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I know Mrs Jones quite well. She doesn’t talk much. She can say ‘yes’ and ‘no’, and a few other words on a good day. Today isn’t a good day.
Today she is lying face down on the floor, half under her dining table. The carpet around her is sodden with urine, as are my knees now. Quite smelly, too; the visit list said ‘?UTI’, and I’d say that’s a good guess.
She’s going to need an ambulance. I’m calling 999 while I’m pulling the chair and the Zimmer frame off her and trying to reassure her; help is on its way.
Time, we are told, is relative. The hour it takes to have root canal work has been shown conclusively to be four times longer than the hour it takes to just quickly check your Twitter feed for five minutes. Time waiting for an ambulance comes into the root canal category. This ambulance is taking forever.
How long has she been on the floor now? There was a time earlier in the day when she was definitely not on the floor because she requested a visit. Then there was my arrival and a little amateur breaking-and-entering, 2pm, by when she was fully face-planted.
Using the squeeze-my-hand method of communication she seems to be suggesting she’d hit the deck about two hours before that. Now it's 3pm. She’s going to start getting AKI and pressure sores if this goes on much longer.
I phone 999 again.
Yes, we still need an urgent response. Yes, I’m still with the patient. Glasgow Coma Score? Well, we’re about neck-and-neck on this now; our eyes are open, we’re talking (sort of), and moving all four limbs to command.
But we are both losing the will to live. What’s more, she might actually be losing the ability; she’s septic, did I mention? She hasn’t just had a fall, she’s had a collapse. She’s burning up at 39.5 degrees, breathing at 40 - going like a steam train - and though her blood pressure is fine, her pulse is 120 and let’s not forget she is face down in a wet carpet. It’s not good.
I was kind of expecting the cavalry to come charging over the hill a good hour ago… what’s going on? We’re having a busy day? You’re not kidding. Help is on its way? Excellent, that’s kind of what I was hoping; but when exactly is that help going to arrive? Oh, she’s category 2, that’s nice to know. So, fully conscious and breathing under her own steam takes her out of the running for category 1, fair enough, and I’m happy for her really; and it’s nice to know she’s not categories 3 or 4 which presumably would involve delays of somewhat longer than the hour I’ve been with her so far.
But are we going for some kind of record here? I thought we were quite big on a quick response to sepsis these days; so what gives? Seriously?
We entertain ourselves meanwhile trying to get her temperature down. I turn off radiators and open windows, manoeuvre off her cardie and ease her crushed specs out from under her face so there are fewer things digging in. Her alarm bell is ironically wedged under her chest and its cord half strangling her, so we pass a fun few minutes easing it out. We ring her daughter and I hold the phone as she lies mumbling her ‘yes’ and ‘no’ into the carpet.
I do her obs a few times, writing a note for the hospital and ringing the bed manager dutifully. We tell a few jokes; well, I tell the jokes and she chuckles politely into the carpet. And then I have another chat with ambulance control; what the flip is going on? I get a call back from the controller. She really is very nice. She tells me that there are a hundred-odd calls ahead of us in the queue today, and that one poor soul in Brum has been waiting more than two-and-a-half hours, also for a category 2 response. She’s very sorry, and that’s nice too but still…
I’m worried about Mrs Jones. And I’m getting worried about my afternoon surgery – 13 patients in person and another 10 on the phone, and all waiting for little old me.
At this point her son arrives like a knight in shining armour on an old red bicycle, lovely man, and packs me off to get on with it while they wait together. He’ll call 999 again if she gets worse, and who knows?, perhaps the ambulance might come quicker if I’m not there. I do hope so.
Ten days later I phone to catch up. She’s still in hospital; IV antibiotics worked just great for the urosepsis and she’s on the mend now, but weak.
Out of interest, how long was it before the ambulance came?
Another hour and a half. Three hours in total. Three hours for an old lady with sepsis lying face down in the carpet.
I guess we were all having a bad day that day.
Felicitas Woodhouse is a GP in Warwickshire and was the winner of the 2016 BMA writing competition. She writes under a pseudonym
We waited 8.5 hours Sunday night for an ambulance for an 85 year old lady with a broken hip in absolute agony, couldn’t eat or drink anything as couldn’t move. Nor go to the toilet. She was conscious and breathing, so not a priority. 4am in freezing weather eventually ambulance turned up, and eventually carted her off for a further 10 hour wait in A&E. That’s 18.5 hours!! The NHS is in a complete mess!
