Posted by: medicblog999 | January 30, 2009

The thirsty man

waterThis job happened about 6 years ago, but still sticks out as on of my ‘you wouldn’t believe it’ jobs.

At the time I was an advanced technician working with another advanced technician. This was way before the introduction of Cat C training (to enable paramedics to make a clinical decision and inform a patient that they do not need to go to hospital/make their own way there/need to see a GP etc etc)

It was 6.45 am on a Sunday morning, the pagers are activated on station and we move to the ambulance. The data screen in the ambulance informs us that we are going to an address very close to the station for a man who is feeling unwell. The only category of job we get is a 17B, which was the code for sick/unknown/other.

We arrive on scene in 2 minutes and the conversation went something like this:

MB:     Morning, Ambulance!!

Pt :      I need to go to hospital!

MB:     Whats the problem?

Pt:       I was out drinking last night and since 3am I have been really thirsty.

MB:     O.k, anything else? Any pain, any sickness, dizziness, headaches etc                      etc?

Pt:       No, nothing, I’m just really thirsty, I’ve had some pop through the                       night but I’m still really thirsty. I think something is wrong with me.

MB:     Did you have much to drink last night?

Pt:        Quite a bit, maybe 8 pints and some shots

MB:     That might have something to do with you feeling thirsty then.

By this point I was thinking that I would do a full set of observations on him and once I knew that everything was within the normal limits, I would reassure him that everything was alright and that he would be fine if he just kept hydrated and had some food etc, and that would be that.

All of his observations were normal. His conscious level for normal, fully alert and orientated. BM normal. No physical signs of dehydration. No significant medical history. The patient denied any recreational drug use and did not seem in any way under the influence of anything.He just seemed a little hung over from the night before.

MB:     Everything seems to be absolutely fine, do you not think that you are                just a little hung over?

Pt:       No! somethings wrong, I need to go to hospital, why arent you taking                  me to hospital? We are wasting time, I should be on the way to                              hospital!

MB:     Honestly, you are fine. There doesnt seem to be any real need to go                    up. Are you sure you want to spend your Sunday morning sitting in                    casualty?

Move forward 10 minutes of further negotiations and the patient is now getting a little upset. Ultimately, there is nothing I could do other than take him up to hospital. I couldnt refuse to take him, so reluctantly we took him up.

When I handed him over to the nurses at the hospital I got the response of:

“What?????, put him in the waiting room!”

Lets move forward now to present day and see how things have changed.

MB : Morning, Ambulance!

Pt: Im not well, Im really thirsty!

(Insert the rest of the assessment process and questioning as above)

MB: Your fine, you seem a little dehydrated from the amount of alcohol you drank last night. Have some regular fluids, water is best, and if you feel up to it try a little bit of food too. If you still feel unwell later this afternoon, you can either contact your GP (home doctor) or make your own way to either a NHS walk in centre of up to A&E. If you really feel that something has gotten SIGNIFICANTLY worse at any time, feel free to ring 999 again.

Pt: No, I want to go to A&E now!!

MB: Thats fine, can you make your own way there or get a lift?

Pt: I want you to take me

MB: I understand that, but unfortunately there is no clinical need for you to travel to hospital in an ambulance. We need to be available for other emergencies so I am not taking you to hospital on this occasion. Try what I have suggested and see how you get on. Take care, Bye!

I have a respond not conveyed form that needs to be filled in which has various options on it to tick. This one would tick the box

“Patient assistance only”

The big difference here is that now its  not the patient refusing to go, but it is me making a clinical decision based on what I am presented with at the time, and ultimately the responsibility remains with me if something goes wrong after I leave the patient. However, as long as my clinical assessment and documentation are up to scratch, I am confident with leaving certain types of patient complaints either at home or referring them on to other care providers.

Isnt progress great!!

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Responses

  1. Perhaps it’s time we educated the public. I’ve been keen for a while that ALL school leavers should have a basic first aid course (CPR, severe bleeding, burns, some minor medical emergencies). We could also tag on something about when to call an ambulance and when not to.

    But please, please no more NHS ReDirect. I was sent out to one last night (I’m a CFR) where the PT was “unconscious” but they’d also ticked the box “conscious & alert”.

    The old boy (90+ and very with-it) had a slight dizzy spell and was assaulted by the ground. Definitely a Cat C (which I don’t get called to) and minor trauma – cut head with a lump like a duck-egg (and I’m not supposed to do trauma).

    Full A&E ambulance running hot.

    All the family wanted was instructions what to do. They’d have taken him to A&E themselves, but NHS ReDirect had other ideas!

  2. I am surprised and reassured that you are able to pretty much refuse to take nonsense patients to the hospital. I only wish that we could do that here in the states, as it is, if they want to go, our hands are tied.
    This is possibly the most brilliant thing I’ve ever heard of. Do you(NHS) have any trouble with liabilities?

    • Hi Ellie,
      Thanks for your comment.
      In answer to your question, no we dont have any real problems with liabilities. When we started Cat C ing patients, i.e. informing them that they can make there own way to hospital, they dont need to go, or there is a more suitable alternative than travelling somewhere in a fully manned paramedic vehicle, my service did a study and sent out questionnaires to a large volume of patients who had called 999 but ended up not being taken to hospital by the crew. The result showed a very favourable response to the new system.
      It does however, rely very much on the communication skills of the paramedics involved and ensuring that they complete excellent quality clinical documentation.


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