The root of all queues

THIS news story relays the current problems we are all facing but I have heard many times that this is fairly common with WAS. However, look at the story and read it carefully. The problem was caused, in my opinion, by the GP and the structure of the pathways set in place for such ambulatory patients.

How did the GP diagnose a fractured spine? He clearly wasn't absolutely sure but had suspicions, so he arranged for an ortho bed and an MRI to be carried out, to see exactly what the extent of the damage was to this lady's back. That is all fair enough. The GP has to act on his experience and knowledge and the given set of signs and symptoms surrounding his patient. But it sounds like he either used an emergency ambulance service, (which is solely for immediately life-threatening illness and injury), just to expedite his patient's journey to hospital, where other means of transport, such as A&E support or Patient Transport Services, were available (in other words he dialled 999 for a patient who was not being admitted for immediate life-saving intervention)... OR, as I suspect, there is simply no option available to him. There are no other transport pathways and so everyone ends up dialling 999.

The woman's daughter even stated to the Press "Admittedly, my mother was not an emergency case, but nevertheless during her long wait she was unable to go to the toilet and was getting increasingly tired and fed-up", before going on to describe the intolerable wait her mum had to endure, and the obvious frustration of the crews, even though they were professional and patient.

The irony is that if she hadn't been sent to hospital, essentially for a scan, by emergency ambulance via the 999 system by a health care professional, the queue would not have been quite so long, because they would not have been in it. The patient coming in behind them would not have had to wait even longer than they did, due to their presence, and the crew may have been saving the life of a seriously ill patient elsewhere.

Without alternative pathways; other means of taking patients to various different departments in hospitals without the need to call 999 and have them go through our already stretched Emergency Departments, this problem is only set to get much, much worse, until, soon I suspect, someone will die in the back of an ambulance because their undiagnosed triple A ruptures, while various GP referrals and District Nurse referrals - Health Care Professionals (HCP) using 999 as a means of transporting non-emergency patients - are brought in by exhausted and frustrated crews who will wait for hours outside hospitals with patients on-board who remain stable for hours. It's madness.

In my opinion, the problem is one of two things when it comes to HCP referrals. They either don't realise what they are doing when they take an emergency vehicle away from genuine emergency calls to transport stable, non-emergency patients. Or they don't have a choice, because there is no alternative.

This lady couldn't get herself to hospital and a car or taxi would have been a non-starter, due to her condition. A fractured spine is serious but it is not necessarily immediately life-threatening. A critical asthma attack, a serious head injury, unconsciousness, neck fractures, vomiting blood, central chest pain, cardiac arrest.... these are all 999 calls. But how do you get this patient to hospital for a scan if you have no safe means of transport? She needs an ambulance with a trolley bed (and a spinal board) and a crew that knows what to do.

The voluntary services offer non-emergency transport services, so what about them? Or private ambulance services... or the NHS Trust Patient Transport Services.

Here's the rub. Many hospitals have contracts with private or voluntary ambulance services but, when it comes right down to it, the HCPs who want their patients taken care of simply don't seem to trust these services and prefer to call 999 instead, knowing that they are going to get a professional front-line crew. I've even heard preferences for paramedics to take care of patients, even though there is no need because the patient did not require paramedic intervention of any kind. The transport services used by hospitals are usually the cheapest quoted and the contracts are decided by management, not necessarily clinicians.

We have a major problem. If this continues, not only will our system fail and patients start to suffer, but ambulance crews will begin to lose heart. They will also become unwell due to exhaustion, stress and frustration. This will have a knock-on effect and before you know it, we will be struggling to cope with the system as it stands.

HCPs aren't the major culprits though. The general public still attend Emergency Departments for the most insignificant problems. Everyone's emergency is personal, I know that, but when are we going to start educating people properly? First aid should be taught in every school - to school students, not just staff. And it should be taught by professionals who have actually done the things they are teaching you to learn. That way, a more realistic perspective is taught and kids might just start growing up taking ownership of their minor injuries and illnesses, instead of assuming that the health system is there to solve every little problem.

If you want an example of how bad things are getting, consider the 14 mile journey I undertook - on blue lights at a doctor's request, so that a patient could have a tooth replaced.

Xf