Wednesday, 4 November 2009

The common sense leak

Day shift: Four calls; one treated on scene - the rest by ambulance.

Stats: 1 CVA; 1 Antibiotic reaction; Scalded hand; 1 Hyerglycaemic.

Now they need to carry out studies to tell us something we already knew!

On the first of my two ambulance duty dates I was tasked to a vehicle running out in the East, outside of my sector, because we are providing much needed cover in that area. So, I found myself crewed up with a friend and running around all day in the Woolwich area.

Our first call came in after a fairly lazy morning and it was for an 88 year-old man who had suffered a stroke and was under hospital care (or so it seemed) until he decided to discharge himself and walk out. He plodded three miles home in his pyjamas and straw hat, plonked his frail body into his little warden-controlled flat and began to make a right nuisance of himself – so much so that when we received the call it stated that police may be required as he was violent.

He was indeed aggressive but not really violent; he shouted, swore and insulted the woman who had called us to have him returned to hospital. She was trying her best to help him but all she got in return was abuse. The man had a brain injury, so it was predictable behaviour, unless he was always a cantankerous old bean.

He wandered around his flat collecting bits and pieces for his trip back to hospital – he knew he was going back and he thought we were there to force him to go. ‘Are you the police?’ he asked matter-of-factly. ‘No, we are here to help you and take you to hospital again’ I replied.

He was in shorts and his legs were smeared with faecal matter, some of it was dried into blobs on his calves. I thought this was a mercy because if it had been fresh and wet, I’d be smelling it all the way to hospital and would have to clean it up – the fact that it was dried meant all I had to do was clear off the larger particles and leave the smears. Sorry, I know it’s a bit in-depth and detailed but now you know what we get up to all day. All that training and it comes down to working out how much poo you are going to scrape off an old man’s legs. There’s no chapter in the text books to cover it. Maybe I'll write one.

After a few tirades and insults, we managed to get the man back to his ward, where the medical staff had been waiting for him. During the journey, he told me he was an ex-WWII pilot and we chatted about the kind of planes he flew (bombers) and regardless of his acidic character and his filthy demeanour, this was a man, among many, that had put his life on the line so that we could all live the way we do today. So, when we got him to his ward and a doctor and two of the nurses began giggling and pointing at him (he was dressed in his shorts, t-shirt, a straw hat and flip-flops) I thought it prudent to discuss the possibility of them watching him more closely next time rather than making fun of him. He’d had a stroke and clearly wasn’t well; what he needed was a safe place to get better, not the ridicule of a few young medical professionals.

Later on we attended a 62 year-old woman who’d just started antibiotics for an infection. She was complaining of feeling dizzy and sick and it was fairly obvious that the tablets didn’t agree with her. She needed to see her GP but s/he had refused to come out to her, so we were called. Sometimes the worst abusers of the ambulance service are the very people who should know better. So, a car and an ambulance were despatched and all we had to do was drive her to hospital. She had no emergency symptoms and her trip resulted in a long stay in the hospital waiting area with her relatives.

Even more stupid was the call made by a University security man who was also one of the first aiders. A staff member had been carrying a cup of coffee and got bumped by a student walking past (with no apology of course), resulting in a small spillage of hot liquid onto the back of her hand. She stuck it under cold water for 20 minutes and was still rinsing it when we arrived (on blue lights).

She had a superficial scald; nothing could be done – no blisters in sight and no prospect of permanent damage. It was a common-or-garden variety liquid burn and all she needed was cold water (done) and pain relief until the hand got better (in approximately 24 to 48 hours). The pain would go within a few hours.

All she got from me was advice. She didn’t want or need to go to hospital – the first aider had panicked and called us or quite possibly (and this is a real problem) the University had a ‘policy’ of calling ambulances for every little thing. Sometimes ‘policy’ really means ‘scared of litigation safety net’.

This was a 49 year-old woman who had burned herself a few times like this in her life and knew exactly what to expect. She knew her hand wouldn’t fall off and she was well aware of the throbbing pain she would have to endure until it settled. We all know this but for some reason we have lost our sense of knowledge-through-experience and have replaced it with policy-minded fear that there are hidden consequences. And there will always be someone, somewhere who will gladly cite a strange and unusual story; a rare thing that happened to somebody else, somebody they have never met in their lives, who got burned just like this and had to have an amputation ‘cos it got all infected and the hand went green. So we live by the principle that if we don’t cover our backsides this could happen again – for God’s sake let's grow up!

