So last night was a busy shift. We were sent 10 emergencies in 12 hours, which is a decent number in our area. However, we only took 2 of those to hospital, and one of those was to an urgent care appointment and not A&E.
Our ‘discharge at scene’ rates are something like 55% or more. That means that over HALF of the people who ring 999 don’t need hospital admission. Now, that’s not to say that those calls aren’t ambulance worthy, but many/most of them could have chosen other options, such as calling the out of hours doctors service, going to a walk in centre, or simply taking pain relief. I take great pleasure in keeping people out of A&E and exploring other options and it’s quite satisfying to help someone in their own home.
Our one and only A&E worthy job was a fair drive from our station, way out in the ‘sticks’. Blue lights on and we arrived to find a gentleman sat on the edge of his bed, he had soiled himself (D&V without the V) and the lower half of his body was covered in it. He was alert and talking, but didn’t seem to know where he was. We examined him quickly and came up with a preliminary diagnosis of sepsis. Sepsis is basically blood poisoning caused by a bad, untreated infection. This patient was, to put it lightly, poorly!
- Problem the first: We couldn’t take him to hospital covered in diarrhoea. Thankfully they had a walk-in shower which we utilised. He needed a lot of help due to his condition…..so…..Two words…..splash back. Yep, gloves were not enough to protect me, but that’s the nature of the beast when working in emergency medicine. I knew I had spare uniform so wasn’t too worried.
- Problem the second: The house was a long walk down a narrow gravel track to where the ambulance was parked. We decided the best option would be to use his daughters car to drive him to the ambulance, as the stretcher wouldn’t wheel over the coarse gravel. We also had to reverse the ambulance down a narrow road to make room to load the patient.
- Problem the third: A dog. A Jack Russell to be precise, who came bounding up the road (bearing in mind it’s past 1am) and insisted on getting under the ambulance while reversing. Cue me – while watching my colleague back and directing him away from walls, pylons, trees etc – ‘shooing’ this dog away from the wheels of our 5 ton truck!! But nope, the playful pooch was so interested in the big yellow machine that 5 or more times he ran almost under the wheels! My solution? I had to pick up the dog and carry the thing down a, not insignificantly long, track. The dog thinks the best thing to do here is to try to lick my face while simultaneously scratching the life out of my arms and beating me with his wagging tail! Let’s not forget, I’m also trying to help my crew mate negotiate a track that is barely wide enough for a car, let alone a ruddy great ambulance.
Eventually, we loaded the patient, I thrust the dog into the arms of a very confused looking daughter, and continued treating my patient. IV access, fluids, oxygen, 12 lead ECG, OK let’s go. Blue lights to A&E. A job well done.
I was questioned by a doctor as to why we were on scene so long with a man so unwell. I smiled to myself, knowing that when we turn up in A&E, we have a patient who is (usually) clean and wrapped up on a stretcher, with no hint of the drama involved in getting them there.
Home to bed but haven’t slept too well today, so tonight could be a long one. Now, where’s my super-mega-Xtra-lightning strength coffee….