The Three Stooges

“43  year old female, chest pains”

This job set the tone for what would turn at to be a very familiar night shift. I exhaled in frustration when I saw the address. It was one of the many regulars on our patch. She was a wine-drinking alcoholic; she always called for chest pains, always went to hospital and was always rude and obnoxious. Tonight would prove to be no different to the norm. We stomped up the concrete stairwell, navigating our way past the vomit on the stairs. Lush! Her door was wide open like it always is. We walked down the landing to her bedroom like we always do and found her lying on her bed smoking a fag like we always do. Then followed a very familiar conversation.

“Hello again”

“Alright luv”

“What’s the problem tonight?”

“I got chest pain”

“Same as before?”

“Yeah”

“Can we do an ECG?”

“Yeah, go on then”

We do the ECG and all her obs. They are all normal like always. 

“Shall we pop you up to hospital?”

“Yeah, I need to see a doctor.”

"Still got the pain?"

"Nah, but it should be checked out."

So, without any fuss he all walked (she staggered) arm in arm to the ambulance. We drove to the same hospital as we always do, where I gave the same handover as I always do. On to the next!

“37 year old female, suicidal, taken an overdose, police on scene”

We all say that the first job sets the tone and shifts have a theme but they really really do and I don’t know why! This address was also well known to us. It was the residence of the most abusive drunk in our area. I say abusive, she abuses the police and most ambulance crews but for some unknown reason she loves me! We pulled up next to the police car, which seems to be a permanent fixture outside her flat. In the hallway outside was one of the coppers.

“Good luck, she kicks off every time I go inside”

Sitting there in her underwear and dressing gown, she swigged vodka while smoking a roll-up. Her face lit up as soon as she saw me.

“Heya babe, tell the pigs they can go and you don’t need them”

As much as calling the police 'pigs' wasn’t acceptable, in all honesty, their presence was only going to make things worse and I knew they’d be only to happy to leave.

“I’m happy to deal with this, I know her well, she’ll be fine with me”

They were only too happy to leave and were gone near enough before I'd finished the sentence! It was the same story, drinking vodka to excess, self harmed her forearms, refused hospital and then there was a 45-minute battle to convince her to go. Sometimes she wins and sometimes I win. Tonight I won. Hospital was the plan and all we had to do first was go through the charade of collection her ‘valuables’ (vodka) and hiding them so they can’t be stolen. After completing this ritual we headed off and handed her over to the less than enthusiastic nurse. 

We left the hospital to go and get fuel and hopefully a Wild Bean coffee and a pre-packed sandwich. It really is 'gourmet on the go'! Well actually it wasn't because we never made it. We were flagged down by a member of the public for what appeared to be an unconscious man in the street.

“u/k male, unconscious, running call”

We called it in and were sent down a CAD number. It shouldn’t have surprised me that he was well known to us. I had picked him up yesterday about 200 yards down the road. In fact, he was being picked up 3-4 times a day, each time by an ambulance and each time taken to hospital. The problem is, each time, the hospital sober him up enough to be able to walk and then either sit him in the waiting room until he walks out or discharges him. He walks up the hill to the shops, buys more booze, drinks said booze and passes out again. The hospital are not willing or able to invest time in fixing the problem & we have no ability to anything else with an unconscious drunk person other than take them to hospital. The cycle will continue until he stops drinking or dies. The latter seemed most likely. 

Tonight, he was lying at the bus stop next to his empty bottle of scotch. He was face down and had wet himself. I often wonder what he was like before this. What kind of life did he lead? What family does he have? What friends did he have? Now there appears to be no one. The only people around him are the members of the public who call 999, the ambulance crews that take him to hospital and the nurses that kick him out. What can we do?! We scooped him up off the floor and onto our bed. We did the usual obs and then drove the half-mile to hospital. We got the usual looks of distain from the nurse and rolled him onto the bed. To be fair to the nurse, we had just brought in three abusive alcoholics in as many hours, but still……not our fault!

