When it gets busy, the dispatch desks spend a lot of time calling back our lower priority calls “apologising” for delays and hoping that the callers will get the message that they shouldn’t be calling us and should be calling a GP/taxi/etc instead. We are not allowed to refuse people an ambulance but we are allowed to warn them of long delays and generally coax them into deciding to cancel and deal with the problem more appropriately. We are on rather shaky ground doing this, but since the Telephone Advice people stopped using TAS and started using a new system called PSIAM we have no option. Gone are the days of the No Send Policy — using PSIAM, Telephone Advice are forced to make us send out ambulances for any person who insists on one. As you can tell, I am not a fan. I fear for us dispatchers, because one day, in an effort to weed out an inappropriate call, we are going end up coaxing someone who is seriously ill but mistriaged as low priority to make their own way to hospital, and the papers will get hold of it, and all hell will break lose. It shouldn’t fall on us to do this; Telephone Advice should be given their old system back, which worked perfectly well in getting rid of the time wasters and identifying the seriously ill people who had erroneously been triaged as low priority.
Anyway, despite these worries, I felt reasonably confident in calling back a thirty-year old man whose symptoms were given as “runny nose, cough, slight fever, headache, for two days”.
“Hello sir,” I began. “This is the London Ambulance Service here. I’m ringing to apologise for the delay. All our vehicles are busy dealing with other emergencies” (I emphasised the word “emergencies”.) “How are you feeling?”
“I have a cold!” grumbled the man, as if that much had not been obvious.
“I see,” I said. “And has anything changed since you called? Have you done anything for your… cold?”
“No!” said the man. “Nothing has changed, and I have had it for TWO DAYS! I went to the hospital yesterday, and they did NOTHING! They told me to take paracetamol and sent me home. They were not able to cure me!”
“Well, sir,” I said. “That’s the thing about the common cold — there is no cure. If you’re sure that’s what it is, then you just have to wait for it to go away.”
The man tsked and muttered something about the state of the NHS, and then cancelled the ambulance, which was good, because we needed five vehicles for an 80mph RTA on a 30mph road, and wouldn’t have had one for him for hours.
I think a lot of our inappropriate callers share the underlying beliefs of this caller, which is that if you are ill or injured and feeling lousy, you shouldn’t have to put up with it, and that someone from the medical profession will always be able to come along and wave a magic wand, which will make you feel better. It just doesn’t occur to people to go to bed and take some time out and wait for whatever is wrong with them to go away. Everything has to be fixed instantly, and if it can’t be, it is always someone’s fault.
February 13th, 2007 at 12:27 pm
Do you think it’s partly because the NHS is free at the point of delivery, and people see it as their right to receive services such as an emergency ambulance, because they’ve paid their taxes?
February 13th, 2007 at 12:34 pm
Definitely. People trot out the “But I’ve paid my taxes, I’m entitled!” line quite a lot. I’d like to tell them “you’ve paid for schools too, it doesn’t mean you can go and join a class of five year olds” but that would probably get me in trouble.
February 13th, 2007 at 1:48 pm
What’s your opinion on the plans laid out by the health minister Andy Burnham for paramedics to be given the right to refuse patients?
Story here: http://www.guardian.co.uk/uk_news/story/0,,2003073,00.html
February 13th, 2007 at 2:10 pm
Some people really try their luck - ambulances are for people who actually need to go to hospital!! I’ve paid my taxes too, but I’m not stupid enough to call 999 for a cold! I felt bad enough about calling 999 when I had anaphylaxis, but at least that’s a good reason.
February 13th, 2007 at 3:00 pm
It’s great to start the day off with a good laugh. Thanks, Mark!
I mean, a grown man who doesn’t know colds aren’t curable? Are you *serious*? /*starts snickering again*/
February 13th, 2007 at 3:10 pm
Rock on Andy Burnham. Hope this also let us tell people to travel with their mum, even if they do need to go to hospital, when things are not bad.
February 13th, 2007 at 3:14 pm
How is it possible to be able to use a telephone yet not be aware that a cold is a fact of life?
