Peter Bradley, the chief of the ambulance service, says there is no such thing as an inappropriate 999 call — all our callers have rung us because they need help and have nowhere else to turn to. I’m afraid to say that after two and a half years of stubbed toes and runny noses, my attitude is a bit less sympathetic than his. Here are some statistics for you:
- 10% of Londoners would call 999 if suffering from flu symptoms. (Elsewhere in the country, the figure is 3%)
- 50% of Londoners would call 999 as a first course of action if a pregnant woman began to go into labour.
- 40% would call 999 if having difficulty getting through to their GP. 30% would call if they were told they could not get a doctor’s appointment for several days.
- Around 60% of 999 calls made in London have no medical need for an ambulance at all.
The ambulance service has tried campaigning to stop people calling 999 inappropriately, but campaigns such as “Only one of these is a taxi service…” weren’t terribly successful. Apparently they inspired even more people to call 999 with rubbish, their rationale being “well, if other people are doing it and getting away with it, why shouldn’t I?” Instead, they’ve tried a new tack. They will let the inappropriate callers continue to call, and tailored their services so the calls are no longer inappropriate.
The 60% who call, but don’t need an ambulance, is made up of various types of call: complete timewasters like the Toe Taxi man, people who need hospital but not an ambulance (eg. someone with a broken arm, women in normal labour), people who need medical treatment but not hospital (eg. someone with chronic backache), people who need non-medical help (police, social work, carer, alcoholics anonymous), etc, etc.
Instead of sending a bog standard ambulance to lower priority calls, they can be dealt with by one of the following. Most of these are sent out by the Urgent Operations Centre, a separate control room upstairs from ours:
- Introduction of “intermediate tier” vehicles, which have a grade 1 technician crew with basic training (not the same as the technicians on ‘normal’ ambulances, who have a wider range of skills and can give some drugs) . Their role is just to get people to hospital if they need to go, but not as a life threatening emergency.
- Emergency Care Practioners, a paramedic with extra training who arrives in a car and treats the patient at home without them needing to go to hospital. They are particularly useful for stitching and dressing wounds.
- Telephone Advice, who call back the lowest priority calls and either tell the patient how to deal with their situation themselves (either homecare advice or by contacting their GP/midwife/etc) or determine that they do need an ambulance, and if so, what kind of ambulance and how quickly.
- Sending a car to every call. This system has not been introduced yet, but my understanding of it is that they will get a responder on scene to all calls as quickly as possible, and that responder will evaluate what is needed next. An ambulance will still be dispatched at the same time if possible, so this will not cause delays, but it can be cancelled by the car responder, so time wasters will not get their free ride to hospital.
Things I’d like to see happen too:
- Fines for those who lie to get an ambulance, or call us out for something they know not to be a life threatening emergency.
- Small charges for all calls (perhaps refundable with a doctor’s signature?) to deter people using ambulances because they can’t afford a taxi.
- Help with transport costs to hospital in taxis for people on a low income.
- Better availability of emergency GP appointments and visits. My local surgery only offers emergency appointments if you ring up between 9 and 10am - not much use if you get ill at 1030am!
- More education for what you should and shouldn’t call an ambulance for, coupled with what you should do instead, and the consequences of calling an ambulance that you don’t need, both in terms of punishment and the other people who will be deprived by your actions.
- Ability for patients to request non-emergency ambulances for themselves in certain circumstances via a different phone number. At the moment this can only be done via a doctor or other healthcare professional
- Reforms to AMPDS for more accurate categorisation of calls
All the methods that I’ve mentioned here are in their early stages, and right now they’re very overstretched. There are not enough Intermediate Tier vehicles and people have a long wait for a call back from Telephone Advice (half an hour to an hour is usual). Any overspill goes back to Nee Naw Control and interferes with the emergency workload, causing delays reaching the most seriously ill patients. But the situation is getting better - even in the two and a half years I have worked in Control, I have noticed the difference. Let’s hope things continue to improve.
52 Comments on “Handling Inappropriate Calls”
November 12th, 2006 at 4:50 pm
Exactly!
Night shifts last night….
Miles travelled - about 200
Number of Jobs - 4
Number of drink related jobs - 3
Number of Geniune Jobs (albeit drunken trauma) - 1
Number of people pretending to be ill because they want company - 1
Number of people pretending to be ill because they live near the hospital and want a free ride home - 1
Did I manage to have a sneaky 40 winks - no
Was I late off? - yes, of course
Am I grumpy? - yes, of course
I’m going back to bed now…..