Alcohol is something that the NHS does not do well, a bit like obesity. We only treat in the short term when it is too late. Very little is done when warning signs are there. Accessing services is far to difficult and it is a lot easier to just give a bag of fluids and let them go than find out the cause and refer to the appropriate places. It’s a shame, if they invested in prevention rather than cure, the long term saving could be huge. Shame no manager or politician is ever that long sighted.

Off we went for fuel, this time we made it. The sandwich was rank and the coffee was a poor substitute to Costa but beggars can’t be choosers! After the start to the shift we had had it was a necessity! We went off and did a few more jobs to a different hospital and at about 2am came back to our area. We handed over our drunken teen to the staff and booked them in. I walked through the busy waiting room and what did I see?! All my regulars sat in a line on the bench together! The Three Stooges! That image summed up how the NHS treats alcohol and mental health. A sad sight but one that amused me! 

“Evening all!”

Elementary, Dear Right Honourable Ann Widdecombe

I may be late to the party but I felt it was time to come out of hiding to have a good old fashioned rant!

So, Richard Madeley of Richard and Judy fame managed to get the backs up of every single ambulance worker in the country with his badly written, badly researched tripe of an editorial about a crew who finished their break before going to the aid of a critically ill child. For those not aware the original story can still be found here. It should have come as no surprise when the article vanished, but it didn't take long for more of the gutter press to spread lies and mis-information and make slanderous, biased attacks on ambulance services and their staff. Why let the truth get in the way of a perfectly good story eh?! It seems to serve no other purpose other than to blacken our name and tarnish the public perception of the NHS as a whole and only goes to make a hard and volatile job just that little bit harder. This time we have The Right Honourable Ann Widdecombe to thank for providing us with one of the worst examples of 'journalism' I have ever seen.

"A BABY of eight weeks is facing possible disability for life as a result of an ambulance crew finishing its break before going on a 999 call."

Belittling the work of the ambulance, police and fire is a right giggle.....

I agree with what she starts with, 'I can think of few more genuine emergencies than a baby having a 'heart attack'. Neither can I. Unfortunately the cardiac arrest the poor child suffered is not the same as a heart attack; never has been, never will be, but that really is beside the point. The child was critically ill and should have had an ambulance quicker than 41 minutes. Why though was West Midlands Ambulance service solely reliant on a crew who was on a rest break? Obviously Mrs Widdecombe couldn't possibly blame the Tory cuts, must tow the party line after all (even when you've retired from office). We can't for a minute blame the lack of funding, not enough staff, not enough ambulances and too many calls for the delay can we?! Oh no... blame the greedy paramedics stuffing their faces ignoring cries for help from a dying baby.

She goes onto draw parallels between staff having the right to a rest break with babies having the right to live. In all seriousness, what does she expect?! Is this the Conservative ideal?! Ambulance crews working 12 hour shifts without the possibility of a break? What happens when we have finished our shift? Does she expect us to answer calls then too? What about before? Do we sign on when we wake up in the morning and offer to answer calls in our own cars? I'm sure she was never advised to starve herself for 12 hours at a time whilst on Celebrity Fit Club....

One of my favourite parts of the article was when she led with 'Members of that crew had better pray that if they ever need to call out the emergency services they don’t find themselves in a clash with a copper’s cuppa or a fire fighter’s elevenses.' It would have only taken asking one member of an ambulance crew to find out how rest breaks work. We have no idea what jobs are going on around us. We are dispatched by a computer (that computer's sole purpose is to assist us meet the government targets), and on the rare occasion we get a break at all, that computer makes us unavailable for that period and we cannot be sent a call. Does she really think that a crew would knowingly sit down and eat in the knowledge that a baby was in cardiac arrest around the corner? I think its disgusting to level such an unfounded accusation at a crew. As for interrupting elevenses, we all know that Trumpton are always at rest!!

As if that wasn't enough she went on.......

"It is bad enough when public servants worry more about their own safety than that of the public and refuse to enter 2ft of water or to hop on a bicycle without a helmet but when it comes to putting sandwiches before a dying baby and then defending such action as reasonable, Britain has sunk to a new depth."

