Monday, 8 October 2007

What's in your wallet?

Ten Emergencies; one assist-only, two ran away(!); one refused and one false alarm. The others went by ambulance.

I've been doing a lot of thinking about the financial consequences of certain calls. For example, alcohol-related calls - collapses, unconscious individuals, violence. Every time we go to one of these, the person who goes to hospital (whether a tax payer or not) is responsible for the costs associated with it. If that cost is, say, £300, it means his or her drinking session, which might have cost £30, has resulted in ten times the expense, payable by you and me. We might as well just go and put a quid each from our hard-earned cash into his or her stupid pocket.

If the person is a tax payer then he or she has made a contribution towards being stupid, although that doesn't excuse it but if he or she is not paying taxes, then we are paying for his/her drinks...and the fall out.

My first call was to a ‘?fit, ?drugs’ but when I got on scene, I learned that the ‘patient’ had scarpered. He ran away when he saw the ambulance coming but this isn’t a problem because, deep down I’m sure he pays his taxes and is entitled to run the emergency services around like that. Stop me when I become sarcastic.

Then a call to a 24 year-old cyclist who was cycling at speed across a junction (I wonder if the lights were red?) and got himself run over by a van, which was turning right at the time. He had a fractured wrist and a sorry looking face.

After that, I was off to rescue a 49 year-old man who called us to say he was vomiting blood. When I got there, he was standing on the pavement waving at me. There was no blood. He told me he had chest pain now and that he had a history of cardiac problems. He had ventolin and GTN with him, so I had to believe his story, although he seemed perfectly ok to me. He also claimed DIB but was able to talk in good long sentences without a problem. After a conversation with him about his circumstances he came clean and admitted he just needed a place to stay. He had been made homeless. I handed him over to a sympathetic crew and he was taken to hospital

The crew were already on scene for my next call; a 49 year-old female with chest pain. I wasn’t required, so I did my paperwork and ‘greened up’. As soon as I hit the button, I was off to wake up a sleeping drunk on a bus. I am now practised at this and so I went aboard, shook him ‘til he got the message, explained his options (get off, be genuinely ill or get arrested) and he responded by choosing option number one.

Another cyclist in trouble. This time the guy was hit by a car. Unfortunately, he decided to leave the scene when he heard the police coming. He’ll go home with his injuries and have another explanation for them no doubt.

Anaphylaxis is a very real and potentially life-threatening problem, yet time and time again I come across patients whose G.P. has either been reluctant or has simply refused to give them an Epinephrine device (i.e. Epipen) so that they can save themselves when the reaction occurs. I hope a G.P. out there can explain this to me because my next call was to a 4 year-old with a known nut allergy who developed a sudden anaphylactic reaction. I found him with a widespread rash and a wheeze when I listened to his breathing. Although he wasn’t yet critical, the swelling had gone far enough to cause his throat to come up a little.

I gave him nebulised Salbutamol and this brought some relief. Then he was packed off with mum to hospital.

Immediately after this call, I received another anaphylaxis job. This time it was a 46 year-old male, again the reaction was caused by eating food containing traces of nuts. I arrived to find him sitting on the floor of his office, surrounded by colleagues. He had puffy eyes, red and swollen hands and was complaining of nausea. He had eaten a trifle at lunch time and it’s possible it contained nuts. He too had been denied an Epipen when he was first diagnosed.

I nebulised him to clear his wheezy breathing and got him off to hospital – I took him myself; he was stable and recovering well after the Salbutamol and there were no ambulances available for him.

A pleasant (not) call to a hostel that I haven’t had to visit since my days working as a relief in another sector. I knew it as a place full of reprobates and I was being asked to go and assist a 60 year-old who had collapsed. The usual cause of collapse in this place is alcohol, so I wasn’t surprised when I was met at the door and told...

‘He got up and went back to his room. He’s absolutely covered in faeces but I don’t think he wants any help’.

One of the hostel workers had greeted me on my arrival with this information and I was glad to know that he didn’t want my help but I still had to check before I left, so I asked him if he would take me to the guy’s room and I would have a word.

We walked along the cramped, smelly corridor and knocked on the relevant room door.

‘Hello. The ambulance man is here. Do you want to speak to him?’ the hostel worker shouted through the wood.

A shuffling sound from behind the door and a moaning, winging comment that I could barely hear (or decipher) heralded his imminent appearance. He opened the door a little, stuck his filthy head through it and looked at us with a fag in one hand and a beer can in the other.

‘Do you need an ambulance?’ I asked.

‘Naw pal!’, he spat in broad Glaswegian.

Then he slammed the door in our faces. The sudden draft created by the force made me blink.

The ambulance crew arrived, despite the fact that I had cancelled them over the radio and I explained what had gone on. They cheerfully left the scene and I completed yet another form for someone who couldn’t care less for the NHS.

My next call took me to an area of London that I’m not familiar with. It’s certainly not a nice area because as soon as I turned into the little street I was confronted by one of those yellow police notices asking for witnesses to the murder of a young woman. The murder had taken place in one of the houses – hopefully not the one I was about to enter.