November 12th, 2006 at 4:52 pm
I love my job as a paramedic and sometimes, just sometimes I have issues with “puzzle palace” (control). But I would not like to do your job for all the tea in China.
We on the road will berate you when a late job comes in making us late off shift (we all know you cold call people out of the phone book to see if they want an ambulance near to knocking off time), We will swear and cuss when you disturb our meal breaks if we get one (as we know you have linked the alerter/red phone/tannoy/bell/hooter/squawking seagull to the kettle or 8 minutes into the microwave programme). We will curse you to have your backsides infested with a plague of a thousand fleas when you pass us that Cat A Red Call which turns out to be Mrs. Gronklebumfartwrinkle who had a fall 2 weeks ago and now cant reach her remote control as her budgie has died and her neighbour has,nt seen her for 3 minutes ( as we are getting to know more and more that AMPDS is absolutely garbage!)
But thats the difference….you are tied by the AMPDS system and when the job does go well in control some of us just comment…”well thats their job innit?”
I take my hat off to you in control and I agree with your ideas for things you would like to happen reference fines and education etc.
I will try to be more understanding of puzzle palace in the future.
Best wishes…Kingmagic.
November 12th, 2006 at 4:52 pm
the first sentence of this posting doesn’t make sense - is it inappropriate 999 calls or appropriate 999 calls?
November 12th, 2006 at 4:56 pm
Well spotted, “me”… not enough sleep… freudian slip perhaps! Now corrected…
November 12th, 2006 at 5:22 pm
According to ‘Streetwatch’ the US blog, their AMPDS system is no better than tossing a coin if you compare priority assigned with the assessment made by the ambulance crew when they arrive. How you rewrite the protocols heaven knows. Till then your stuck.
Training everyone in first aid at school and then, like in Germany, learning first aid as part of the driving test would go a long way to solving this.
November 12th, 2006 at 6:12 pm
The ambulance service in Ontario had put a fine program into place - an ambulance would be dispatched, but if it was discovered that it wasn’t a true emergency (or if the ambulance was NOT necessary), the “patient” would be charged for the transport.
We saw a huge drop in non-emergency calls, including maternataxis and broken bones which could be handled by family transport, taxis, and so on.
It seems like that kind of approach would probably help you guys greatly.
November 12th, 2006 at 7:23 pm
Hey Mark, I found your blog through Tom Reynold’s Random Acts of Reality blog. Your blog is a fantastic read and got you on my blog-feed list, as well as on my Livejournal friends page.
But I have to contest your statement that someone with a broken arm doesn’t need an ambulance.
You see, my dear old mum has managed to break and dislocate her right arm so many times, I’m surprised she can’t take it off and reattach it as and when she fancies. Last time she broke her arm was abroad while snokelling, but before then was when she fell down the stairs at home.
Now, I don’t think I’m completely inept but I would have feel much more comfortable if I had a professional make sure her arm was bandaged/splinted well at home before going to hospital instead of trying to follow instructions over the phone with clumsy old me trying to bodge her arm back in place. Before said professionals could look at it in hospital!
So, OK, maybe an ambulance isn’t strictly needed, but it would be MUCH better if somebody like an EMT or in an FRU could come along and bandage my mum up before I drive her to hospital. But until the alternative ways come about and are more available, it looks like if myself or someone I know breaks an arm, I’ll be calling for an ambo.
Make of this what you will, sorry it might be a bit rambly, but I got distracted by writing this. Keep up the great writing!
Cheers,
Stuart
November 12th, 2006 at 7:48 pm
Stu, you’re right in a way, but wrong in another
Sometimes you will need to call an ambulance for a patient with a broken arm. It depends a number of things: eg. the seriousness of the break (I think you would be right to call for a fracture dislocation, by the way); the age and overall state of health of the patient; how they got the injury. There are no absolutes and not all broken arms are created equal!
On the other hand, tying a sling is really easy and not knowing how to should not be the reason for calling. You can learn this from a first aid book or a basic first aid course — and I am firmly of the belief that everyone should do a basic first aid course. A sling is not strictly necessary, so long as the patient can keep the injured arm still. A good way to do this is steadying it with the other arm. The ambulance crew will not splint the arm or try to replace a dislocation; they will just immobilise it in a way you could easily do yourself.
Also, remember that a GP can arrange a non-emergency ambulance for someone with a broken arm or other non-life threatening emergency. Just call your surgery and tell them what has happened and they will call us and arrange for someone to come within 1-3 hours.
Some good questions to ask yourself when deciding to call 999:
a) Is this a life threatening emergency?
b) Will the patient get worse if they do not get to hospital immediately?
c) Is the patient able to get in a car or taxi? Will putting the patient in a car/taxi make the condition worse?
d) Will the patient need treatment on the way to hospital?
