None of your business

"56 year old woman, headache"

The first night shift is always the worst. Like I have mentioned before, as a poor sleeper at the best of times, by the start of the shift I've been awake for 12 hours already. Between 3am and 5am is the worst time. We are sat at hospital and I was nodding off left, right and centre. Head drifting forwards and then a sudden jerk upright over and over again. Seeing a "headache" appear on the screen did not thrill me either; far from it. We headed round to the address, it wasn't far away so we were there within a few minutes. At this time of night it's normally pretty easy to spot the patient's house as it's normally the only one with lights on. Tonight however we were not so lucky. No lights in houses and no street lights. We crawled along at 2mph with the search lights on peering through hedges and gates trying to see a house number. Eventually we found it. Sorry to digress but seriously, there should be laws about house numbers! They should be a good size and easily visible for all, not black, 3 inches tall and covered in leaves! Just sayin'!

It was a big property, a large Victorian terraced house, by the looks of it 3-4 bedrooms and high ceilings. We wandered up the drive to the large oak front door which had a heavy black knocker. I gave it my usual 'ever so sarcastic' three slow knocks; nothing. I knocked again, this time with more force; nothing. We shouted through the letter box and knocked again but you guessed it... nothing. We asked control to give the caller a ring back. We heard the phone ringing and after only a few rings it stopped. She had answered. After another 5 minutes the door was opened. She looked me up and down and walked off into the living room; it wasn't until she was a few feet away she began talking:

"You took your bloody time"

Not the best way to endear me; in fact, it's highly likely to get my back up. Needless to say I bit my tongue and moved swiftly on, ignoring her snide remark.

"Well we are here now; I gather you have a headache?"

"No I don't, it's not a headache"

"OK then, what's the problem? What have you called for?"

"I have a feeling in my head"

"What kind of feeling? Does it hurt?"

"It's just a feeling, it doesn't hurt but I'm fed up with it. I need to be admitted to hospital"

"We can pop you to A & E if you like, I can't say whether you'll be admitted or not, that is down to the hospital"

She went on to say the hospital she wanted to go to. It wasn't the nearest by any stretch of the imagination, in fact there were 4 closer. Up to a point patients have a say where they want to go, and I am often more than willing to go, but she was being rude so I didn't commit. I said we would discuss hospitals once we had checked her over on the ambulance. After waiting 20 minutes for her to pack a bag she marched passed us at the door and said:

"Shut the door behind you"

As you can imagine, by now I was getting pretty ratty! It was 03:30, I was tired and not in the mood to be treated like a naughty ginger step child. I sat in the jump seat to get started on my paper work while my crew mate tried to do her obs.

"No, you don't need my blood pressure, you're not a doctor"

"You've called us, we are here to help, let us check you over and we can go to hospital"

"No, I don't want you to"

"OK then, what medical problems do you have?"

"That's none of your business"

"Well it kind of is! You have called an ambulance, we need to give a handover to the hospital as to why you are here, you medical history is pertinent to that"

"Well it's none of your business"

"OK, do you take any regular medication and have you taken any today or this evening for your 'feeling'?"

"You don't need to know that." 

"Yes we do, it is important for the hospital to know because it may effect what treatment they give you"

"Then I'll tell a doctor when he asks, not you"

"Fine, who is your GP?"

"I fail to see how any of this is your business, stop asking questions and take me to hospital"

She wasn't listening to a word I had to say, it was if her fingers were in her ears like a petulant little child. At this point I told her we would not be taking her to the hospital she wanted as it was too far away to justify, and quite frankly, I didn't feel like it. 

"Why not?"

"You are not willing to tell us anything about what is wrong with you, your medical history, your medication or you GP. You won't let us check you over yet you called 999 and asked for an ambulance. If you didn't want an ambulance then you could have got a taxi."

"I pay my national insurance and my taxes pay your wages. You will do what I say and take me where I tell you to take me. That is my right"

"You can go to one of the three nearest hospitals"

"You either take me where I want to go or I'm going back home"

"(I just looked at her blankly)"

"Fine, I'm going home"

With that, she got out of the ambulance and not before flipping me the bird, stomped off back inside. EMERGENCY AMBULANCE. That is what it says on the side. That is what it is there for. On speaking to another crew about it after the following job it turns out she is a regular. It just so happened our paths had never before crossed! 'I pay your wages'! Pah! It never gets old!!