Look at them all! Scum! Every single one of them in it for themselves....

I don't remember 'can expect to take regular abuse and beatings' as part of the job description of Paramedic, maybe I missed it. I was probably too busy stuffing my face while watching this model citizen use her public standing to earn a few extra quid prancing around on Strictly Come Dancing. Silly me! For the record Ann, yes, we do worry about our safety but that doesn't stop us doing our job. We just wear stab vests so it hurts less. I was recently at an award ceremony for my service where staff were given the Chief Ambulance Officers Commendation for bravery. There was a crew who were beaten with a fence post and still went on to treat their attacker despite numerous broken bones. A crew who continued to do CPR whilst being repeatedly stung by wasps. A crew who disarmed a man with a gun. A policeman who sat next to a burning motorbike to protect the man lying in the road. Crews who day in day out put their lives on the line and for what? For the appreciation of our wonderful politicians?! If Britain has sunk to a new depth it's because of people like you. People so deluded and out of touch, that they label the little people their servants. Ms Widdecombe is not alone. Only today Tory MP Christopher Chope refer to the House of Commons catering staff as his servants. It's YOU who is out of touch, YOU who should be defending actions and YOU who should be answering accusations of sinking Britain to new depths.

I don't recall her or any Tory writing an article about the members of the emergency services who have sustained serious, life changing injuries in the course of duty as one of their 'servants'. Then again when she has the opinion that 'the service exists for the benefit of those who staff it rather than those who need it' it's of no surprise that these articles are not forthcoming.

'The purpose of education is teaching the young, not keeping bad teachers in their jobs, the purpose of the National Health Service is to make people well, not to give doctors evenings and weekends off and the purpose of the emergency services is to protect the public, not the staff’s nosh. Elementary, Dear West Midlands Ambulance Service.'

The purpose of education is teaching the young, so stop moving the goalposts and start supporting your teachers. The purpose of the National Health Service is to make people well, so stop privatising it, cutting funds, cutting staff to line your pockets. The purpose of the emergency services is to protect the public, so stop trying to turn the public against us, stop cutting ambulance funding, stop cutting police numbers, stop reducing wages, stop taking away our pensions, stop expecting us to work for 12 hours with no breaks and stop lying. Elementary, Dear Right Honourable Ann Widdecombe.

Oh and just for the record, you of all people should know that we the ambulance services are NOT emergency services. We are essential services. School girl error there! And I thought you were an educated woman, how on earth did you land the role of questionmaster in Cleverdicks?! They certainly didn't teach you the art of investigative journalism in your time at Birmingham University or Oxford! (See what I did there? Researched! You should try it some time.) You simply cannot put an article making sweeping statements into such a public forum, full of conjecture based on inaccurate information. It is nothing short of negligent, especially from someone with your social standing.

Like Ann, I also rage against the society we have become and when I heard about Thomas Passant it was indeed upsetting and heart wrenching. As a parent I know only too well what I would be feeling in that situation but putting food before the life of a child is not what we have become, not what we have ever been nor will ever be. We will always, always always try everything in our power to help anyone who needs it whether or not we have eaten, whether or not we have had a break, whether or not we have been at work for 14 hours already and whether or not we may get hurt along the way. We certainly don't work 80 hour weeks, 12 hour shifts, long nights, take abuse, receive violence and take repeated public attacks from washed out politicians for the money! £10.12 an hour is only tolerated because it's a job we love. If I wanted money and an easy life I'd work in McDonalds or go into politics. I reckon I'd be rather good at fiddling expenses and reality TV! Maybe that's what I'll do!

Perhaps Ann Widdecombe would like to come for a 12 hour night shift on a Friday (Or Richard Madeley). Would she be happy to face her adoring public in their time of need? Would she like to explain the real cause of the delays? Would she be happy to interrupt her rest break for a 43 year old male bleeding from the wrists, holding a knife and threatening to stab the first person through the door? Come on Ann! It'll be fun! I'll bring the nosh! Or maybe you'd like to find somewhere safe and warm, paid for by your servants, and write about it instead.

