(The title of the post is the motto on the new London Ambulance mouse mats dotted about control, most of which have already been pinched).
Last Friday (that is, the Friday before I originally wrote this post) was the busiest day the Nee Naw service have had this year, with a total of five thousand and something calls, even more than we received on New Year’s day. Not only was it topping 30°, it was Friday night (always busy) and it was the last weekend of the month, meaning people everywhere were rushing to pub gardens to spend their newly acquired wages and have alcohol related accidents. The upshot of an increase in demand is inevitably an increase in waiting times. You’ve probably seen at some point a TV documentary about someone’s gran who died whilst waiting hours for an ambulance that never came; this is by no means a common occurence in Nee Naw Control but on days like this it does happen and when it does, Nee Naw Control is not a nice place to work. There is a horrible sinking feeling because you know that the service is completely unable to meet the demand. A red flashing light above the call takers’ heads inform us how many calls are waiting to get through (the highest number I saw on Friday was fifty-one, which means someone could wait ten minutes just to be connected) and behind the dispatch desks there are piles and piles of pink call receipts waiting to be given out. Half the calls that come through are The Operator informing us that someone has hung up whilst queueing to be answered, people ringing back to see where the ambulance is, and people wanting the complaints number because of the time they’ve had to wait.
One of the worst examples of the consequences of the increased workload was a call I received from a desperately-trying-to-remain-polite woman who had stumbled across a man possibly having a heart attack on the street. The call had initially been received as “chest pain”; now she was ringing back because, fifteen minutes after making the call, the patient’s condition was deteriorating and there was no sign of the ambulance. The nee naw service’s target for a call like this is to be on scene within eight minutes; 75% of the time we manage it. I checked with the supervisor and was told we were still holding the call. Because the patient was now unconscious, I retriaged the call, it went up a notch from a “red 3″ to a “red 2″ and finally it was top of the queue and got the next ambulance. I stayed with the woman on the phone for another ten minutes until the ambulance arrived. She did everything by the book, and although her frustration was obvious, she did not lose her temper and start shouting “Just send me a b*****y ambulance!” (unlike most of that day’s callers). Despite this, the man’s condition continued to deteriorate. His breathing became slow and rasping and eventually she wasn’t sure if he was breathing at all. We began CPR, and finally nee naw sirens were heard in the distance.
After a call where life has been hanging in the balance, I usually pop up to dispatch on my next break to see what happened next, but on this occasion I didn’t really want to. I think I heard that man die before my eyes (well, my ears) and all due to the fact we couldn’t send him an ambulance in time. It wasn’t a very nice feeling.
Another consequence of the increased demand is that, while the serious calls receive an ambulance late, the non serious calls sometimes don’t receive one at all. Calls are given out in such a way that the top priority calls always jump to the top of the queue and the low priority calls are only given out when there are free ambulances and no higher priority calls waiting. Low priority calls are stuff like broken arms, backache, stomachache and women in the early stages of labour. Most of these calls can be dealt with by TAS (telephone advice) or suddenly develop an ability to get in a taxi when they realise how long they will have to wait for a free ride. There’s always one that won’t give up, though, and this was a pregnant woman who’d called for an ambulance the second she went into labour. It was her first baby, the contractions were miles apart, the birth wasn’t going to happen any time soon, but she insisted she couldn’t get in a taxi. This is not true, pregnant women are perfectly capable of getting into taxis. I explain that she’d have to wait, and that unfortunately I didn’t know how long and she became irate and started shouting, saying “What do you want me to do? You want me to have my baby here before I get an ambulance?” The thing is that that situation would constitute an emergency, whereas the early stages of labour do not. I tried to explain this, and the woman threatened to report me to the complaints department. I am not bothered; the complaints department would be on my side as I was only Following The Protocol and they have enough on their hands at the moment dealing with deserving complaints about long ambulance waits. Besides, I’m sure the new arrival will make that woman forget all about the trouble she had getting to hospital.
I think the problem here is that people think ambulances deal with the prevention of emergencies, rather than emergencies that are actually happening. They call us out because of something that they think might happen, which isn’t what ambulances are for. There simply aren’t enough of them to give people lifts to hospital as a precautionary measure. Of course it’s better to be safe than sorry, but there are appropriate channels to go through. If the pregnant woman had asked her midwife, she would have been told it was perfectly safe to travel in the car (and if the midwife thought she should go by ambulance, the midwife could have rung us to authorise the ambulance).
