Nee Naw

Here’s a question for any NHS Direct bods who might be reading this. The other day I had to arrange a out of hours GP for a patient who had decided not to travel to hospital with the crew. (Why people ring for ambulances and refuse to go to hospital I will never know. People are strange.) NHS Direct were handling the GP out of hours calls. I had the following conversation:

NHSD: Okay, I just need to run through a few questions. Is the patient conscious and breathing?
Me: *confused noise* Er, yes, he is.
NHSD: Sorry, we have to ask everyone that…
Me: No, it’s not that — you just threw me because that’s what we ask everyone too!
NHSD: Okay then. Is he blue around the lips? Non blanching rash? Chest pain? Overdose?

I recognised these last questions as NHS Direct’s “trigger” questions that they have to get an ambulance for. But we already had an ambulance on scene. So my question is, what would have happened if I’d answered yes to any of the questions? Would they have insisted on sending another ambulance? Would they have put me through to one of the call takers downstairs? And if not, what was the point of going through the questions?

Fortunately the answer to all of them was ‘no’ and the patient got his GP without any trouble. I’m just curious!

When an ambulance crew take a critically ill patient to hospital on blue lights, we ring the hospital to warn them. This is called (imaginatively) a ‘blue call’. All the blue call numbers are programmed into our phone system so we only have to dial a couple of digits to get them. The hospital in Romford, however, has just moved so we have to dial the full number to put the blue call in.

T601 were bringing in a man in cardiac arrest, so I dialled the number.

Them: “Hello, can I help you?”
Me: “This is London Ambulance with a priority call.”
Them: “Yes?”
Me: T601 are bringing in a 60 year old male, suspended…
Them: Uh… sorry… I think you have wrong number. This is Chinese Takeaway!”

I was a laughing stock for the rest of the shift. My sector controller insisted on telling everyone who she spoke to, including all the ambulance crews, “watch out for our radio operator today… he tried to blue a patient into the local Chinese!” Everyone thought it was hilarious. My face has never been so red!

On my last post about abusive callers, Dave asked: Is much of the abuse you receive related to the panic of the patient or the people who care about him/her? Or is it generally just abusive drunkenness? I think this is a good question, good enough to warrant a post of its own in a reply. Here, in my opinion, are the reasons why people are rude/abusive and the types of rudeness that result.

1) Personality of the caller. You can’t really do anything about this one except try not to make the situation worse. Some people are just plain rude. Sometimes it’s a psychiatric problem, sometimes they just aren’t very nice. For some reason, rude people are forever calling 999, possibly because they have an exaggerated sense of entitlement, or because they like taking charge of situations.

2) Panic. Yes, panic is definitely a factor. Panicking people tend to lose all track of time (so they think the ambulance is taking ages, and get angry) and have difficulty listening to what you are saying (causing frustration, because they don’t understand what you are going on about) and it all comes out in a big rush of “Just f***ing help me or I’ll sue you!” Often by the end of the call they’ve calmed down and apologise or say thank you. Occasionally they even get the crews to ring control with an apology for the call taker.

3) Alcohol. Definitely encourages rudeness, especially coupled with factor 1. Also encourages blathering and unhelpfulness. Drunken callers are definitely not my favourites.

4) Not knowing the system. Callers get frustrated because they have to answer lots of questions and because we don’t know where “the big road near Tesco’s in West London” is. They expect it to be like it is on TV. They think that if they are asked to do something to help the patient, we are trying to fob them off. They think that we should be telling them something more concrete at the end of the call (eg. “we’ve dispatched an ambulance from Homerton and it will be with you in three minutes” rather than “if his condition worsens, call back immediately for further instructions”).

5) Attitude of the call taker. As Big Al remarked on the last post, some call takers seem to get more than their fair share of grief because of the way they react to rude callers. Getting cross is obviously a big no no, but I think we’ve all had moments when we’re exhausted and some horrible is shouting the odds at you that you snap and answer back in a manner not depicted in any customer care manual. There are other ways in which we accidentally antagonise callers too. You constantly have to weigh up how the caller wants you to be and change your manner accordingly. Sometimes they feel we are too blaze and it comforts them if we pretend to be shocked at whatever they are reporting — but go too far and they will lose confidence in your ability to cope. Interrupt too little, and the callers will waffle on, too much and they will get annoyed. Speak too fast and they will not understand you, too slowly and they will feel you have no sense of urgency. It’s a constant balancing act, and given that we are not exactly getting callers when they are at their best, it’s very easy to overbalance.

So now imagine a call where the caller is drunk, panicking, doesn’t know the system, not a very nice person at the best of times, and doesn’t think you’re taking his situation very seriously. Yes, all five factors equals Call Taker gets an Earful. It’s very rare to get a call from someone who is nice, calm and sober, knows the system and who you respond correctly to and manage not to upset, thus almost every call leads to varying degrees of Earful.

Fortunately, we all have thick skins.

A piece of really shocking news (not) in today’s Metro — 999 call takers suffer abuse from callers!