'Nero fiddling while Rome burned is the image which comes to mind.' Indeed.

92 minutes earlier

My cup of Costa went flying as our brakes ground to a halt at the same time as the second ambulance. The patient was lying there motionless. A woman was doing CPR. Blood was trickling out of his ear.  We all rushed over (no ambulance walk today) and each started doing our thing. As the crowd began to gather, I began to suction his airway. It refilled with blood almost instantly. Where was it coming from? He was still alive.....just. We stopped the CPR, he had a pulse albeit very faint. It was a case of two of us managing the airway, a combination of ventilating, suction and draining. We just had to make do. He still had a gag reflex so without ‘grown ups’ we were powerless. There was now 6 of us swarming around him. IV access was gained in both arms, 2 bags of fluid were hung up. He was attached to the heart monitor, his pulse was fast but regular. His blood pressure was still in his boots. 

“Can someone raise his legs please?”

“On it”

“Right, lets get these clothes off him”

“HEMS are on way”

“More suction please”

“How’s the BP looking”

“Try some more ventilation”

“What’s the SPo2?”

“About 77 over 40”

“80%, did we have an ETA?”

“I’ve got decreased air entry on both sides, possible bi-lateral pneumothorax”

“More suction please”

“18 minutes” 

“Want some cannulas?”

“Yeah, you alright to do the right side?”

“His left pupil is blown”

“Yeah, no probs”

“Can you grab us bed, blocks, straps and a scoop?”

“Who’s conveying?”

“Think the pelvis is gone, can we get a strap on here?”

“What was the resp rate when you arrived?”

“Did anyone see what happened?”

“I’ve got a sheet, we can use that until HEMS arrive”

“About 4”

“No idea”

“That’ll do, we’ll get it underneath on the log roll”

“I’ve got no respiratory effort, how’s the pulse?”

That’s the conversations that were going on between the 2 crews, the FRU and the duty officer. It’s probably worth mentioning I only knew 2 of the 5 people who were there. That was the same for all of us. At one point I thought to myself that it was amazing how we were all task focused on different parts of him without ever discussing who was doing what. There were two of us solely on the air way, two were getting IV access and decompressing the chest and two were removing clothing, getting kit and monitoring obs. 

The crowd was getting bigger by the minute. My crew mate lent over to me:

“His entire family are over there watching”

That always adds an extra emotion to an already chaotic scenario but for now we just had to ignore that. 

“Are we ready to move him?”

“I think so, lets get the scoop in here?”

The scoop was split into two, I was on the head so couldn’t move, leaving 3 of them to do a log roll, 1 to slide the scoop in and the other to carry on suctioning. 

“OK everyone in position?”

“Yep, on your count”

“OK, one, two, three, roll.....hold it there....one, two, three down”

(Everyone swaps sides)

“OK, one, two, three, roll.....hold it there....are all the clothes clear?”

“Yep”

“OK, one, two, three down”

“Right, lets get some straps on”

“More suction please”

“Police are here”

“How long for HEMS”

“About 2 minutes”

“OK, how’s BP, pulse and sats?”

“BP is up slightly, lets get the bed over.”

The beautiful sound of HEMS sirens could be heard in the distance. Being early evening the helicopter was offline so they come by car. The three orange jump suits came bounding towards us. A handover was given by my crew mate and then they took over. 

“Right guy, lets get him on the bed and move him over here. We need all round access”

We followed the instruction, all the while bagging and filling up our 4th suction unit. They were going to perform a Rapid Sequence Induction (RSI) which would basically put him into a coma. Once under, he would be able to be intubated and his airway would be protected. Whilst one of HEMS were setting that up, the other two were playing with scalpels! Two incisions were made in each side of his chest, fingers were inserted into the holes to see if his lungs were inflating properly. I could still sense the family watching from afar as well as the eyes and expectations of the crowd baring down on us. It was quite a scene, 9 of us standing around him, some performing procedures, some drawing up blood transfusions, some ventilating and others just doing.....stuff!