For a broken arm, the answer to the first two is No, and to the second two is Maybe. You are the person on scene, and at the end of the day it is up to you to decide whether you need us. No one will ever say you are wrong to call an ambulance if you understand the system and genuinely believe one is needed.
November 12th, 2006 at 8:04 pm
The problem with the “charge for an ambulance wheeze” (from where I stand) is that:- the further down the social ladder you are, the fewer taxable hours you have ever worked in your life, and the more benefits you are claiming, the more likely you are to throw us nonsense calls. New Labour would therefore have to introduce “Trivial Calls for an Ambulance” Benefit which frivolous callers could draw and then pass on to us. Of course, the cost of accounting for, and administering such a system would greatly outstrip the actual amounts of the fines; and the system would be funded by the taxpayer anyway. If people failed to pay up, we would then have to blacklist them within the EMDC, and refuse to turn out to their next 999, or only turn up if they agreed to pay what they owed before we picked up the patient. Oops, that went wrong somewhere!
Some time ago, I was asked to comment on the Treasury Audit Committee report on the Scottish Ambulance Service; one of the first things that I noticed was that, whilst the ratio of non-emergency calls to emergency calls in rural/small-town Scotland was about 3:1, within the Central Belt, it was 1:1. Isolation makes you self reliant. The answer to the LAS’s problem (and ours) is therefore clear. Move all of city dwellers into the countryside, and demolish the towns.
Oh dear, I remember recently suggesting to the boss that the obvious answer to Scotland’s CatA compliance problem would to forbid anyone to live outside of the Central Belt, and to site all ambulance stations on a line between the Firth of Clyde and the Firth of Forth. A bit of a dilemma, then!
November 12th, 2006 at 9:32 pm
Absolutley totally agree with many of the above suggestions:
1. I think individuals should definitly be fined if they lie to get an ambulance, or if they call one when they know its not a life threatening emergency.
2. Not sure about a charge…because the time you really need to call…will be the time you are out of credit…plus, people get free minutes on their phones and probably wouldn’t mind ringing us to waste their minutes!
3. Better availabilities of GP’s full stop. No offence if you are a GP but they get £800 a shift and still refuse to visit a patient, or diagnose their illness over the phone we get it as a CATA and arrive to find the pt perfectly fine but with a slight sniffle and a tickly throat!
4. Education in the subject at school combined with first aid at school…..to replace those useless tutor period where you discuss your career for the year and never end up being n astronaught!!
5. ECP’s - fantastic
6. Support Tier - Fantastic for doing our urgent work, leaving qualified crews available for CATA and other emergencies
7. FR Cars….more needed, would be great to send one to every job to assess…..only issue is scenarios like an assault or violent pt, they can’t go alone and rarely the police turn up before us when we request them!!
8. AMPDS is a waste of time…need new systems
Sorry rant over….apologies if any offence caused
November 12th, 2006 at 9:34 pm
OOOH and KingMagic,
x
As much as we curse when you moan and as much as we hate it when u take that extra bit of time come clear….we really don’t like the jobs that come just as your about to finish either and we will try every other option but sometimes it just isn’t meant to be….just remember at the end of the day we love you too
November 12th, 2006 at 9:37 pm
[...] Dr Crippen has posted an excellent article; If you are ill, call a taxi, and Nee Naw has countered with another superb post: Handling Inappropriate Calls [...]
November 12th, 2006 at 10:40 pm
Aaaaah, Mark - very insightful. I’ve had to call for an ambulance only once so far personally. And that was when a friend got concussion from falling off a shopping trolley and hitting her head on the kerb. Fortunately she’s totally fine now and all the medical staff I met while there were fantastic.
I know that some campanies, if their fire alarm has a fault, the fire brigade turn up and then promptly charge the company for the service. I don’t think it’s very fair to charge people for calling an ambulance if it’s genuine, but I do think there should be tougher legislation as to what constitutes a waste of time. I’m not exactly qualified to say anyways. I’m just glad our health care in the UK is state-funded and not charged for privately like in the USA. I think that’s grossly unfair.
November 12th, 2006 at 10:46 pm
Blimey, I should have said as well that I am fully intending on taking a First Aid course, or doing some volunterring for good old St. Johns. But I don’t have the time immediately to enlist on a course like that. And I do agree that a basic first aid certificate should be compulsory for all school leavers. I think it’d make life much better for all.
November 12th, 2006 at 11:18 pm
Think you might need to explain this a little more clearly
“Introduction of “intermediate tier” vehicles, which have a technician crew with basic training. Their role is just to get people to hospital if they need to go, but not as a life threatening emergency.”
