"27 year old male, severe pain in finger"
Like I've said before, who am I to judge the pain that someone is experiencing. Pain is of course subjective (apparently) isn't it? Regardless of how bad the pain is, the fact still remained that someone with pain in their finger does not need an ambulance. They need a lift or a taxi. Then again, who am I to decide who does & doesn't need an ambulance? Calls are triaged; calls are filtered and given a category. That category decides what kind of response the call gets. Category A calls are for cardiac arrests, chest pains, difficulty in breathing and seizures etc and get an 8 minutes response. Category B calls are for abdominal pain, vomiting, falls, moderate bleeding, and a variety of other calls and get a 19 minute response. Everything else that is minor is a Category C and will get an ambulance as and when one is available. These calls are normally filtered again through Clinical Telephone Advise where more details are taken with the view to discharging some patients back into their own care and making their own way somewhere to get treatment. Unfortunately, in a system controlled by algorithms and a computer, some buzz words pop up which automatically upgrade a call to be worthy of an ambulance. The most common of these is 'not alert'; it automatically upgrades a call to a Category A and thus gets the FRU and an ambulance relatively quickly.
We had been at work for the best part of 45 seconds when the job came down. Surely a hurty finger didn't need an ambulance?! Apparently it did! Off we went at a leisurely pace, desperately hoping to get cancelled for a higher priority, or better still, 'call downgraded'; nope! Instead the call got upgraded to a category A:
"27 year old male, severe pain in finger, patient thinks it may be a splinter, patient is not alert"
A splinter?! Really?! Who is making these decisions? Who is authorising the use of a £750-a-call ambulance for a splinter? Why isn't he being told to get a taxi/ walk/ get a lift, or use some frickin' tweezers?! Seriously? The problem is, no one has decided this. They have answered the questions in a certain way which means they will get an ambulance. They know what buzz words to use, and if they want one, as things stand, they will get one. It's also not my job to ask these questions. It's my job to treat these people so that is what we did.
A few minutes later we arrived at the house. We walked into the living room and my eyes were drawn immediately to the TV. It was at least 70" across and took up most of the wall. For those who have read The Rules of EMS, you may remember rule 80; 'The size of a patient's TV is inversely proportional to that patients social worth.' Oh, how true this was. The place was a pit. Most of the family were there and the cynic inside me said that at 14:30 on a Wednesday afternoon the fact no one was at work meant none of them did. I was right.
"What's the problem today sir?"
"My finger is killing me innit"
"What have you done to it?"
"I don't know, I can't touch anythin' with it, I think it's a splinter"
"A splinter?"
"Yeah, I thought I got one earlier and pulled it out but maybe it snapped inside"
At this point his mother / sister / aunt chipped into the conversation.
"Can you tell him I'm right and he can get blood poisoning?"
"I very much doubt he'll get blood poisoning but let me have a look"
And have a look I did. He held out his grubby index finger, nail bitten back to the cuticle, nicotine stain on the skin and I inspected. There was a slight mark where a splinter may have been or still was, the skin was slightly redder than the rest, but that was it. It was indeed a splinter. The first time I had been called to one.
"Yep, it's most likely a splinter" I said with a slightly disgruntled tone.
"What do you reckon I should do?"
"Nothing?! It's a splinter, if you are worried you could go to the walk-in-centre or go and see your GP"
"So I don't need to go to hospital?"
"No, not for that"
"Safe"
Safe?! You've called an ambulance for a splinter and now you're saying safe to me?! What is wrong with people?! When did calling an ambulance for a splinter become the thing to do? I was always taught that ambulances were for emergencies. All advertising I have ever seen says the same, and all schools that I know of explain what an emergency is. Every time an ambulance is dispatched to a job like this the bar is lowered as to what it's acceptable to call an ambulance for. We are not far off sending a truck and a car to hand someone the tissues, cook dinner and wipe their arses. Something has to give. The fear of litigation has to stop and they simply have to say NO! NO, you don't need an ambulance. NO, you cannot have an ambulance. NO, you will not get an ambulance. NO! NO! NO!