The drugs were administered and they managed to intubate. Now we could think about leaving. Or not......

“We’ve lost him, CPR please”

I started compressions and after a minute or so, couldn’t help but look over to the shocked faces 20ft away. Hands were over mouths, some people were crying. I could feel the hairs on the back of my neck stand up. 

“OK, he’s back with us, well done guys, let’s get moving”

In all honesty, I had zoned out, I don’t know what was done in those 4 minutes, I just know I was doing CPR and now I didn’t have to. The guy was loaded on. In the ambulance was the patient, 2 of HEMS, me and my crew mate and a copper. In the second ambulance was the other crews and all the kit that was lying where we had been. The police followed with the family and the HEMS car and another police car drove up front. Off went the convoy. 

24 minutes later we arrived at hospital. The bed was rolled out and onto the ramp. The door swung open revealing the long corridor ahead of us. The huge trauma team was waiting in resus and the now 8 of us did a rapid walk towards them. Some pushing the trolley, some holding fluids, 1 ventilating, others carrying monitoring equipment. He was transferred to the hospital bed while a handover was given. We then left to clean up the bomb site that was the back of our ambulance. About 25 minutes later HEMS came out to us.

“How’s he doing?”

“Not great, he’s got a sub-dural and extra-dural haemotoma, bleeding on the brain stem, a depressed skull fracture, a shatter jaw, fracture spine, bi-lateral haemo / pneumothorax, bleeding into the abdomen, a shattered pelvis and a broken mid shaft of femur.”

92 minutes earlier......

A man was celebrating his 75th birthday in a pub with his family. They had had a sunday roast. He had treated himself to a few whiskeys and why not?! He’s 75, he can do what he liked! He was with his wife of 55 years, his two sons, their wives and his 5 grandchildren. I can only imagine the joy he was feeling seeing all that was important to him sat with him smiling and laughing. It was time to go home, but before he got in his sons car he wanted to nip into the shop to grab a paper. He left them all getting into cars in the car park, he went to cross the road.

“RTC, car vs pedestrian, 75 year old male, cardiac arrest, CPR in progress”

In that moment, the joy was gone. In that moment 75 years was over. Maybe it was the alcohol that made him cross without looking on a bend.  Who knows? He’ll never be able to answer that. 

I remember looking down as his 3 piece suit was being cut off and his pocket-watch fell to the floor. I remember thinking to myself:

“I bet he was a lovely guy”

I never found out his name.

R.I.P

Just say No!

“51 year old female, can’t sleep”

You may have noticed a large proportion of my writing is done about night shifts. This is mainly because at night there are the drunks, the drunk drivers, the gangs, the violence, the stabbings, the business, the tiredness and the crazies! These are generally more interesting than picking up an elderly lady from the GP who has shortness of breath and needs taking to the Clinical Decision Unit (Can't Decide Unit) at the local hospital. Let's be honest... that would be dull! 

The other thing that happens at night, obviously, is people sleep. Some need 10 hours, some need a square 8 every night, others 6, and people like me cope with 4 or less. Everyone, now and again, has trouble sleeping. You’re either too hot, too cold, just wide awake, don’t feel well, are restless, neighbours keeping you awake or a car alarm repeatedly going off. What do we do? Deal with it! We try and try and try to fall asleep; we put our head under the pillow, we flip the duvet around, we take sleeping pills; anything to get to sleep! None of us want to get to that moment where you are awake because you are worrying about how soon you have to get up. Eventually, the alarm goes off and we all realise that we did, eventually fall to sleep! One thing we don’t do is call 999...

If there was anywhere for me to storm off to I would have done so in a instant.

“CAN’T SLEEP?! Are you having a laugh?”

My finger could not have moved quick enough to call up control and ask as politely as possible:

"What...

The...

F**K!!" (I never really swear!)

The response I got was basically, and I’m paraphrasing here:

“I know, I know, it’s ridiculous, but she keeps ringing back so we don’t have a choice but to send her an ambulance.”