To end the shift we were treated to a 65 year-old man who sat in a sticky-floored front room, in a filthy little drug-den flat, drinking a can of lager as his druggie friends insisted he needed to go to hospital because ‘he wasn’t right in the head’. The man had a history of walking out of hospital before being seen and he adamantly refused to go this time when I asked him. I can’t force him to go but I have to reason it out before I just say ‘ok’ and leave, so I asked about a medical history and they told me he was a diabetic but that he hadn’t been taking his tablets. I checked his BM and it was high (33.3), so I used that as an excuse to coax him into going to be checked out.

When we arrived at hospital, the staff recognised him and before I could even finish my hand-over the triage nurse said ‘waiting room’. I explained that his BM was very high and this changed her mind. He was given a cubicle and I booked him in. I watched from the receptionist’s booth as my patient wandered past on his way outside – he was escaping again. I managed to stop him and turn him back to his cubicle but I found, to my astonishment (because it had only been ten minutes) that another patient was being put into it!

‘This patient is in here’ I said as the nurse settled another old man into the chair.

‘Not any more’ she replied.

I had to argue with the medical staff that if my patient wasn’t treated he’d likely become seriously ill and that he needed to be watched because he would walk out. I had a suspicion that this is why he was being slung around. He’d come in with a crew, be sat in reception, walk out and then be returned again later on or on another day. Meanwhile, his blood glucose level was rising and rising through neglect.

None of us are perfect and we all (in the medical profession) have to bear the strain of the sheer number of patients, real or imagined who require care every day. We also have a limit to our internal professional patience because we are human but if writing this blog and receiving criticism from some of my readers has taught me anything, it’s that making assumptions about individuals just because I am fed up at times, will cause clinical misjudgement. So, much as I rant about timewasters and the stupidity of some people, I will always look at the bigger picture in case I miss something. Today I saw various levels of lethargy in my fellow professionals and in all levels of care, from first aid to medical practise; I was confronted with an impassive attitude to those who really needed help and I am reminded of what someone said to me very recently about a visit to their GP in which the doctor had to look up an illness in her book while the patient sat waiting for an answer. ‘I could have done that myself on Google’, she told me with disbelief.

Be safe.


Oliver Smith said...

I can understand the attitude of the A+E department with regards to the last patient. However, regardless of his past reasons for attendence and the way he has acted; when the day comes that he does need medical attention before becoming seriously ill the staff of the A+E department should be able to remain professional and treat as required. Easier said that done I know, but that's part and parcel of being on the front line.

Andrew said...

Welcome to woolwich! I've lived in the area all my life and the stuff you've seen in a single shift I never knew existed! I can guess what hospital you are talking about and it's not all bad I promise you! It's luck of the draw, and it's always the small minority that can tarnish and spoil the reputation and appearance for everyone else, imagine if the hospital was under inspection and they saw said members of staff. You are very far from your usual stomping ground eh?

Lynne said...

I find some of the attitudes you describe very worrying.

MarkUK said...

As a Health & Safety Officer, First Aider and CFR, I'm annoyed that someone with a superficial scald should be the centre of ambulance attention.

The university should be ashamed of itself if that's their protocol. In a situation like this, it should be the Firat Aider, not protocol, that decides if an ambulance is necessary. The First Aider should be backed, not be frightened to use his judgement.

I have also come across the opposite. In a school, the First Aiders were told that they could not call an ambulance without Senior Management approval. So, we have a kid with a severe asthma attack, and we're supposed to wait until we can get an UNTRAINED SLT member out of whichever meeting they happen to be in? Not bloody likely!

The policy has now been changed.

Sue said...

I want to disagree with Andrew,if it's the same hospital we are thinking about. I've only experienced the A&E dept and wouldn't touch it again with a barge pole! There's a reason I go to a hospital in town...

Glad you survived your excursion to Woolwich!

Viking83 said...

The patient with 33 BSL with go into DKA soon enough and then there'll be an investigation as to why at least an effort wasn't made to treat him, although I must admit my sympathy is with the nurse: if he wants to walk thats his choice, after being informed of the risk of such a high bsl.