The Nation's Health + Paramedic

Hot Potato

"31 year old female, 37/40 pregnant, loose stool, NHS111"

WHAT?! A loose stool. Why in God's name is a bum-wee worthy on an ambulance?! On top of that, how, in a huge busy city, am I the nearest ambulance to this?! It was 9 miles away, which if my maths is correct (∏ x r2? Right?!) then I was the only available ambulance in an area of almost 255 square miles. That means, based on the cities population, I was the only ambulance covering the needs of 3,449,880 people, at that particular snapshot in time, isn! Thinking twice about calling an ambulance now?! Good! Anyway, the powers that be over at NHS111 deemed it appropriate to use the only resource available covering the equivalent of the entire population of Berlin, for a woman with the runs! I can't for the life of me understand while people have to wait for ambulances from time to time......

So, after an indignant statistic filled rant, similar to the one above we pulled up at the house. Within two seconds of knocking, the door swung opened and out came our patient, wrapped up warm, all ready for a night at the hospital. Clearly, hospital was where she wanted to be! Formalities and introductions out of the way we headed into the warmth of the ambulance where she appeared most put out by my request for her to remove her layers so we could do her blood pressure.

"Can't it wait until we get to hospital?"

"You might not be going to hospital, I haven't assessed you yet."

"What do you mean?"

"I'll assess you, if you need to go to hospital, we'll take you, if you don't, we won't."

*shocked face*

I decided to follow the 'lets start where it all begun approach'. After various questions I established that she had had an 8 hour history of the shits and her abdomen felt warmer than normal. Once I was happy that that was all that was wrong with her, I had to ask the question that was burning on my mind.

"Why do you think you need to go to hospital?"

"111 told me I had to go."

What transpired ran deeper than that, and goes a long way to explain why the ambulance service is under such strain. It also explained why we were the only available ambulance in such a large area!

At lunch time the patient's symptoms begun. Personally, a loose stool wouldn't give me any cause for concern or invoke a need to seek medically attention or advice but she did the right thing, she called her maternity unit. They didn't answer so she left a message. Two hours later, she rung again. Like before there was no answer so another message was left. Maternity units are notoriously hard to get in contact with. Obviously they are busy departments but the amount of expectant mothers who then call an ambulance because there was no answer is quite astonishing.

Anyway, after two failed attempts she called her GP. The GP had no appointments that day. She was told to go to hospital if it was an emergency or call back in an hour to speak to a GP. It wasn't an emergency so she phoned back an hour later to talk to one of the doctors. She got the answer machine as the surgery was now closed!

Annoyed at the lack of help and advise available to her, she phoned the number she had for the out-of-hours GP service. This service no longer existed and the message she got told her to hang up and dial 111. So she did. The friendly voice at 111 asked her lots of questions and after the thorough 'clinical assessment' it was determined that she needed an ambulance. She told them she didn't want an ambulance. She didn't want to go to hospital. She was told she had to go to hospital and an ambulance was on its way. So she got ready and waited by the door.

So, after being ignored and passed around like a hot potato all afternoon and evening, here we were! I phoned the maternity unit and got through to the delivery suite. A rather angry sounding midwife started lecturing me about how the patient didn't need an ambulance and didn't need to go to hospital. She then gave the patient the same ticking off, told her call her GP and ended the conversation. Midwives fill me with such joy.....perhaps she should have answered the phone hours ago and saved all this nonsense now!

I told the patient to go back indoors, relax and try to sleep. I said I would phone the GP and get them to phone her within an hour. Off she went, appearing slightly confused that the ambulance wasn't driving her to hospital like she had been told! I phoned NHS111 and referred the patient back to them to get the duty OOH GP to phone her. Annoyingly the GP decided to phone me instead so I decided to take my phone to the patient to get a conclusion to this ridiculous episode of passing the buck! The GP told the patient to take some over-the-counter remedies and to call back the next day if she had any further concerns. Wouldn't it have saved a lot of time and money if they had all just told her that 8 hours ago?! Why does everyone need an ambulance to facilitate common sense?!

No wonder the NHS is in a bloody mess. Not only can people not cope with minor ailments and treat themselves at home, but every part of the NHS is determined to pass the buck and hope the ambulance service will pick up the pieces!

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