The Nation's Health + Paramedic

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Don't ask, just do…

"2 x Doctors acting like arrogant tits"

Some time ago I wrote a post entitled 'To Blue or Not to Blue' about how sometimes doctors and nurses question us putting a pre-alert to a hospital and bringing our patient in on blue lights. In my opinion, our decision to do this should really be beyond reproach. The fact of the matter is they are not there when we arrive. They don't see our patient at their worst and they don't take into account that on route to hospital we are treating them. With treatment often comes improvement and therefor a GCS 3 may indeed be conscious and talking by the time we arrive at hospital 10 minutes later. We shouldn't be criticised or made to feel stupid because the doctor is annoyed that they have had to walk from one part of A & E to another for what they don't deem to be an emergency. All blue calls are placed in good faith. At the time we put them in the patient is either dead, about to die or in our opinion would hugely benefit from being seen immediately rather than sit in a corridor for an hour waiting to hand over. If the patient has improved and they don't need to be in resus then move them. Simple.

The reason I am bringing up this subject again is I have been criticised / questioned twice in two days and quite frankly, it pissed me off. We were called to a guy fitting. When we arrived he had stopped. A precautionary cannula was placed in case he had another, and seeing as he had now had three seizures in the last hour it was likely he'd have another. We got him to the truck and started monitoring and set off to hospital. Within about a minute he started seizing again. My crew mate pulled over and jumped into the back to help me. We got him on high flow oxygen and tried to give him the IV Diazepam. Due to the violence of the seizure we couldn't access the cannula. Not wanting to waste time we gave the drug PR (up the arse for want of a better phrase) and within a minute or so he stopped! And breathe! We monitored him for a couple of minutes with the idea of continuing our journey but off he went again. Status Epilepticus is defined as a seizure lasting more than 20 minutes (depending where you read) or repeat seizures without a period of recovery between. Seeing as these seizures were not normal for our patients epilepsy and the diazepam wasn't stopping them I put in a blue call. You won't find many ambulance crews who will say we did the wrong thing. We arrived at hospital, took him into resus and began transferring whilst handing over to the team. By now our patient had begun coming round. I finished my little speech and the doctor replied:

"I understand that but I don't get why it was blue call. It's a seizure, you should know that doesn't warrant a crash team"

I didn't bite but I was clearly pissed! I explained my reasons, chucked my paperwork on the side and walked out, tail between my legs. If this wasn't bad enough, the same thing happened he following day!

This time a middle aged lady with bad asthma. She was unresponsive to Salbutomol and Atrovent and despite repeat doses and adrenaline she appeared to be having failing respirations. As far as we were concerned it was Life Threatening Asthma and given her history of ITU admissions we were not going to take any chances. The blue call was placed and we headed off to hospital. On route however, there was a marked improvement. All the drugs were doing their thing and by the time we arrived she was able to talk. Good job well done. The handover was given to the waiting team and again, I got a stupid question. This time however I did bite!

"Why did you put in a blue call?"

"Why are you Doctor?"

Everyone looked at me, crew mate included. I just shrugged my shoulder and walked off! She shoots.....she scores! How dare they? We don't do it to annoy them. We do it so our patients get definitive treatment at the earliest opportunity by people much better equipped than we are in the back of an ambulance. No one has ever got in trouble for putting in a blue call and no one will. If you don't and someone dies the hospitals are only too quick to point the finger and blame us. We've done our job now you do yours. Don't ask, just do! Rant over!

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Relevant to: Don't ask, just do… + Paramedic


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