Sunday, 5 July 2009

Headless chickens

Day shift: Six calls; one assisted-only, one treated on scene, three by car and one by ambulance.

Stats: 1 ?Flu; 1 Abdo pain; 1 Burned foot; 1 Bee sting; 1 Cut scalp.

A beautiful sunny Sunday, marred only by the nature of the calls I had to deal with but, of course, that’s what I’m paid to do, apparently.

A 22 year-old man with ‘flu-like symptoms’ was attended to by the crew, who arrived with me, so I decided it was best not to get involved directly. He would be told to stay at home and get well soon… unless he insisted on going to hospital and you won’t believe how stupidly stubborn some people can be when it comes to their ‘rights’, so I expect there was a lively debate going on.

Then a call to a popular tourist area for a 32 year-old French man who was suffering abdo pain and looked very uncomfortable with it. At first there was a bit of confusion because the call I’d gone to was for an 80-something female who was ‘unwell’; I thought there might be two calls from the same area and, to be honest, this guy initially looked like he was hyperventilating, so I wasn’t desperate to give it a higher priority – it wasn’t until I started getting his story that I realised his condition might be worse than that. But I was concerned that some old lady was waiting for me somewhere nearby too, so the complex little scenario had me thinking on my feet. Oh, and to wrap it all up in a bow, neither he nor the family around him could speak much English, so I was once again forced to resort to my High School French, which is not great, even when I have had a drink of wine. Nevertheless, through badly constructed sentences and pidjin terminology, we managed to communicate effectively enough for me to establish that he did not have any serious medical conditions, was not suffering chest pain and had been through this before but, as yet, had not been diagnosed by his doctor.

It would have been cruel and unprofessional to say ‘avez-vous deux pieds?’ although it would have been nice to exercise my ‘parlais’; instead I offered to take him and his wife/sister/mother (I have no idea these days) to hospital in the car. Control had agreed with me that this was probably the one and only call from the area and that the confusion had been produced as the result of someone consulting a French-English dictionary as the call was taken, so off we all went.

At hospital, the man was given a cubicle and a bed and I was informed of the strong possibility that some old lady was still sitting in a nearby church hall (apparently), waiting for an ambulance or God to come and help her.

I also conveyed the next patient; a man with Parkinson’s who was very difficult to understand. The long journey south seemed wasted but he’d fallen a few hours earlier whilst on the loo and now he had leg pain, although he could weight-bear and move around with the help of his stick. It wasn’t an emergency really but the day was unfolding that way and, even with the pressure we are currently under, everyone’s ailment must have seemed important enough to dial 999. I just wish he’d cleaned the toilet before sending for us – it was an unpleasant sight to behold as I entered the little flat. He left it in a mess, even though he’d let hours go by and was quite able to clean it and himself.

But the call that took the biscuit was to a restaurant where a 24 year-old chef spilled hot soup onto his foot. He was sitting front of house with his damaged extremity in a bucket of water (which is the right thing to do). It had been soaking there for half an hour (also a good idea) and his colleague, a young woman who obviously ran the place, had decided to dial 999 and summon an emergency ambulance for it.

I’m sorry if I offend some of you with my attitude to this but if I burned my foot and had two blisters on it (which is all that he had), I’d pop a couple of paracetamol for the pain and elevate it for the rest of the day, applying Calamine as it healed over the next few days until the skin, which is perfectly capable of healing itself, repaired completely. That’s what I’d do. That’s what most of the population would do but I got an argument (and most likely a complaint made against me) for my ‘attitude’ when I asked her why she thought this was an emergency. I also asked her if she thought an ambulance would be better served going to someone’s heart attack but she was completely indifferent. In fact, she became so defensive that she ultimately made me believe that she thought of us as merely taxi drivers that should do as we are told and no more. If a doctor had arrived and queried her judgment, she probably wouldn’t have been so aggressive about it, and believe me, any doctor worth his or her salt, would have given her some grief. Let's be honest, a good nurse would have said the same.

‘If it is so minor, why didn’t they tell me not to bother with an ambulance when I called?’ she snapped.

