To think some things should just be turned away from A&E?

[ifallinlove]

I saw a channel 4 video about a day in a&e during the heatwave.

The first guy seen was a bloke who had decided to walk across hot tarmac to get food while at the beach and now had burns on the bottom of his feet.

He said he had “forgotten to get shoes”. I’m sorry but it’s been 35 degrees for at least two weeks now. There is no way on earth that you “forget” to put shoes on. He made the decision to do it and now sought emergency care.

AIBU to say things like this should be redirected to minor injuries and the appropriate referrals made from there? It’s his own stupidity taking up a bed in a&e!

If the NHS decided who to treat where based on the stupidly that lead to the injury, we would be in trouble!

Saying that, it did sound more like something for minor injuries but in some hospital, the two are in the same building so it's not forcibly obvious to patient which unit they are into.

I've heard from much worse reasons for people to go to A&E than that though.

Some people aren’t there because they are the ones who decided they should be.

A woman I work with has a knee problem. No immediate urgency, no injury that caused it, just pain when walking, been steadily getting worse over many weeks etc. She went to the GP, who sent her to A&E for an x ray. She’d never have gone otherwise. But she was absolutely someone who might have been there and thought “oh it’s a bit busy, I’ll come back tomorrow”.
What else could she do other than A&E?

Yes, that’s literally my point.

Exactly. I turned up to A&E with a sore leg and it turned out I had an aggressive bone tumour so there you go.

Our local A&E moves almost everything through to Same Day Urgent Care, which is basically A&E by another name but slightly tiered down. And they already triage by importance.

Our triage in A&E seemed pretty effective, it looked hugely busy but the triage doctor was going through people within minutes of arriving taking a history doing basic checks, and obviously putting them on different tracks, serious cases were seen pretty quickly, some seemed to leave after triage possibly referred back to gp or just given advice. It wasn't the chaotic system of years ago when it was one queue for everyone unless you were carried in.

I think anyone who decides to live somewhere without a functioning medical system should be turned away 🙄

So is the issue that it was self inflicted or that you didn’t deem it an A&E case? Because you can’t decide people should be sent away because their injuries are self inflicted, yet you seem to be quite focused on that part

It’s a bit of both.

He was stupid enough to walk across boiling hot tarmac without shoes on. We all know that when it’s sunny the tarmac gets a lot hotter than the air! Even if he waits 9 hours, he still takes up valuable time that could be spent on true emergencies.

True emergencies includes stupid people?

you’re mixing medical care up with a moral judgement on self responsibility

But a serious injury from trampolining or jumping out of an airplane or playing rugby is also entirely self-inflicted. People know these are very dangerous sports with high levels of injury risk.

Our A&Es here do this. There's an initial triage and you either go into a&e, minor injuries or ooh GP.

It’s a bit of both
So if you stupid enough to have one too many drink and break your ankle walking in high heels, should you be thrown out of A&E too?

There was a trial years ago where it was shown that the most effective way to manage a&e was to have a consultant on triage.

someone with enough experience, authority, and decision making ability to redirect people home or to other services.

obviously didn’t make it into practice because the idea of having a consultant on triage seems a waste of their experience on more complex cases…

probably should have 2- one to manage the complex cases, one to triage. Only the nhs budget doesn’t work like that, they won’t spend 100k to employ a consultant, even if it saves 300k in admissions. They’ll employ a 35k nurse and save nothing instead because budgets look at spending not savings…

Burns can be really serious and can easily become infected, tarmac holds the heat and if it's getting to melting point would stick to the feet and carry on burning, sounds like a legitimate trip to A&E. If you accidentally poured boiling water on yourself and were coming up in huge blisters would you consider that an avoidable accident so you shouldn't go to A&E or should be turned away?

I was in A&E after calling 111 for advice and them insisting that I went. An aquaintance was there, and my people pleasing manners kick in. I didn't want to to chat, I'd have much rather she hadn't seen me feeling so unwell, but I wasn't going to be rude.

I took my mum who suddenly lost all use of her leg. We chatted while we waited. She was desperately worried and in pain, but sitting there determined to be miserable wasn't going to help her, and we both tried to keep spirits up.

Our a&e asks breaks to attend MIU, or UTC, not a&e.

Its a risk benefit analysis though - when it comes to sports the risk of injury is outweighed by the benefit of keeping fit.

There are no benefits to walking across burning hot tarmac

Our a&e asks breaks to attend MIU, or UTC, not a&e
But again, maybe that's where the guy was sent to.

It doesn't matter whether an injury is self inflicted or not. FFS. Are you nuts?

Unfortunately (for you) how triage works is they look at symptoms according to risk of life and risk of rapid deterioration. So someone with chest pain, even if they seem OK within themselves, will be seen sooner than others in case it's a heart attack. Burns will also be seen quickly as if untreated they get worse and worse. Kidney stones is crazy painful but equally not an immediate or urgent risk for life so it's one of those situations where you have a long wait with horrible symptoms. It feels really awful and unfair but that's the way it goes sadly.

For my own part I had a pretty awful 15 hour wait last year with a thunderclap headache, impaired vision and nonstop vomiting. I had a pretty frank discussion with the doc who explained that either it was a terrible migraine (dreadful but not life threatening) or a brain hemorrhage (life threatening but not time critical) I was a lower priority even though I was probably the sickest person in the waiting area.

Fair enough right.

Many people end up in A&E because of their own actions. Where do you draw the line?
There aren’t MIU everywhere.

Yes that is usually how triage works but unfortunately this time it was based on waiting time which I have never experienced before. Kidney stones can be life threatening if not treated quickly enough, you can't get sepsis.

OK and then what happens when idiot with burnt feet’s burns get infected and he dies? Or loses a foot?

People don’t all have the same level of intelligence, knowledge or can even have mental disabilities or illnesses that make them make decisions you wouldn’t. Doesn’t mean they’re not worthy of treatment.

I image he had a brain fart in everyday life didn't think it through ie it's really hot at minute and was left learning a painful lesson.

I don't see how jumping out a airplane or climbing a mountain is beneficial as there are less risky ways to stay fit - it's actively chosing a dangerous situation.

This man probably walked across thousands of pavements in his life- meaning he was less aware of risks as environment changed on him - wasn't considering the risks had changed.

You really can't attack judgement to injury - as where do you draw the line - what I think of as stupid another thinks of as keeping fit or never considered could go wrong.