Sunday, 23 May 2010

Count to Ten

Chest Pain.

Category A.

Immediately Life Threatening.

The FRU wails and worms its way through the early evening traffic, scattering cars and pedestrians alike. Arriving in just a few minutes at the address, where the door is opened by a woman in her 30's. I wait for her to show me in and direct me to the patient. Instead, she blocks my way in and waves a piece of paper in front of my face.

"Are you taking me to the hospital?" The look of expectation is matched by a stare of disdain.

"Can you please tell me what the problem is? Maybe you don't need hospital!"

"I've told you I need to go to hospital. Your job is to take me."

Count to ten.

I ask to see the piece of paper that was thrust in my face, and find that it's a hospital prescription for some medication that is just as readily bought over-the-counter.

"The local pharmacy says they can't fill this - only the hospital can. So now I need to get to the hospital."

Count to ten.

It's a ten minute walk at the most.

In the traffic, it'll probably be a ten minute drive too.

I ask a question I already know the answer to. "Then there's no-one with chest pain?"

"Just take me to hospital. I need to be home in half an hour."

Count to ten. Again.

I'm in no mood for a fight, so point to the back seat of the car, make sure she puts her seat belt on, and shut the door. On the walk back round the car to the driver's side, I call control and cancel the big taxi. The small taxi will suffice.

On route to the hospital she tells me to wait while she gets the prescription and then take her home.

I didn't wait.

But I did count to ten.



Fee said...

Selfish cows like that should be sent a ruddy great bill. Or random members of the public (ie, me) should be allowed to slap some sense into them.

You have my deepest admiration for keeping your lip buttoned. It must have been tempting to strangle her with the seat belt (but I suppose that would make an immense amount of paperwork!).

Ian said...

I would have told her (politely) to stick it. Invite her to put in a complaint but also point out that her actions, lying about her condition etc, could be deemed as purposly blocking the ambulance service from performing their role which can carry a fine of up to £5000.

Anonymous said...

I have been trying to promote the policy that' If the patient isn't sick or injured when they get on the ambulance we ensure that they are when they get off.'

Joe said...

Good job on keeping your cool, think my blood vessels would've started bursting in all sorts of places dealing with someone like that.

I agree with Fee, people like that should get a big bill as a deterrent.

Raindog said...

Tell me and actual taxi took her and not an ambulance.....

Anonymous said...

I just hope that it wasn't a member of my family having a cardiac arrest in the 15 minutes or so it took you to get her to hospital. Quite simply, you shouldn't have took her. The RRV isn't a taxi service.

If Paramedic's want to be paid a professional wage, then they need to act professionally. This means assessing your patient and perhaps deciding they don't need to be taken to hospital by ambulance. If ambulance staff are doing to fit the "stretcher monkey" sterotype and just do exactly what the patient tells them to do, then they deserve to get paid the going rate as a taxi driver.

InsomniacMedic said...

Harsh words anonymous (2). I agree with you - no one should have to wait for an ambulance whilst it's busy ferrying a taxi ride. Unfortunately - the law tells me otherwise. If someone's called an ambulance and is adamant on travelling to hospital, then I am not allowed to refuse. Irrelevant of how much of a waste of time it is. My decision to take her in the car was obviously not the ideal solution, but it did save another ambulance that was also on route to this call. Sometimes you have to cut your losses and find the least of all evils. In this case it was getting her to hospital to stop her wasting any more ambulance resources. Believe me, I have no wish to be a taxi driver and my assessment of the patient in this case made no difference. The law says drive to hospital, and that is what I was forced, against my will and better judgement to do.

S said...

I really think that England should introduce some fees for ambulance use, I live elsewhere and here, if you have an ambulance take you to hospital and aren't admitted, you get charged (I think it's the equivalent of about £50). Obviously this isn't foolproof because being admitted isn't the only criterion for really needing the ambulance but you can also appeal and people will think twice about call outs such as the one you describe here.

Anonymous said...

Sorry if my post came across as too harsh. It was written when I was very tired, hence the spelling and grammar mistakes.

Unfortunately, you're mistaken. The law does not require you to take a patient into hospital if they demand transport. Some countries have this law (e.g. certain US states), but the UK does not (I'm pretty sure you're English right?). A Paramedic, being a registered Healthcare Professional, can make an assessment of the patient and decide they don't need an ambulance tranfer to hospital. It may be that they need a taxi to hospital instead or they're OK to stay at hope. But refusing transport is within any clinicians scope of practice, and I'm certain you wont be able to refer me to any legislation that says otherwise. As always, document, document and document again!

Great blog by the way.

InsomniacMedic said...

Anonymous (I really wish people would give themselves names, and stick to them, even if they're fake) again.
The new post wasn't meant as an attack on you - much the opposite. Neither had I intended to be critical of your typing skills. I was trying to make the point that I was trying to concentrate on everything but the real point you made. Because you had a point.
You're right (I think) that there is no LAW that I HAVE to convey to hospital - but there are work rules. And they are that if a patient insists on being conveyed, that I have no choice but to convey - however inappropriate I find the case to be.
I can, in agreement with the patient, leave them to alternative and more appropriate care pathways. The problem arises in cases like these - where I have no choice.
Problems like you spoke of, such as critical calls waiting whilst we deal with the rubbish, are real problems. Which at the moment we have no way to deal with.
I used your comment not to attack you personally - and apologise if that's how it came across - I used it to highlight the point that every so often I get caught up in a game that I really don't want to play...
Thanks for reading and commenting - keep 'em coming - and please pick a name rather than anonymous!

-Ross- said...

That is an absolutely shocking abuse of the ambulance service!

There should be legislation to punish people that do this.

Anonymous said...

I love debates like this where both sides are right.

This patient should have been denied transportation and fined for wasting ambulance time. The job was a waist of time and may have taken a responder away from a dying person.

If Insomniac had refuse (as some of us would have) all it would have taken is one little letter.
One little letter to the LAS or the HPC saying that 'she was ill and been refused conveyance to hospital' and there would be no more blog as Insomniac would be suspended pending the sack.

I agree with Anonymous, this is a ridiculous situation and one not proscribed by law.
If I meet this patient, in the same circumstances, tomorrow I shall be taking them to hospital while trying not to say all the things I want to say. I will get home, at the end of my shift, fuming at the inappropriateness of it all but safe in the knowledge that I still have a job.

Anonymous said...

Hi there.

I'm a Tech down in Hampshire. This person would have been told to call a taxi and we would have turned on our heels. A log would have been made with control. A PCR would have been completed stating that she only needed a taxi. Unless they provide medical evidence of chest pain the HPC/Trust would tell her to do one.

You are an autonomous clinician, not a cabbie. The CoP, Union and HPC would be on your side in this case.

Love the blog ! BigYellowSyringe