October 31st, 2005 at 5:13 am
Anxiety and how two words can get you into trouble
I once precipitated an angry outburst from the mother of a potential patient, who had called an ambulance after a glass of juice had fallen on the floor and exploded into the air and a shard had supposedly stuck her daughter in the face.
On arrival at the house I was directed to the dining room where a young woman was sitting on a chair and in the company of her mother. I approached the couple making the usual introductions and asking the appropriate questions, but I didn’t ask for a previous medical history. The problem was immediate! I bent down to the young woman and examined her face asking, “What cut”? The mother answered, “There!”
Not being able to see what she was talking about, I again asked where?
Mum went into one! “There! There!” as her finger stabbed out towards her daughters face. “Are you bloody blind!” she cried, “Is that why you wear specs?”, and with that she flounced across the room and angrily threw herself on her settee.
I though,”what is going on here?” I then looked back to the daughters face and noticed a little mark. I suffer from old eye syndrome and wear bi-focal spectacles. As I focused into towards this mark, it suddenly became clear what it was. A tiny little mole. The attractive face was otherwise, blemish free. I told the girl I was going to reach out and touch her face, and as I touched the mole asked her if this was what had concerned her mother. Was it painful?
“Well no!” She replied.
After getting my crew-mate to check I asked, “Did you know that you have a tiny little mole in that location?”
The young woman coloured and lowered her eyes for a moment, coming up with a shy look spreading across her face. She went on to explain. A few weeks before she, the daughter had been diagnosed as being in the early stages of ovarian cancer and her mother was very anxious about the situation. As I was sinking into the floor, the girl went on to say that it had been her mother who had dropped the glass and she and her sister had jerked back out of the out of the way, as she thought unhurt. Her mothers reaction was an anxiety attack, provoked by the belief that the mole on her sick daughters face, was too her eye an impacted shard of glass. The mother was possibly clinically anxious!
By then the mother had started to calm down so I approach her and got down on one knee (not in servitude, no, I’ve found that it is best not to talk to anxious people for nearly two meters high). I apologised for any upset I had caused her and told her I understood her fears, and I did. The previous year I had a similar experience my-self when my wife was in the same situation! She had got bitten on the ankle by a middgy, whilst we were travelling up through the Lowlands of Scotland on route to my mothers. By the time we arrived, her leg had swollen to the knee and my anxiety levels rose to near panic levels and off to casualty we went and on arrival I unnecessarily demanded immediate attention!
Sometimes people have a need to be anxious, not as a symptom of neurosis, but as a result of a justifiable, heightened sense of danger. When some-one close to you is in danger, this type of anxiety is a by-product of ones care. Any medic who is worth their salt and who has spent any time in the back of an ambulance, with very sick patients is always at least slightly anxious about what could possibly happen during the time that the patient remains in their care. Sometimes and all too often that anxiety extends right into the resuscitation room where on occasions it can and does quickly turn into a depressing episode with a dead patient! Vigilance is a type of anxiety and that is the one that the Service gets paid to apply!
Four words got two of my ex-colleges into a lot of bother last year and they didn’t even do anything wrong! “Dose she speak English”? Was asked of the family of a conscious, but verbally unresponsive Bangladeshi patient.
You can read the reminder of this true story at
http://randomreality.blogware.com/blog/_archives/2005/10/27/1325368.html#comments
December 28th, 2005 at 3:04 am
Mark
I was looking back through your past posts because I’m bored on a night shift when I stumbled across this post.
I don’t know if this will be any consolation to you, but the man you heard die would probably have died anyway. Sometimes there is nothing you can do for people, and despite your best efforts they die. It’s even worse face to face when they’re talking to you one minute, and halfway through a sentence they just stop talking, stop breathing and their heart stops.
After a job like that, you always end up thinking “Is there something more I could have done, or could I have done anything different”. The answer will invariably be no. As long as you did everything you should have to the best of your ability, your conscience can stay clear, and it was probably that person’s time to go.
The job can be shitty at times, and we all have a moan and a bitch from time to time, but it’s still the best job in the world.