The house I went to was inhabited by an 83 year-old man who sat on his sofa, shaking and breathing with some difficulty. His wife, who seemed like a long-suffering woman, wasn’t happy that he had ignored her previous requests to call an ambulance. He had been coughing up blood for the past four days and now had a high BP. He had a cardiac history and had also suffered a stroke in the past.

‘Why didn’t you call an ambulance when you started coughing up blood?’ I asked. I could sense his wife rolling her eyes to the ceiling behind me.

‘I thought it would go away on its own son’, he said. I like going to older patients – I can get called ‘son’ every now and again.

I made sure he was taken to hospital by ambulance and I warned him about ignoring things like this in the future. I hope he gets better.

My final call of the shift brought me back to reality. That is, I was sent to another complete waste of time and tax-payers money. Someone called an ambulance for a collapsed person, ‘probably fitting’ but I arrived, as did the motorcycle responder and the ambulance, to find a drunken female who had been sleeping. She hadn’t called us remember – a Good Samaritan had.

‘I’m sorry you were called out’, she cried after us as we departed to go home.

Not as sorry as this country is for allowing such a shambles to continue.

Be safe.

10 comments:

Anonymous said...

I agree entirely - the NHS and paramedics are abused to a ridiculous degree. I tend to think that fining people on the spot for moronic call-outs might work, but then it's a question of how to implement these (you might find yourself demanding £whatever from a drunk and end up being hurt yourself).

~ C

Sian said...

I am amased byt eh number of alcohol relatd calls you get when you are not needed!

As for the epi pen, why doesnt a gp prescribe them? my daughter has severe allergies to milk and egg and her consultant has wanrned us many times about what could happen if we dont carry her epi pens.It seems mad that they arent prescribed!

anyway my rant over, its good to be able to catch up with everything thats been going on with you, got a release date for the book yet?

oliviascotland said...

I'm so with you on the epipen subject - my daughter has a serious allergy, with swelling and occasional difficulty in breathing, and we were told by the Allergy Consultant that it IS a true allergy, and may develop into anaphylaxis at any time, BUT we don't get an epipen. I know I can use a half dose of mine if push comes to shove (and if I'm with her!), but it's not an ideal situation. There's only so much that Piriton can cope with .....

PeskyResponder said...

Slightly off topic, but a slightly bizarre policy @ work...
One of our workers has an epipen. However, our insurance policy at work states that no-one is to use an epipen, unless they are 'trained and qualified' to do so!
This to me seems completely absurd, and needless to say, we have all stated to the man in question, that in the event of him needing the pen and unable to do so himself, we WILL administer it, putting the pen back in his hand, pretending we didn't!

Kieran said...

Hey, i've just read over your blog and found it very interesting and informative. I'm currently studying a Health Diploma qualification and hope to further my education by studying at Sheffield Hallam (Paramedic Science) and to one day eventually become a paramedic- my cousin is a Doctor and always speaks highly of his job and how much he enjoys his work. I just wanted to say thanks for posting this blog, i'm sure it'll be a lot of help to any teenager hoping to one day become a paramedic, as it has been to myself.

Cheers,

Kieran

Minty said...

Last week i had the dubious pleasure of seeing the inside of our local A & E- my little boy hasn't been too well at all. I'd suggest he was one of the very few sober paitents there (at 9 months he bloody well should be).
Amazed me the number of people staggering around the waiting area.

Xf said...

anonymous

It is difficult deciding on a fool-proff method of fining people. If they are taken to hospital to sober up then they can be charged a fee for their stay. Most of them would pay and learn a lesson but the alcoholics of our society would not, of course.

Anonymous said...

I can sympathise with your frustration over the reluctance of GPs to prescribe epipens. I am allergic to wasp stings and the reaction becomes more severe each time I am stung. Naturally I wear an insect repellant and take every measure possible to avoid wasps but it's not always as easy as it sounds. The advice from the doctor? If you get stung, take an antihistamine and call an ambulance, letting his practice off the hook re. funding i suppose.

Xf said...

anonymous

I also know that people are being advised to take a piriton and 'see how it goes'. Highly risky in my book but I haven't heard from any dorctors yet to explain why there is a reluctance to prescribe.

Xf said...

On the subject of Epipens

I forgot to answer those of you who enquired about the use of Epipens. The Prescription Medicines Act has an amendment containing a list of emergency drugs that CAN be given by ANYONE (trained or not) to save a life. One of those drugs is Epinephrine -the drug in an Epipen.

The instructions are on the damned thing and it is unlikely you will cause harm by giving it mistakenly but it is always a good idea to get training, although this is not a legal requirement.

If your employer tells you not to give it then I'm afraid they rule the roost at work and you can't disobey. However, the Press will have a field day if it is discovered that someone died and you were told not to try and help.

Litigation, litigation, that's all everyone is worried about these days. People die of litigation.