I don’t know where this study was performed, but it certainly wasn’t the LAS. Apparently these unnamed call takers took an average of 59 calls per shift, which is absolutely nothing in my book (I have taken 250 on a Friday night. I think 150 would be about average, though that is a guess) and only four were abusive. It depends on your definition of abusive, of course, but I would say that at least half of our callers are rude/unco-operative/shouting and I would estimate 5% cross the line into swearing, threats, insults etc. It depends a lot on the time of day - this is one of the many reasons why I prefer dayshifts and loathe weekend nights.

I’d like them to do a similar study in our control room so I can see if my guesses are right, and if this control room where they only take 4 abusive calls a shift are recruiting, please send me an application form!

It’s been three years since I joined St John Ambulance, so this week I was dispatched to the wilds of North London on my day off for a refresher first aid course. People imagine that as a Johnny you are treating casualties all the time, but it’s not actually like that. A lot of it is standing around in the rain watching rubbish football teams waiting for something to happen, and when something does happen, all the Johnnies swoop like vultures on the poor patient and fight over who he is going to treat him or her. It can get very silly. Anyway, as a result our first aid gets a bit rusty and we have to requalify every three years to prove we still know what we are doing. The course is called First Aid at Work and as the name suggests, it is intended for people who are the appointed first aider in their workplace. I was the only one on the course doing it for another reason.

The St John first aid course was largely very good. Our instructor was very knowledgeable and my sling making improved immeasurably during the course. There was one thing about the course that was absolutely terrible, though, and that was the instructions about calling for ambulances. My initial first aid qualification was done before I got the job with the LAS, so I didn’t pick up on this before. It seems to me that St John and the ambulance service have never, ever got together and talked about this.

Things I didn’t like:

* There was no discussion whatsoever of when you should call an ambulance, and sending a bystander to call an ambulance was part of every scenario, even nosebleeds and cut hands! The trainer did explain that she wanted to get everyone into the habit of sending for help at the correct point (after you know what the problem is, and she did make a point of getting us to tell the bystander why we needed an ambulance, which is something) so I might just let her off this one.

* The trainer told us that you would never have to wait more than 15 minutes for an ambulance! I almost fell off my chair laughing and felt at this point I had to butt in. The trainer also did not know that 999 calls were prioritised or that we could respond with a call back from Telephone Advice for green calls - she had thought that the differing response times depended on the area you lived in.

* In every scenario, a bystander was sent away to call an ambulance. You should never send someone away to call an ambulance unless it’s absolutely necessary (you have no phone, or you need to find a landline to call from because you don’t know where you are and you need the call to be traceable). All the scenarios happened in the workplace, where the bystander would almost certainly have been able to ring whilst standing next to the patient.

* The bystander was always asked to find how long the ambulance will take. The ambulance service are not allowed to give you this information.

* The trainer did not seem to know what information the ambulance service would ask for. In fact, there was nothing about them asking questions at all, it was all “you must tell them this, this and this”. Nothing gets our back up faster than callers who start giving you information, some of it relevant, some of it not, without letting you get a word in edgeways. According to our assessor, the most important information you need to give (after “what’s wrong”) is what position you’ve left the casualty in and what your name is and that you are a first aider. This is not right!

* Absolutely no mention of getting a good location to give to the ambulance service, which really is the clincher in my book.

I am not blaming our trainer for this - St John people rarely have to call 999 as they usually have their own ambulance on duties, so I guess they just don’t know how the system works. I do think St John and the ambulance service should have got their heads together on this one though. I know it’s a first aid course and not a dialling 999 course, but it would only take five minutes to give a few pointers on ambulance calling which would make life so much easier for us and the first aiders, and there is certainly no excuse for giving people information that is actually wrong (”send someone off to call and find out how long it will be”).

I hope they’ve fixed it by the time my next requalification is due, or I will not be very impressed!

So, what feels like several years ago now, I was invited to come out and see how the other half live, doing a day turn on an ambulance not far from my home in East London. The crew who were kind enough to take me aren’t bloggers, so I shall have to invent pseudonyms for them. I shall call them Ant and Dec. I was expecting this to be rather different from my last shift out with Steve, where the most exciting thing that happened was the football on the telly, and I wasn’t wrong. Steve works in a fairly posh suburban area where all (well, most) of the callers are polite and the calls are genuine. There’s no such thing as quiet in the ambulance service, but it’s certainly quieter. The area where Ant and Dec work — I’ll call it Callsville — in contrast, is a hot bed of activity. When we see a call coming in from Callsville we just know half the time it’s going to be a difficult one — someone shouting at us in a foreign language, demanding an ambulance but refusing an interpreter, and after half an hour we find out the ailment in question is toothache. The map of Callsville is always peppered with the triangular dots which represent outstanding calls, and us dispatchers know the road names up there by heart.