Doesn’t exactly create an impression of EMTs being trained ambulance staff. Not sure of the score in London, although I am lead to believe it is the same as most the country, but up here in EMAS land double tech crewed front line A&E vehicles are common place.
November 12th, 2006 at 11:55 pm
The technicians on intermediate tier vehicles in London are EMT 1s and have fewer skills than the EMTs on regular A+E vehicles. I’ll edit the post to make that clearer - thanks.
November 13th, 2006 at 12:59 am
Sorry, but I think Mr Bradleys assertion that there is no such thing as an inappropriate 999 call is tripe.
This is an EMERGENCY SERVICE, it isn’t Social Services, it isn’t the OOH service (yet), it isn’t the Community Psych Team and it isn’t a Drink/Drugs bloody helpline.
Perhaps if we stopped trying to be all things to all men and some of the others pulled their fingers out we might have half a chance of doing the job right, first time.
SD
Off to do my deep breathing exercises now…………
November 13th, 2006 at 6:28 am
The “within the hour” ambulances are the worst casualty of excess demand - when all the ambulances are out they can just wait and wait. An 80 year on the floor comes above an 80 year old safely in a hospital, which is fair enough, but when it’s a 20 year old with the sniffles taking up the ambulance instead it is really frustrating. The rules say the 20 year old comes first, because they dialled 999, while the hospital booked an non-emergency ambulance. I hate it.
Elderly people often need an ambulance for something a younger person wouldn’t. A broken arm on its own isn’t a very compelling reason to call but a elderly patient with a broken arm who is pale and clammy and very distressed is. If you think you should call, call. Hope this isn’t going to turn into a debate on whether you should call 999 for broken arms
My idea with charging would be to charge something like £5 for each call - the equivalent of a cab fare. They would get a bill for it when they arrive at hospital to pay within a month or something (don’t want people to be worrying about cash when they call). A doctor could sign to say the call was a life threatening emergency and cancel the charge. That way people could have an ambulance if they felt they needed one, even if it was for something non life threatening, but no one would call just because they wanted to save the cab fare (which a lot of people do).
BabyEMD, I didn’t mean charging for the phone call, that should definitely remain free!
November 13th, 2006 at 7:54 am
Mark, I’m sure I’ve mentioned this before, regarding fines for timewasers - but what about the little old lady who sits there in pain, worrying that she’ll get a fine if there’s nothing really wrong? I know of so many elderly people already who “don’t like to be a bother” even though they’re seriously poorly.
Aside from that, yes, fines are a brilliant idea. Your toe man should have his fine doubled for deliberately ringing back and getting the call re-triaged. (is that a word? you know what I mean!)
November 13th, 2006 at 9:23 am
In reality you have to go through quite a process before a fine is levied and the ‘patient’ is made very well aware of what is appropriate and what isn’t.
One of the premises of the NHS is that it is free at the point of delivery, the answer lies in not delivering the service in the first place for inappropriate callers. Every time an ambulance goes out their behaviour is reinforced.
SD
November 13th, 2006 at 10:44 am
kevinmillhill said,
“If people failed to pay up, we would then have to blacklist them within the EMDC, and refuse to turn out to their next 999,”
We downunder are not allowed to not send an ambulance if they have not paid us for the last time. We to have a few time wasters, and under AMPDS they still get an ambulance, unless we can catch them out,
Drs are not all inocent either. We have had Drs ring us to book an ambulance, they have seen the paitent at their rooms, sent the paitent home, which can be in the middle of knowhere, and they requested we go and pick them up and deliver to the Emergency Department. Sometimes it can be a 1 1/2 hour or more transport time.
November 13th, 2006 at 10:46 am
Yes i realise there are spelling mistakes. It is 10:46 PM here, not quiet thru halfway thru a 14 hour shift.
November 13th, 2006 at 11:23 am
I think fines for inappropriate use would be good - I also think that the idea of a charge which can be cancelled by a doctor (even possibly the A & E doctor) if the call is valid is excellent.
Schools should do First Aid courses (I know my school did many years ago), and I also think that a First Aid course should be a part of ante-natal care (for both parents where applicable) to ensure that as many people as possible stay as current as possible with their first aid skills.
