.

I think it's a matter of perspective, I can see why you feel aggrieved. It used to be the practice where we'd stand crews down to write a statement/then a response to the patient directly but all this achieved was that we lost a crew for the morning (sometimes 2 crews if they weren't regular mates) and it wasn't observed that anything positive came of it.

What happens now is we look for themes and incorporate them into training days which occur twice yearly for all staff - as an example the current theme is about leaving thorough written worsening advice. 30-40% of patients calling 999 are discharged at scene by the crew without being transported to hospital, part of doing this safely needs to be writing down the 'red flags' in case of misdiagnosis or sudden worsening - typically this was just being verbalised but obviously people aren't going to retain everything so now pushing for it all to be written down. If we had a lot of reports of people falling whilst walking then we might revisit how we look at walking with patients. But it's all risk benefit - in hospital the floors are flat and it's relatively safe. Outside floors are uneven/steps and it was actually resulting in lots of injuries - we used to have it where anyone with 'chest pain' wasn't allowed to walk but though all the injuries from being dropped with their arms strapped into a chair we stopped this. Some care home identified that staff were being hurt catching residents so whilst previously some care staff were forbidden to lift residents from the floor after a fall, they're now also forbidden from steadying them if they wobble!!!

The hospital made the crew being me in on the trolley - they didn't think I was 'fit to sit' let alone walk!

Yes, they did a sitting and standing but it wasn't orthostatic hypotension that was causing me to fall. They obviously didn't take into account the whooping cough due to the fact they didn't understand it. Surely in an outbreak of Whooping cough where they may come across other patients with the same it would be good to give them some information about it and that these patients are at risk of fainting if made to walk.

I could feel my legs again but most of the symptoms had not resolved. I told them how awful I was feeling.

And no - I have made it quite clear I do not want them told off! What would that achieve? I want them given the information which means they can improve their practice and not be in a situation with their next patient who falls is seriously injured/killed. I care enough about my staff and my patients that I would always make sure information was passed on/support was given with making better risk assessments if something like this happened. It's so dangerous to just assume 'they won't do it again'.

It's not about writing a response! It's about you supporting your staff! How you can't see that and think this is just about bureaucracy baffles me.

Exactly, outside is uneven/steps/kerbs - even more reason to not let a stroke patient walk to the ambulance without anyone even paying any attention to them. Honestly, you're telling me that because ambulance crew couldn't manage to push patients to the ambulance without dropping them, now everyone no matter how high the risk of fall will just have to walk!

Hospitals may be even ish, but actually there are a lot of hazards/uneven bits/stairs in the average hospital plus it is very common to have to take patients outside to get to separate buildings. In my time working at hospital I never dropped anyone and I find it bizarre that noone in the ambulance crew felt able to wheel me in the wheelchair to the extent they just left me to walk and have the inevitable fall and despite knowing that didn't even watch me so at least they could help once I'd had the fall. They suddenly were able to get me to the ambulance without me walking after this fall.

They saw you fall first hand and be injured, tended to your wound & reassessed you. They'll feel awful and I'm sure will reconsider their actions/choices. If someone is dropped/injured during treatment it's normal to document this in the patient report form and submit what's called a datix which records that something has either occurred/nearly occurred that shouldn't have done. Paramedics are generally known for actually over reporting incidents and we get a lot of reports on very minor occurrences that really actually didn't need reporting at all.

If they're just awful people and having seen all that don't care about what happened to you then they're the kind of people who if stood down to write a response will be happy to have an hour or so on station still not caring a jot about what happened to you then just get chatGPT to write a quick apology letter. Whilst people we do have members of staff that become like this essentially they're damaged and burnt out and need a long rest away from work, not something that is typical/tolerated.

So what you're saying is ambulance crew don't take the history into account. They only take what happens in front of them into account?

I wrote this post because I wanted to understand how ambulance crew work/what they are trained in/what could be expected of their practice because I just couldn't understand how terrible their risk assessment was.

And I guess I'm getting the answer now. I must admit I'm shocked. I suppose I thought they were trained in depth about making risk assessments. But I see I expected too much. I just hope I never have an ambulance called for me again.

Again this is nothing to do with them feeling awful/being bad people/writing apology letters. They just aren't given enough training and aren't supported by senior leadership.

We found overwhelmingly that being aware of every complaint/grievance was detrimental to staff wellbeing and performance and this is why it was stopped. I don't believe your complaint here would meet the criteria to pass it onto the staff members involved but that is decided on a case by case basis so as I said no reason not to write it for yourself.

It'll be apparent if the crew haven't taken the event on board if it's been omitted from all records - whenever I've reviewed a similar complaint and review the prf/datix lists it's always been referenced in at least one if not both - which is my point it very very likely was recognised by staff as something that shouldn't have happened already. If there's no reference at all to the fall then that would trigger a conversation certainly.

The only ambulance I called was for a woman who couldn't breathe. Ambulance brought in oxygen can and placed it in front of the open fire

Of course they are trained in risk assessment, consultation, moving and handling and do this well the majority of the time. As I said it sounds like a misjudgement/error has occurred on this occasion, but I recognise that people aren't perfect and misjudgements can and do occur.

We support staff by not passing this kind of complaint onto them because it was identified in most instances it just causes stress, time off the road, and there were no benefits. The benefits came as I explained by using it to guide the training packages we put together for the stat&mandatory refresher days all staff undertake.

Must've been a mix-up between resuscitation and incineration.

@SleepyRich awesome responses!

But there's an outbreak of Whooping cough now, but you're not going to arm your staff with the information now but do a training session in 6 months.

They may be trained in risk assessment but obviously not thoroughly if you don't believe they would be able to take the patient's history into account and couldn't have been expected to understand the risk of falling because they'd not actually seen me faint themselves.

The technician also had no idea about baselines. Again I know I was probably hard to understand but he just came across as not interested. He either knew nothing about baselines or was just incredibly patronising. I assume now that probably had no training in this area. Which is ridiculous. I mean I understand baselines will often not be available but if they are it means they can better understand the observations.