I spent the full six hour NHS111 for a verification of death of a 105 yr old with no family, last patient of the day but oh my what a long day that was! Definitely putting myself on the Registered Nurse verification of death course for future reference.
I think we should be showing some respect to paramedics for their effort in these days of icy road... Pt are waiting for GP appointment for weeks, waiting in ED, waiting for hip replacement so why not for Paramedics...
As a paramedic you learn to work with what you’ve got - it’s a case of having to, to manage each patient scenario to give them as best an experience considering circumstances.
Ambulance crews are expected to manage more & more urgent care scenarios as a mobile healthcare unit & not just for life threatening emergencies. A high percentage of work is treated & managed in the patient’s own home, which takes time to sort if requiring to involve primary care & other HCPs. Whilst this takes place that’s a transportable resource out of the picture of being available for life threatening emergencies.
Think. Can I start treatment in this situation. Can I prevent a worsening scenario.
Let’s use our knowledge & skills to improve patient scenarios. Let’s make every contact count to pass on common sense care to the public to prevent them becoming patients.
But when I try to engage colleagues in political discussion- it’s like knitting fog. They don’t vote,don’t care,don’t understand . Don’t know what STPs are etc etc They are sleep walking into the destruction of the NHS
I'm sorry, I don't know if this is intended as a dig at the ambulance service, but that is how it comes across.
I am a paramedic and work on a rapid response car and so have been in exactly this type of situation waiting with a very poorly patient for a crew to arrive. There simply aren't enough ambulances and this is compounded by members of the public abusing the service.
As for the category of response, Cat 1 jobs are cardiac arrests or peri-arrest patients. Sepsis at present does not fall into that category, nor does someone having a stroke or an MI. GP surgeries requesting an 8 minute response...they do too.
We're all in this together, so please don't take it out on the ambulance service who are doing our best with not enough resources or staff.
“The right to the highest attainable standard of health” implies a clear set of legal obligations on states to ensure appropriate conditions for the enjoyment of health for all people without discrimination.
My mum died of septic shock. The paramedics told the hospital she was septic with a news score of 14 and they still made her wait in the ambulance outside A&E for close to three hours. She was only 49
Am I the only person in the universe who associates the pressure on the ambulance service with the advent of NHS 111? This disastrous, politically driven nonsense of a service must be held responsible for dispatching so many unnecessary 999 ambulances at the expense of those genuinely in need. Let me be clear, I do not blame the call handlers, they can only follow the algorithms at their disposal. But this very expensive service needs a radical re-think or, better still, recognised for the failure that it is and abandoned.
5 hours on Saturday for a patient with a stroke
- whatever happened to time is brain?
I don't think anyone is blaming the ambulance service. As a GP I have nothing but respect for paramedics who are unfailingly patient and caring whenever they arrive. But someone needs to take responsibility for the lives that this inability to respond is costing. We need to resource the ambulance service and stop inappropriate use. I hope Jeremy Hunt gets to see this blog.
IV line? First dose of antibiotics? GP's still have some drugs don't they? Perhaps assess her for injuries and get some help from a neighbour to move her off the floor and into some dry clothes?
Disappointingly, this article makes it sound like you made no effort to manage your patient beyond moaning about the wait for someone else to come and do everything for you.
You are right, sepsis kills people so be more proactive and if you don't have the skills, learn them.
No desire to be derogative here... I was in the same situation with a patient that had collapsed with an urosepsis in her very small bathroom last summer ,on an unusual hot day for North Wales and no air in the patient's bungalow.The ambulance ,called as a blue light was not showing itself at the horizon ,the frail - elderly husband of the patient could not help to lift her from under the sink . Luckily one of our nurses left her workplace and helped me to move the patient from the bathroom to the corridor whilst we waited for the ambulance.
IV line- sorry we don’t carry them and we’re not a makeshift out of hospital ED or battlefield station. Potential sepsis needs URGENT ambulance response. And we don’t work by the hour so we can’t spend hours with a patient that should be somewhere else immediately.
When ambulances are being called out for a lot of nothings, this will keep on happening, and there is nothing that one can do about mornings.