But, it would also be nice to have better out of hours back-up. For example, we live in a rural location and our “local” hospital is 42 miles away. We can see a doctor easily (and I must stress that our local GPs are absolutely excellent - same day appointments, emergency appointments with no problem, really good back-up!) between the hours of 8.00 a.m. and 6.00 p.m. But if anything happens outside those hours, we’re reliant on NHS24, on-call doctors who don’t like doing home visits, and the nearest “minor injuries/doctor unit” 12 miles away. That’s fine if, like me, you’ve got a car, but if you haven’t, you are completely stuck with an hourly bus service (running until 9.00 p.m.), a taxi if you can afford it, or an ambulance. So that extra tier that you suggest, ECPs and response cars, would be an excellent addition here.
November 13th, 2006 at 11:34 am
Use your ECPs, Use your ECPs, Use your ECPs, Use your ECPs, Use your ECPs………………………………….
‘cos if you don’t they’ll leave, just like many of them are already.
SD
November 13th, 2006 at 1:01 pm
Dear Olivia,
The joys of life in rural Scotland; the fact of the matter is that - in areas such as yours (and mine) - ambulance demand simply isn’t that great. The existing service -allied to NHS24 and OOH copes with the weight of calls, and there is neither need nor justification for additional resources. Our real problem is that of meeting response targets; on an average shift, I’ll handle 3 - 4 calls, which doesn’t sound much, until you realise that I work within a catchment area of 34miles by 64, and that most calls take about 2hrs from start to finish. Bang goes your 8min rsponse!
The OOH/NHS24 response hereabouts is a measured one; country folks tend to be self reliant, and are reluctant to “bother” the ambulance service. In an intersting inversion of the “frivolous calls” problem, many people will try to call for a doctor when they should really be dialling 999. By careful questioning, the NHS24 call taker decides whether she actually has such a case on her hands, and, if so, puts it straight across to our EMDC. If it’s less urgent, the options go:
a. Can you bring the patient to OOH yourself?
b. Can you get a taxi?
c. OK, we’ll send a car for you.
d. OK, we’ll send an ambulance, low priority.
e. OK, we’ll see whether we can get a doctor to attend.
f. That will keep. See your GP in the morning.
The logic of keeping the doctor up your sleeve for as long as possible is that he/she can see umpteen patients in the OOH surgery in the time it takes to go and see one person in a distant village. It isn’t because they don’t want to.
Our local OOH surgery is situated in an extension to the hospital adjacent to the A&E entrance. It is bolted and barred and has large notices telling you that you need to call. It is not a “drop in” centre. It operates four 4-wheel drive cars on each shift. As we come and go at A&E during the OOH hours, we notice a steady trickle of patients, most of whom get there under their own steam.
The fact that - however you got there - getting home again is your problem, is probably a big incentive.
We still see plenty of jobs where the OOH doctor has already attended (usually to the elderly or bedridden); and, now that the system has been up and running for a while, the worst it seems to do is to “fail safe”. I’ve often arrived - whistles, flags, and bells blazing - at a job that - once seen - didn’t really merit the emergency response NHS24 had allocated, but I’ve seldom been sent by NHS24 to a job that didn’t need an ambulance.
November 13th, 2006 at 2:25 pm
The problem with the idea of fining people who call inappropriately is the proof - some of our regulars are so clued up on what will win them a trip to hospital. Often these are people who live near the hospital and want a free ride back to their area, and will then discharge themselves and go home, or No fixed abode types who fancy the idea of a sleep on a nice comfy hospital trolley when it’s raining (I do sympathise with NFAs on a rainy night, but A&E just doesn’t have the room). A patient the other night claimed central neck pain from tripping up a curb - not a mark on him, story made no sense, we know he lives near the hospital and the only legitimate way home at that time of night is a £40 taxi ride, but how can I prove that he’s just after a free ride? Obviously we put the hard collar on nice and tight and strapped him down good (make him suffer a bit!) but I have to take him to hospital, and he knows it.
November 13th, 2006 at 6:10 pm
Re; RuralPara above. Until 4 years ago, I worked at a small-town/rural station which had the blessing of being precisely half way between two larger towns (40 miles apart), each of which had a fully-functioning A&E Dept. This meant that, when we thought we were looking at someone who just wanted a lift home, we simply had to ascertain his home address. A little bit of straight-faced acting would then leave the patient believing that we had no choice but to take him to the hospital in the other town; at this moment, a miraculous recovery would often take place
If he didn’t recover, we would assume that he was genuine, and take him to his “home “hospital
November 13th, 2006 at 7:16 pm
I’m going to go against the crowd here and say I don’t think that fines for inappropriate calls would be a good idea. I don’t think you could set the fine at a level that would discourage drunk/stupid people without also discouraging genuine emergencies (drunk/stupid people aren’t in my experience the best at judging what constitutes a waste of money)
Also there was an interesting chapter in Freakonomics by Steven Levitt which covered a similar situation - A childcare center had a problem with parents arriving late to pick up their children. They tried to combat this by imposing a small fine for every minute that the parents were late. Once this system was in place they found that the problem got much worse. The fine wasn’t big enough to discourage the parents, and as they were paying for the extra time the parents stopped feeling bad about being late - having to pay the fine just gave them a sense of entitlement.