My crewmate sat there quietly while I launched in to a tirade of foul mouthed obscenities (to myself) about how much I hate this stupid job! I’m fickle; one minute I hate it, the next I love it, then I’ll blog about it and move on! 

After a stubbornly slow drive, hoping desperately we would be cancelled for a) a nearer vehicle, b) a higher priority call or c) no longer required, we pulled into the road and stopped. There wasn’t the usual grinding to a halt and enthusiastically hopping out of the cab. Instead there was a 10-15 second silence where we both just looked forward, exhaled slowly, then begrudgingly trudged towards the house. We were met at the door by the patient wearing her My Little Pony dressing gown and a fag hanging out of her mouth. We followed her into the living room where she sat down.

“So, what’s the problem tonight” I said whilst picking up some old ambulance paperwork off the coffee table. 

“I can’t sleep.”

“What would you like us to do?”

“Give me something to help me sleep.”

“We don’t carry anything and you were told by my colleagues 4 hours ago the same thing.”

Yes, you got it; this was her second ambulance of the night for the same ‘problem’. 

“Yeah but last time I really needed a poo so the ambulance men told me to have a poo and then go to bed.”

“So why didn’t you?”

“What? Have a poo? I did.”

“No, why didn’t you go back to bed?”

“Because I’m not tired.”

“So why have you called 999, which is for emergencies.”

“Because I should be asleep and I’m not tired.”

“Without being rude or dismissive, this is not an appropriate use of an ambulance. There is nothing specific wrong with you, nor are you complaining of anything that we could treat. You need to speak to your GP if you are having problems sleeping and stop calling us unless it's an emergency.”

She looked at me blankly as if I had just spoken to her in Mandarin about quantum mechanics. 

“But I can’t sleep.”

*walk over to brick and hit head repeatedly until the relaxing state of unconsciousness is reached*

This conversation went on for about 10 minutes. We left, having given her strict instructions not to call back for not being able to sleep; I had every suspicion that she would regardless.

I really could have screamed! Why did that conversation have to be had in person?! Why did she NEED an ambulance? Why did control HAVE to send one? Why has NO ONE got the power or willingness to say no to these people? Maybe when I can’t sleep EVERY night I should just phone 999. Clearly it’s my right. Clearly as a taxpayer it is what I am entitled to. Who cares what the consequences are or how much it all costs? No one apparently! What this country needs is a government with balls; balls to say ‘NO’! I don’t mean the wishy-washy policies and PR friendly trials. I don’t mean working-groups and consultations on the best way to say ‘NO’ without hurting someone's feelings. I simply mean:

*ring ring*

“Which emergency service do you required?”

“Ambulance”

“Hello, what’s your emergency?”

“I can’t sleep.”

*hangs up phone*

Simple! Don’t even waste the manpower talking to these people. By sending an ambulance we are making it OK to ask for one. It isn’t! There has to be retrospective fines for abuse of the service. The fire brigade now charge for various things they deem they shouldn’t have to do like lifts breaking down etc. The police can charge and fine someone for wasting police time. Why oh why oh why can the ambulance service not issue fixed penalties for people who repeatedly abuse the service?! It’s beyond me. 

Anyway, the night shift had a few hours left to run. We did a couple more jobs and at about 5:30am became available for our last one. I didn’t take long to get it...

“51 year old female, can’t sleep”

Don’t...

You cannot be serious!

“66 year old female, diarrhoea“

It was a weird morning; weird because it was very quiet. Obviously we never say the "Q word" whilst at work, we just ignore the elephant in the room. We chat away, drinking coffee, eating crap; all the while thinking ‘blimey it’s quiet'. We managed a nice breakfast in peace, a hot coffee and a newspaper. After 2 hours of relaxing we were finally sent a job! The cheek of it! There was only an address to go on so started trundling in the right direction: 

“Diarrhea, really?! I’ve just eaten! Surely we will be cancelled?!”