‘Because they don’t do that – they send ambulances based on what you tell them and no more’, I answered.

The truth is, we have clinical decision makers who can sieve through calls like this and cancel ambulances but on this occasion it hadn’t been done – probably because they are too busy but the point I was trying to make was that she had called in the first place.

‘How am I supposed to know it’s not serious?’

She was making the ‘you are the professional and I know nothing about this stuff’ statement that I hear all too often. It’s a cop out because we all know what’s minor when it comes to this type of injury.

I cancelled the ambulance and took the man, who hadn’t even asked to go to hospital, to A&E, where he hobbled to the waiting area to do just that – wait. Even the triage nurse rolled her eyes when she saw the extent of his injury.

The next call was no better but I kind of understood it. I was sent miles away for a bee sting to the thumb. The patient was a 2 year-old girl and mum was just concerned about the possibility of her daughter puffing up and suffering a full-blown anaphylactic attack. They are from Africa and they believe that they can ‘catch’ these mostly Western diseases and problems just by being here – crazy really.

I checked the child’s thumb out – it was a tiny bit swollen; checked her airway and decided she needed no more than a smile, which she got and returned. Mum was happy too and I was able to leave them all to go out for the day, reassured that no bee was likely to kill her baby because, with her ethnic background, the chances were slim. This is a culture with hard-knocked immunity.

I have to admit I had a tear in my eye when I went to help the family of a 4 year-old boy who’d fallen and cut his scalp on the escalators at an underground station. His wound was very minor but the mum and dad (and grandmother) wanted to have it checked before they continued their journey. The little boy was very scared in case I did anything to hurt him, which I wouldn’t – I didn’t even do a BM, which is required of me for every child. I just put a makeshift bandage on his head and chatted to the family. I even managed to clumsily knock mum's head with my elbow as I tied the bandage on (whoops).

I am not pleased that grown up healthy people call ambulances for burned feet and other minor injuries and illnesses but I really don’t mind going to help a small boy with a little cut to his head who has just endured long and sickening chemotherapy for a brain tumour.

Be safe.


Steve Irwin said...

I promise I shant burn my foot and call you. Infact to be honest I shant be as stupid as to burn my foot in the first place. And well said, tell him - 'On yer bike'

Tim K said...

To be fair on the burnt feet, the first aid manual states that 'all burns involving the face hands feet or genital area' require hospital treatment. It's also stressed during first aid at work courses that burns require a proper assessment at hospital.

Personally though, I'd be sending any of my colleagues there by taxi or getting someone to drive them unless the transport was likely to require pain relief or the burns were time critical

Xf said...

Tim K

I agree... my point, as you have highlighted, is that too many people are reaching for the phone and dialing 999 as if everything is an emergency. Where in any manual does it say that a (minor)burned foot has to go by ambulance?

I want people in workplaces, especially first aiders (and she did not have one on duty that day), to use common sense when dealing with injuries.

crapsack said...

I can honestly say that in my 44 years so far here I have called an ambulance twice - for a woman with a severely broken leg and for my mum when she was having a fatal heart attack which her GP had diagnosed as - wait for it - gastric flu. And I've had one called for me just once, when I was 10 and broke my arm.

I cannot comprehend the utter stupidity of anyone who considers an ambulance anything other than a serious emergency vehicle. I wouldn't have the patience to be a paramedic, I'd be sacked very quickly for being rude to people!

Tom said...

I have just made a visit to Suzi's Nee Naw blog, which like this blog is both entertaing and enlightening.

There were some brilliant references, the best of which is the nation appears to be gripped with a fear of 'hamthrax' which requires front line staff at all times.

A 10 year old with a broken arm and in distress is something I happily turned out for when I was on the service. As is a severely broken leg, and more importantly, a lady suffering an MI.

Where has it all gone wrong?

Anonymous said...

hey, i almost missed that last little paragraph and now im crying. Your writing constantly grounds me, Keep it up :)

i found you some time ago when i lost my gran unexpectedly to a heart attack after a ten year battle with Alzheimers and your post on the subject really helped me.