I can just imagine an increase in patients with flu symptoms - “I don’t feel well, I want an ambulance and I’ve got the £5 to pay for it - what are you complaining about!!!”
November 13th, 2006 at 7:47 pm
Dear Rachel Morris,
I don’t think that you are going against the flow . The comments above from those of us “in the job” show that we instinctively know that such a system would be unworkable, and that it would probably make matters worse (though you’d have to try it in practice to see what totally unexpected effects it would have). I speak with the voice of experience!
North of the Border, we once had a “fines” system which worked beautifully in the bean counters’ heads, but which fell apart when applied to “real” people. ie. us. In the early 90s, our last Chief Executive, appalled by the sickness rate, introduced an “Attendance Allowance”. If you had perfect attendance, you received a monthly bonus (I think that it was about £30); if you had even one day off, you lost it. So what happened? Staff who had had a legitimate couple of days off thought “I’ve lost my 30 quid now, so I might as well make it a week”. The sickness rate went up, not down.
The same man also introduced an “Inventions and Ideas” scheme which awarded you £20 even if your idea was turned down………….
November 13th, 2006 at 9:05 pm
I was thinking of a huge fine for timewasters, equivalent to what it actually costs to send them an ambulance (that is, people like the toe taxi guy, who wilfully misuse the service). The £5 charge would be people who are genuinely ill but not an immediately life threatening emergency. People like the examples other readers have given about broken arms.
You’re right, though, the idea probably is full of holes and wouldn’t work in practice. There’s a reason why I work in the control room and not in management
November 13th, 2006 at 10:45 pm
[...] Nee Naw [...]
November 13th, 2006 at 11:56 pm
In reply to Baby EMD. Our RRVs/FRUs get sent to most types of job. Apart from drink related in a pub/club, assaults, domestics, drug related or where the call is very vague to a dodgy area.
The exception is where the RRV/RFU feels safe to attend for example a collapse in a pub where the info is a ?CVA or suspected heart attack. We can be asked to attend anything but if we feel its too dangerous then we can decline with no comebacks…..and its not abused.
A new system we have employed is the Papa-Charlie RRV which is a car crewed by a para/tech and a police officer. It gets sent to all the normal calls but also to the drunken assaults etc.
So far it has been very succesful with a second unit coming on line in the near future. Its good for us and good for the police with an increased working partnership helping us to get a police presence right away. Its run by the ambulance service with the para/tech driving/attending and the police officer being there to enforce the law and protect and also to help out if the job turns out to be a resus for instance.
On another note I think Marks Nee Naw blog should be recommended reading for all new trainees in the service if not everyone.
November 14th, 2006 at 1:08 am
In Ontario they charge schools for false fire alarms. You’re allowed a coupe per year, but after that you pay for the cost of turnout, which is between $5000 and $10,000 per visit. This provides schools with a real incentive to catch kids who pull alarms for pranks — and we aren’t shy about passing the bill on to the kid’s family if they’re caught (eg. on videocamera).
Oddly enough, after this poslicy was announced, and after a family had been billed (thus proving that the financial cost was real), false alarms dropped by a factor of 10.
November 14th, 2006 at 7:29 am
We have laws in place for false 911 calls (999 in your bog) but getting a copper to actually charge someone is almost impossible. I guess we’re just stuck with this one.
November 14th, 2006 at 11:21 am
I can see that the idea of fines has already been decided on here to have a lot of holes in but i thought i’d add my thoughts…
yesterday i had reason to call an ambulance. i found an unconcious male on the pavement as i was driving home. when i shook him (gently) he groaned and tried to sit up. after a few attempts he managed to sit up but was unable to answer questions regarding his name, whether he had epilepsy or diabetes or where he lived. i could see that he’d had a nasty knock on the head from the fresh graze on his forehead.
this young man didn’t appear to me (or my doctor friend who was with me) like a standard drunk, he insisted he didn’t need an ambulance but we couldn’t leave him sat on the pavement unable to stand and unable to recall his name or address.
I called an ambulance (against his wishes) and explained to the dispatcher that he was breathing and now concious but not making any sense, we received an ambulance within 6 minutes of ending the call.
my question is this, if it did turn out that he was just a drunk and therefore an inappropriate call, would i be responsible for the fine? if that is the case wouldn’t that significantly decrease the helpfulness of passers by in an emergency?