Sure enough we were. Result! We pulled over and got back to the arduous task of doing nothing; sadly, this was short lived:

“66 year old female, diarrhoea & chest pain”

This stank to high heaven; not of diarrhoea, but of ‘been told you’re not having an ambulance quickly so ring back with chest pain-itis’. It’s a very common condition, and is a bi-product of a campaign telling people to call an ambulance if they get chest pain. It didn’t take long for people to realise that by saying those two magic words they would get an ambulance every time; quickly & regardless of age, sex, medical history. I believed the chest pain we were en-route to would be just that; a load of tosh (but I’ll stay open minded, ish!)

We pulled up outside of the block of flats; there was a huge grassed area, so we parked in the bus stop on the road and walked over. Because we were told chest pain and she was semi-elderly we took the chair with us, just in case. We made our way across the grass and up the stairs to the first floor. The door was ajar so we made our way in giving the obligatory ‘Hello, ambulance’.

To our surprise, there was a first responder on scene. His car wasn’t parked out the front so I assumed it was just us. He had a fed up, angry, dejected look on his face. He was kneeling on the floor in front of our patient who was sitting up in the chair.

“Hello guys, it’s not as given. This is Cheryl; she doesn’t have any chest pain or any diarrhoea for that matter. She has an appointment at the hospital for her eyes in 45 minutes and doesn’t fancy getting the bus. I was just explaining how this is an inappropriate use of the ambulance”

I think I still have a bruise on my chin from where my open mouth hit the floor. In the words of John McEnroe ‘YOU CANNOT BE SERIOUS?!’ Obviously I didn’t say that, but my jaw hitting the floor with a thud said it all!

“So can you take me to the hospital for my appointment then?”

“I’m afraid that isn’t what we do. We take patients with a medical need to accident and emergency and you have said you are not ill.”

There was a brief pause……

“I have some chest pain”

“You have chest pain?”

“Yes”

“OK, we’ll have to do an ECG etc here and then take you to accident and emergency where you will be booked in as a patient with chest pain”

“I don’t want an ECG but I do want to go to A & E”

We were powerless to do anything about it. She was playing the system and intending to self-discharge and get to her appointment.  We are not allowed to refuse hospital to someone, let alone someone saying they have chest pain. She declined the offer of a chair and walked off to the ambulance. Oh, incidentally, the bus stop we had parked in was the stop for a direct route to the hospital main entrance. Oh, and she has a freedom pass. 

“Couldn’t you have got the bus?”

“I didn’t fancy it”

“...Or a taxi?”

“That costs £16”

We drove to hospital in silence while I wrote the most sarcastically professional paperwork I could muster. As we arrived, I said:

“How’s the chest pain now?”

“It’s gone”

Hmmm, funny that! We took her into A & E, her appointment now 15 minutes away. I could sense she was waiting for an opportune moment to leave, luckily for us A & E is nowhere near the eye clinic and she needed directions. I gave a full handover to the nurse in charge. The whole time I was talking she was glaring at the patient.

“Where is your appointment?”

“At the eye clinic”

The nurse walked over the phone, looked at the list of phone extensions, picked up the handset and dialled. 

“Hi there, we have Cheryl Smith (not her real name) in A & E with chest pain, can you cancel her appointment please………thank you”

She came back over to us:

“Right, your appointment has been cancelled, you can wait in the waiting room until your name is called, just be aware, it’s a 4-6 hour wait.”

With that, she signed my paperwork and walked off.

VICTORY!! Now why can’t we get away with stuff like that?! Her face was a picture, she whined and moaned, swore and shouted but it all fell on many sets of deaf ears. 

Age is no excuse for bad behaviour and this is all this job was; bad behaviour. She simply called 999 to use us as a taxi. Seriously though, what can you do when someone plays the system like that? As a service, or as individual clinicians, we are in a very grey area when it comes to refusal of an ambulance or refusal of conveyance. We end up playing another game of ass -covering and passing the buck simply because that is what we are told to do, or realistically, not doing so is more than our job is worth. Until decisions are made at a high level, and I don’t mean ambulance management, I mean government level, nothing will change. This is a national policy problem and not something we can fix with well-placed lectures. Needless to say, I had an epic rant afterwards and spent the rest of the shift well and truly riled by the whole thing!