I would be very tempted to give a big long list of things that really must be done to make the cold go away within seven days, whereas without doing these things the cold could last as long as a week! Give him a big old shopping list (orange juice, “balsam” tissues, polo mints, vicks vaporub, chicken soup, you name it) and then tell him to drink exactly half a pint of plain water every hour on the hour, only sleep facing south, make sure he puts his left sock on first, anything you can think of.
Failing that I’d be tempted to tell him it’s bird flu and he mustn’t use the phone any more as it can be transmitted down the wires.
February 13th, 2007 at 3:16 pm
Ollie, I totally support the health minister’s pan, although I thought paramedics were already supposed to be able to refuse patients anyway - see the link on “no send policy”.
quixote, what I’ve been wondering is had this guy never had a cold before?! Thirty years without a cold isn’t bad going. I seem to have one every other week! I should call him back and ask what his secret is.
February 13th, 2007 at 4:18 pm
To put my devil’s advocate hat on, surely it is the point of the NHS to cure the sick and the ill? However, the man in question, demanding an ambulance for a cold, was a prat and common sense wouldn’t go amiss sometimes with such people.. (I even took the bus to the hospital when I broke my hand, so I suspect I may have different criteria for what is a genuine emergency than others).
February 13th, 2007 at 5:18 pm
Perhaps we should have the Vicks Vaporub and Chicken Soup in the drug bag along side the adrenalin and morphine?
February 13th, 2007 at 5:20 pm
Sadly, people have funny ideas on what constitutes an Emergency. And the people that I feel truly sorry for are the little old ladies who always say, “I’m sorry to trouble you dear…”, despite the fact that they do truly need an Ambulance!
Regards all
Nick
http://nickhough.blogspot.com
February 13th, 2007 at 5:28 pm
“Everything has to be fixed instantly, and if it can’t be, it is always someone’s fault.”
That should probably read: “it is always SOMEONE ELSE’S fault”, because Heaven Forbid anyone should acknowledge the slightest bit of responsibility for themselves ( or their family)! Great post, as always.
February 13th, 2007 at 6:29 pm
In reply to Mark Reed:
To put my devil’s advocate hat on, surely it is the point of the NHS to cure the sick and the ill?
I think the point of the NHS is to cure what can be cured, and minimise pain and discomfort for what can’t. I think as far as some people are concerned that’s not good enough, they think the NHS should be able to eradicate illness altogether. If only they could! And good on you for getting the bus with your broken hand
Not everyone is so considerate.
February 13th, 2007 at 6:55 pm
I don’t know what is happening in your service Mark, but we use psiam and it seems to weed out a lot of the nonsense, (when I say a lot, there is still plenty more to be able to send us too!!).
Nicenurse
February 14th, 2007 at 1:46 am
An ambulance for a cold?!? Should have sent the police round
Last time I had to call an ambulance, I just collided with a car at 30mph (on a pushbike), and I felt real bad about it - im sure after some time, I could have gotten up and walked to the hospital - It was 300 meters up the road! All the fuss having 2 crews being called out for little young me lying on the cold road…
February 14th, 2007 at 11:36 am
Re 30 year old male with cold.
Not man flu, but boy flu, he just needed his mum (not an ambulance) to come round and look after him.
February 14th, 2007 at 1:46 pm
My parents had to call an ambulance for me before xmas - I had a catheter in which was blocked and I was literally screaming with the pain. They tried for ages to get hold of the out of hours district nurses (but as the calls go through the OOH GPs no one was picking up!). Mother was so apologetic when she rang, a blocked cath is not an emergency, but when 30 mgs of Sevredol wont touch the pain you know you need help! Someone did ring back (just as the dam burst and it went everywhere!)and were very nice. said that we did still need an ambulance and not to worry about ringing. I was mortified that we’d had to call in the first place.