November 14th, 2006 at 1:17 pm
Ellie, I think passersby can be “helpful” without necessarily calling an ambulance.
If you’re in an area with a shop or office then you score, because workplaces (especially that members of the public may visit) are supposed to have a designated first-aider and you can ask them to take care of things. Or you can try and get the person to check their pockets (don’t start doing it for them!) which can turn up medications, or a driver’s licence, or a wallet containing cards with their name on, and if you’re lucky their mobile phone so you/they can call whoever is under “home” “dad” or “mum” or if they are really sensible, whoever is under “ICE” (In Case of Emergency). If there’s no help there, just take two minutes to sit with them and see if they improve at all - often if someone’s collapsed because of low blood pressure or whatnot, things get better after a minute of being on the floor.
(I worry about your question from the opposite side of the fence - if I collapse in public while I am on my own (happens more often than I’d like) and while I am too groggy to get up or speak sense, someone else calls me an ambulance that I really don’t need at all, would *I* be responsible for the fine?)
November 14th, 2006 at 1:46 pm
I’m a bit concerned about the ethics of deliberately going contrary to the stated wishes of someone and calling assistance for them when they are obviously conscious. Personal stake in the answer: I was sitting with a collapsed drunk one day trying to persuade him to get help for a head wound which was not bleeding any more but looked nasty, and a woman walking by asked if I’d called an ambulance. I said that the drunk had refused one but I was trying to persuade him to change his mind; she called one and walked off. I sat with him until the ambulance and police arrived; the ambulance staff were clearly annoyed that they’d been called, and rightly so, and he was annoyed too. I was able to tell them his first name and the name of the street where he lived, because of my conversation while he was bleeding gently onto my jacket, but nothing more. I couldn’t even tell whether he smelled of drink because the smell of cigarettes was so strong.
November 14th, 2006 at 5:12 pm
The arguement for calling against someone’s wishes would be in case that person who appeared drunk was actually having a diabetic hypo, or had some kind of head injury/bleeding in the brain, all of which can seem like drunkeness - lack of co-ordination, slurred speech, aggressiveness, etc.
I don’t tend to get annoyed with well meaning passers-by who call on behalf of someone else, unless it’s for something silly like a grazed knee, or sometimes people are so ‘concerned’ that they call the ambulance for the person they see ‘collapsed’ (often an NFA snoozing harmlessly in a doorway!) and then scarper. Of course sadly they aren’t there anymore for me to get annoyed with…
November 14th, 2006 at 5:31 pm
+++++If you’re in an area with a shop or office then you score, because workplaces (especially that members of the public may visit) are supposed to have a designated first-aider and you can ask them to take care of things. +++++
Not strictly true. If the person isn’t in the shop, or wherever they are, and is merely on the road, then the shop don’t have to send out their first aider to deal with it. Its issues with insurance.
At work, we would absolutely NOT send our first aider onto the street to deal with a problem (well, depends on the situation really! But generally its a no. You just can’t get involved anymore incase you are sued!).
November 14th, 2006 at 7:04 pm
the situation last night was that it was late (about 10pm) no shops were open and there are no other businesses in that area. it was cold and raining. the man had been unconcious / sleeping in the middle of the pavement wearing only a thin jacket. he showed no sign of being able to find his way home as he couldn’t remember where home was.
neither me or my friend were willing to leave him as we were both concerned that if he got to his feet he might stumble into the road (he was showing no awareness of where he was or what was going on really)
having been unable to rule out epilepsy or diabetes, and considering the man’s grazed head and incoherent words we decided to call the ambulance anyway. i feel that i did the right thing as there was obviously something wrong with him and he could not have got home safely. i’m not sure if the ambulance crew decided he was drunk and called the police or if they took him to the hospital but either way i know that he was looked after and not left on the pavement to get hypothermia.
November 14th, 2006 at 8:57 pm
Ah, I asked my victim if he’d been drinking and he said yes, that was why he fell. However, to do this I had to hold a much longer conversation with him than the woman who phoned was willing to do; she rushed off as soon as she’d phoned, leaving me to face the rightfully indignant ambulance staff.
November 14th, 2006 at 9:32 pm
In reply to Ellie…
The thing about calling for someone who is refusing help is that the ambulance can’t treat a patient against their will. So if someone says “I don’t want an ambulance” and you’re pretty sure they mean it, you probably shouldn’t call. All that will happen is that the ambulance will turn up, the person will say “Go away, I don’t want you to treat me” and the crew will have had a wasted journey.