As I expected, our shift hadn’t even started when Control rang asking us to take an early job for an asthma attack. As they had me on board, Ant and Dec kindly offered up for it, and off we went. The first thing I noticed was the inferior standard of driving in the area. I know this is the pot calling the kettle black (my usual reaction to seeing an emergency vehicle is to panic, flap my hands and stall the car) but this was ridiculous — people cutting in front of the ambulance, tooting at it to get out of the way and generally acting like it wasn’t there. We got to the asthma attack, which was actually more like an asthmatic with a cough, and took her to Callsville Hospital. This hospital has rather a bad reputation; callers often ring up and say “you’re not going to take me to Callsville, are you?” The staff there were very nice, but the A+E department was very small and in need of a lick of paint. The cubicles, obviously meant for one patient, had been divided into two with a curtain meaning the patients were practically on top of each other.

Back in the ambulance, it was straight on to another job. A Category A maternity! I was momentarily excited as I envisaged delivering a baby in person. My excitement because trepidation as I approached the house and heard loud screaming, but on closer inspection this seemed to be coming from a small child. The mother-to-be was sitting on the sofa fully dressed in no obvious discomfort. We took her to the hospital, the most taxing part being persuading the aforementioned screaming child to board the ambulance, and waited whilst Callsville’s two maternity departments argued about who would take her.

Next were two seemingly identical calls to patients with “abdominal pain and near fainting” which turned out not to be identical at all. The first was a grown man who was crying and writhing around in agony. Dec had to give him morphine before we could go anywhere. He was later diagnosed with gallstones. The second was a young woman who just appeared to have a bit of stomachache and really should have been given a paracetamol and sent to bed. This was very interesting to me - abdominal pain calls are usually low priority (abdo pain is rarely serious or life threatening and when it is, it comes with other symptoms) and in control, we are taught to ignore how painful an ailment is and concentrate on how likely it is to be life threatening. It’s only when you see it in real life that you realise what it is really like to be in that severe pain.

We were just on our way to a very boring sounding green call when Control radioed for someone to go to a Multiple Fitting call in a school 5 miles away. I suggested we offer up for it.

“They’ll never let us, it’s miles away!” said Ant.

“Bet they do,” I said, and I was right. Eight minutes later, and a nausea inducing sprint down the dual carriage at breakneck speed, we were there. I huffed and puffed my way across the school grounds and up a flight of stairs carrying a carrychair and a blanket, and was ushered into the room where the patient was…

She sat up and smiled at us. Still, all’s well that ends well.

The local hospital was now the Royal London (there is no point changing the name!) so we dropped the patient off there and went for a wander around. Dec saw Martin from Trauma in the corridor (I missed him, damnit) and I got to see HEMS taking off. Ant was going to take me up to the helipad to meet the HEMS team and see the copter, but someone very inconsiderately decided to have a major accident the other side of London, and they all disappeared.

The next call was in another school, and was to a very morose eight-year-old who’d had a fall ice skating and bumped his head. He seemed to be fine but it is best to get head injuries checked out in hospital. Ant and Dec had limited success trying to explain this to the child’s father, who was taking the attitude “if it doesn’t hurt, he must be fine”. In the end they had to use all their persuasive wiles to charm them into the ambulance. I tried to get the solemn looking kid to cheer up by showing him the ambulance and telling him he was very lucky to get a ride in our special ambulance. This made him cry! When I was his age I would have jumped for a chance to ride in an ambulance. I would probably have got injured deliberately if I’d thought of it. Ant said that I was probably one of those attention seeking children at school. I don’t know what he meant by that.

After Miserable Sprog had been delivered to Callsville Hospital, Control decided to put us on a break. I told Ant and Dec to take a scenic route back to station or go off the road with a dirty uniform, but Control weren’t having any of it. Beaten at my own game!

After a false start chasing after an assault victim who decided not to bother waiting for the ambulance, there was just time for one last call. This was to a woman who had everything in the world wrong with her. Her daughter had called because she’d had some unfortunate accident with a falling pole landing on her head, but Ant and Dec were more concerned with the slight chest pains she was having. They got her in the back of the ambulance and did a 12-lead ECG, which showed she wasn’t having a heart attack, but treated her with aspirin and GTN anyway. We took her to hospital. Ant and Dec argued half the way there about whether she should be blued in. In the end, they decided not to, which was very disappointing from my point of view as I would have been the one making the blue call.

After that, our twelve hours were up and it was home for a well earned rest. I was even more knackered than after my usual twelve hour stints in Control. It was a very interesting day and I learned lots of stuff (mainly about why crews hate break) and though I was slightly disappointed that there was no gory trauma or blue calls, I certainly got to see the whole spectrum. I’m still waiting to see a suspended so I will be out observing again soon — but I fear that five observing shifts without a Vomit Incident is starting to push my luck. I might go to the next one wearing a rubber apron!

Just popping in to let you know I’m still alive. It’s been two very busy four-shift weeks at work, and I’ve been off gallivanting around the country at weekends (yes, that ‘having a life outside the ambulance service’ thing) and just not had time to update my blog. The New Trainee did very well and has been signed off, and I think my training was a lot better this time too. I will be back soon with a detailed post about my day out observing in East London. Hope you’re all well out there in Blogland!