I guess the point of this waffle, is to say that having read your blog for ages I knew that this would happen (knew that AMPDS would put a blocked cath as non urgent - wish it could have felt the pain!). Maybe if the general oublic were more clued up on what actually happens when you ring 999 some of this could be avoided. ie, someone at work had a funny turn and my boss got someone to call 999, so the questions were being shouted down the office, and unnecessary answers being shouted back. I did tell her afterwards that it is best if the person ringing is actually with the casualty…
February 15th, 2007 at 12:39 am
Sue, they should have sent you an ECP……….. Whoever wrote the AMPDS guidance on blocked catheters has clearly never experienced it.
Who says everyone who rings 999 has the right to an ambulance? People with acute life threatening conditions have a right to an ambulance, idiots ringing with common colds are the ones denying the service to sick patients, not the NHS.
Some services need to grow some balls and stop pandering to people who abuse what is afterall an emergency service to the detriment of seriously ill patients.
SD
February 15th, 2007 at 2:20 am
Mark Myers said,
on February 13th, 2007 at 6:29 pm
In reply to Mark Reed:
“To put my devil’s advocate hat on, surely it is the point of the NHS to cure the sick and the ill?”
“I think the point of the NHS is to cure what can be cured, and minimise pain and discomfort for what can’t.”
Out of the many terrible illnesses that cannot be cured (and sometimes not even minimised) a common cold is nothing. That’s not the fault of anyone woking in the NHS, it’s just mankind doesn’t have all the answers. Fact of life. This “man” with the cold needs to build a bridge and get over it.
February 15th, 2007 at 2:30 am
Sorry Mark Reed, that wasn’t a dig at you. I’m worried my post may have come across wrongly. I just quoted that question because I thought Marks reply was a good point - the fact that the point of the NHS is to cure what can be cured. I probably should have just quoted that bit. Ignore me; I’m tired.
I just can’yt believe that this man was moaning about the state of the NHS because they have no cure for his common cold.
I remember having a cold one time and my ME/CFS symptoms seemed to ease off while I was “ill” with my cold. I felt better than I had in ages and got lots more done.
February 15th, 2007 at 3:28 am
The problem facing the Ambulance service in general, is that Sod’s Law has entire chapters devoted to us.
I dream of the day when I can tell the time wasters, whiners, blaggers and frequent callers exactly whats going on and where to shove it. But I know that according to Sod’s Law they will choose that day to die of some hitherto unheard of disease, that we should have known about all along.
Fines would help. Education would help…..what would really work is if the Country remembered that life isn’t nice or fair and sometimes people deserve the consequences of their actions. But people have got used to having everything on a plate and someone to blame if it’s not to their liking.
February 15th, 2007 at 8:23 pm
i have ended up in hospital twice in the last two years and each time i have been asked how i go there. once with a nasty broken arm - i called a taxi and most recently with pleurisy and pneumonia - no taxis because of snow - i took the bus. each time the doctor said i should have called an ambulance. i am not an emergency i said….
February 16th, 2007 at 11:37 pm
That’s OK, I was just playing devil’s advocate - it seems to me that often common sense is missing from the illness equasion of people. I know what can’t be cured, and I have to let that slide.
February 19th, 2007 at 6:01 am
I enjoy your blog so much and thank you for the frequent posts about your work. Sad to say but there are folk who’d take poison sure to kill them if a government offered it “for free”. Actually, that might be a way to clear the gene pool!
August 9th, 2007 at 11:42 am
I’m trying to find out exactly what medical services are available ‘out of hours’. I recently needed to consult with a GP outside of normal working hours and found that I couldn’t make an appointment. It’s been years since I last visited the doc. so it was something of a surprise. When I managed to speak with someone (NHS direct I think) they recommended that I use a Provate GP servide such as this one: http://www.yourguidetomenshealth.co.uk/treatments_private_gp_services.asp
Is that the only option?
October 3rd, 2008 at 7:27 am
Use of Telephone triage is only as good as the user. I use PSiam at work and often alter the disposition for one which is more sensible, using my skills of nearly 25 years to sort out the snifflers from those who really do need an ambulance. PSiam certainly does not force me to send out an ambulance
Judith