If you see someone who looks as if they need help, and you’re sure it is safe to approach them, ask them what is wrong and what you can do before calling anyone.
I don’t think anyone should be fined for calling an ambulance for something they thought was a life-threatening emergency but turned out not to be one. They should only be fined for things such as hoaxes and lying to get an ambulance, or calling because they won’t pay for a taxi or wait for a GP appointment. Your heart was in the right place when you called, and I’d hate to see people get fined for trying to help someone.
November 15th, 2006 at 1:58 am
FAO KingMagic
CharliePapa is fantastic, we also have a para/tech with a police officer on duty….unfortunatly not often enough but when they are there it really counts.
And i agree…this website should be in every newbies EMD book everywhere!!
x
November 15th, 2006 at 5:48 am
Here we have a dual system that seems to work.
For a small sum a year, you can join St johns Ambulance. Then if you call an ambulance you get a ride for free, if it is a real emergency - the hospital or doctor decide. Otherwise you pay. If you have an accident, then the ACC (our compulsory accident cover) will pay. However if you don’t join you have to pay for the ambulance. There are add on extra’s, like alarms for old people who are ill or fall. We had one for my father, which he did us, as he thought the ambulance service was ‘more medical’ rather than one of the security firms. Of course in the rural areas here, you might get a fire engine turn up if all the ambulances are busy. A bit disconcerting but still a comfort in an emergency. Still I haven’t seen any ambulances sent to put out fires!
November 17th, 2006 at 6:25 pm
[...] Inspired by this post at Nee Naw. Technorati Tags: ambulance, fuck+you, Fuck You, funny+shit, funny shit, nee+naw, rant, spot+the+difference, taxi [...]
November 18th, 2006 at 6:53 am
Mark said Around 60% of 999 calls made in London have no medical need for an ambulance at all.
I teach English to international students at a Sydney university. I’ve been teaching what it’s not okay to call an ambulance for since one of my students told me the ambulance they called refused to take them to the airport to get their flight.
Several commenters said a lot of elderly people are reluctant to “bother” the ambulance. Dead right. My Gran wouldn’t ring for an ambulance until her 3rd stroke (1st and 2nd times someone else rang). I’d say the same for most of the Dear Old Things living near me. However, the drunk down the road rings 000 (999/911) every time he knocks his beer over.
November 19th, 2006 at 12:03 am
It strikes me that an awful lot of the inappropriate calls you handle would not have occurred if people had some first aid training at school. Simply describing the symptoms of an eplieptic fit, explaining that early labour is not enormously risky and basic techniques such as stopping ordinary bleeding, would save a lot of ambulance time. But we have such an aura of mystery around the human body in this country, we prefer to call an ambulance and shunt the responsibilty onto someone who, we imagine, has more knowledge than we do.
November 28th, 2006 at 1:17 pm
I strongly support better first aid training in schools. Not only should it be universal, but the scope needs to be better; all we were taught (in a moderately dodgy comprehensive in the Midlands) was CPR and the recovery position. All very useful if someone has a heart attack, but what use was it to the kids hanging around with my brother when he fell and broke his wrist?
Mind you, the one time I did call an ambulance I got a bit of a telling-off from the FRU guy for not ringing NHS Direct instead. This for a roommate of mine who was semi-conscious, running an appallingly high fever and groaning in pain, with every calendar in the building provided by a meningitis awareness charity and neither the patient nor the pal of his who found him able to speak much English.
November 28th, 2006 at 1:26 pm
Yeah, I think I’ve seen the charts provided by that meningitis charity and I find them a bit misleading. They give all the signs of meningitis but don’t point out that a lot of those things are a sign of flu too.
December 1st, 2006 at 7:07 pm
Perhaps you should have the ability, as we do in the police service, to tell callers to piss off if we think they’re taking the michael…
December 3rd, 2006 at 3:43 pm
I’ve been wondering for a while what would happen if the ambulance service just paid for anyone who took a taxi to A&E (and was ‘admitted’, or whatever the term is). Sure, some people who would have paid for a taxi will then get their ride paid for, and possibly some who would have driven (but of course they still then have to make their way back).
But, especially in London where the distance to the nearest A&E isn’t generally that far, how many free taxi rides would it take to equal the cost of sending out one ambulance?
It would be a lot more popular than a £5 call-out charge, too!
December 7th, 2006 at 1:00 am
In the area I work in all Cat C calls are now put through to us at NHS Direct. Joe Dolequeue often gets quite a shock when, instead of a neenaw machine he gets a call from me about his hiccups/stubbed toe/earache