You Again?...

"48 year old male, ? Hypo"

Every ambulance service, every ambulance station and every ambulance crew have frequent flyers. Patients who abuse the service, some of which call in excess of three times a day. The average person only needs to call 999 once in their lifetime for an ambulance but these people feel compelled to call repeatedly. Be it through boredom, attention seeking or medical need it bears the same cost, a financial one and a resourcing one. At the best of times the ambulance service just about copes with the call volume but at weekends and peak times it doesn't. This isn't a dig at the service, it isn't through poor management or poor performance. It's through a lack of core funding and an inability to put enough ambulances on the road. The limited resources available can ill afford the additional waste caused by regular callers. They really are a drain. As road staff you see the same patients so often that you memorise their name, their address and in some cases their date of birth and medications. As soon as the address pops up on the MDT you know exactly what you are going to.

This particular shift had been spent miles out of area. At about 2am we got sent the above job. We knew the address, we knew the patient, we had seen him yesterday, and the previous week and in excess of 20 times previous to that. We were off to see Steve. Steve was an insulin dependant diabetic who lives with his mother. Steve doesn't control his diabetes well and often has hypo's. We are called by his mother every time. Sometimes we are needed, sometimes we are not. The problem isn't just Steve, his mother is also a huge part of the problem. She will call us if she thinks he's having a hypo, more often than not in  the middle of the night. Half the time we enter his filthy bedroom to find him asleep in his single bed, in his sleeping bag and he is simply that. Asleep. His blood sugars are normal. We still have to check him over and fill out paperwork. On other occasions he is hypo. Sometimes we have to give IV glucose, other times glucose gel and sometimes just food and sugary tea. No matter what the treatment we have to stay until his sugar levels are up, give the same advise, leave the same paperwork and fill out the same frequent referral form. On the living table is a pile will no less that 300 PRFs that have been left by crews in the past two years alone.

We pulled up outside, grabbed our stuff and knocked on the door. Like always his mum answered, dressed in a dressing gown and what looks like a tea cosy on her head. 

"Hello again, is Steve hypo?"

"Yes I think so, I can hear him snoring"

"Have you tested his blood sugar like we suggested"

"No"

She never does. Ever. We went into Steve's room and woke him up from his sleeping bag. We tested his blood sugar. 3.1. A blood sugar reading should be somewhere between 4 & 8 in a healthy person. His sugar was low but for him they weren't too bad. Regardless we couldn't leave him like that. He got up and he went to the toilet as per usual. I went to my seat at the dining table where I do my paperwork. Another thing worth mentioning is that he never goes to hospital. He always refuses despite being advised otherwise. He came and plonked himself down in the armchair while his mother made his tea and gathered his two pre-packed sandwiches and fruit cake. It's the same, night or day. A black tea with 6 sugars, a salmon and cucumber and a chicken and bacon Waitrose sandwich and Tesco fruitcake. Like always the offer is extended to use and like always we declined. Like always I wrote while he ate and I advised him to see his diabetic nurse, to adjust his insulin levels and I told his mum to test his sugar before calling. Yes, Yes and Yes.  My crew made did his ECG and all his OBs, then I re-tested his sugar, it was fine, he went to bed, we put our PRF on the pile and we left. It is beyond deja vu. Once in the truck I fill out a vulnerable adult form and a frequent caller referral form. Job done.

Clearly the frequent caller form has no effect whatsoever. What can be done? That isn't an open question or a rhetorical one. What can actually be done? I have no idea. I would love to have an answer. It's not like he is calling for attention. He has a chronic condition he seems unable to manage. You can't refuse him an ambulance. Half the time he has a medical need and without one could die. You can't charge or fine them for misuse. They have no money, neither of them are able to work and his mum, as annoying as she is, has cancer and is getting very frail. The cold fact of the matter is, this abuse of the service will stop relatively soon. His mum will die and when she does he will die too. He will enter a diabetic coma and there will be no one to phone an ambulance. That's when it will end. Unfortunately you then have a question. How can a man be left to die when in the past two years he has had more than 350 ambulances? Why has nothing been done? Why is this allowed to happen? All good questions. It's just a shame in the society and system we live in it'll only ever be post mortem questions and not anti mortem solutions.