Posted by: medicblog999 | May 5, 2009

Wheelie Bin Wrist

wheelie-binI was on standby in the rapid response car in a lovely partially lit layby next to a large cemetery when I was dispatched to a 3yr old boy who had had been scolded by a cup of hot coffee. The address was 9 miles away, Category B call, so off I went with lights and sirens. I had travelled about half of the distance when I was stood down and diverted to a “? broken wrist, elderly male”

I assumed (and hoped) that meant their was now a closer response for the scalded child, so I changed my direction and headed off to the new address.

Arriving a short time later, I entered a sheltered accommodation bungalow to find an elderly male and female in their front room. The man was holding his wrist and crying out in pain. I asked what had happened whilst looking at his wrist. He informed me that he had been outside putting some rubbish in the wheelie bin when the lid had blown shut and had landed on his wrist.

On examination, he was exquisitely tender to his wrist, crying out in pain whenever I went anywhere near him. My only concern was that there was absolutely no deformity to the wrist, no reddening or swelling and thinking of the mechanism of injury, there was unlikely to be sufficient force to cause a significant injury to his wrist. 

All of his baseline observations were normal and there was no significant medical history. At this point I am starting to get a little suspicious, but I keep to my belief that if a patient states they are in pain, then they are in pain. Its not my place to decide otherwise.

I tell him that I will place his arm in a sling to support his wrist and that if he is in so much pain I will run him down to the local hospital to get checked over. There is no way that I am going to have him transported in a full ambulance so I get ready to take him in the car. 

I apply the sling, with him screaming and flinching throughout, although something still doesn’t seem right. I make an excuse to pop back out to the car and after I have been outside of the house for a couple of minutes I make a quiet entry back in to the house.

” Ahh Haa!!! Got ya!”

I walk in to see the patient with his arm out of the sling tying his shoe laces with no apparent discomfort. On seeing me he quickly places his arm back in the sling and starts complaining of the pain again.

M999: Whats going on?

Pt: What do you mean?

M999: I have just seen you moving your wrist to tie your laces, I thought it was really painful.

Pt: It is, its so sore, I cant move it.

M999: Ive just seen you move it! And it didn’t look like it was hurting you too much!

Pt:Its really sore, Ohhhh it hurts, it hurts!!

M999: Lets just have a look at it again…

I proceed to reassess the wrist, again he screams out in pain when I touch it. Its his right wrist, so hoping that he is right handed I inform him that I need a signature on my paperwork before I can take him to hospital (which I don’t, but it will make a good test)

He signs my form, after pulling his arm out of the sling, with no complaints of pain!

M999: See you have just done it again!

Pt: What?

M999: You have just moved your wrist and It didn’t hurt. Whats going on here? Somethings not right!

The ongoing conversation goes to and fro for about the next 15mins, with the patient continuing to state they need to go to hospital, but without realising, he keeps moving his hand and wrist without any pain. By now Im starting to get a little exasperated. I am aware that if I got stood down from the scalded child because another vehicle was closer, then that pretty much means that I am now the only cover for at least 10 miles. The longer I stay with this patient the longer the area remains without cover.

I make my decision.

M999:I dont believe that there is anything wrong with your hand or wrist, I have witnessed you moving it numerous times without any pain. I  really dont know what is going on, but I know there is nothing wrong with your wrist. I am not taking you to hospital tonight.

Pt: You have to take me, I want to go.

M999: Unfortunately I don’t have to take you if there is no clinical need, and unless there is some other reason that you feel you need emergent medical help tonight, then I am not taking you anywhere.

The only other thing I could think of was that maybe the patient had another problem that he just didn’t want to tell me about and so was making up this injury to get transport to the hospital. 

I gave him ample opportunity to change his story. I informed him that if it was a personal matter, then I would accept that and take him up, but he kept on just saying it was his wrist.

The mobile warden then arrives:

“What did you call 999 for????, I told you there was nothing wrong with you!”

It all becomes clear, the patient had bumped his wrist before, the mobile warden had checked on him and told him that he was okay, yet he waited until the warden had gone then called 999.

I have never point blankly refused to take someone before, I can usually get them to accept that they don’t need to go and they agree that there is a more suitable care pathway to go down, whether that be seeing the GP the next day or making their own way to Accident and Emergency or a NHS Walk in Centre. This wasn’t working on this gentlemen. No matter what I said, there was no sense of acknowledgment. I couldnt help but think of what may be happening elsewhere whilst I was stuck in this situation.

I left him in his home, still with the usual advice of calling back if there was a REAL emergency. I informed him about the pressures on the service and how this was an inappropriate use of the 999 service, but I could tell it was all going in one ear and out the other.

I moved back to the car, completed the paperwork, relayed a message to control about what had happened and then pressed clear on the terrafix screen.

Immediately….

“Cat A Chest pain..” 

With an address within 2 minutes of my own station 7 miles away!!

If I hadn’t been dealing with this patient I may well have been on the doorstep for the next patient.

You don’t expect the time wasters to be 80 yr old well dressed gentlemen.

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Responses

  1. Here, in that situation, you would have been reprimanded, placed on administrative leave pending the lawsuit and advised by your supervisors it would have been easier to just take him already.

    Way to stick to your guns 999, you know what they need, they know what they want and we should not be robots simply doing what they want.

    Now if only I can convince an entrenched establishment of that, we’ll be all set.

  2. You’ve got bottle, 999.

    Sounds like the silly old sod either had some psychological reason to get ambulance company or he was maliciously wasting your time. If it’s the second case, he should be prosecuted.

    Usually I find that older people are more likely to apologise for wasting your time when you go to a real emergency than genuinely waste it with non-jobs.

    There are, of course, exceptions!

  3. That is really impressive that you have the ability to refuse transfer (and you did it!)

    In BC our crews cannot (under ANY circumstance) refuse transfer to someone who has called 911.

    Much to our chagrin…especially when they arrive with ‘Debbie’ once a week, who calls 911 from gas stations around town to get a ride to the hospital for free food. She’s made >500 calls to 911 in the past 2 years. Has never paid a cent and never been charged by police. Even my bleeding heart liberal sensitivities get rankled when I see this woman in our ED.

  4. We can refure transport down here.
    The other way is to have the patient abuse/threaten/etc you.

    I was not doing pt care (my partner was) for this particular patient last week. Picture a skinny male from a very low socio-economic background (a scumbag – I still often revert back to parts of my previous policing career).

    On our arrival he’s claiming he can’t move his L shoulder at all.
    My partner questions him about the alleged assault and he shapes up like he’s boxing to describe what happened last night.
    I put it to him from the other end of the couch that he’s now moving his shoulder very freely. Caught out in a lie he “fires up” and screams at me.
    “you don’t believe me, well f&@k off, f#@k off you fat c*#t”

    I don’t appreciate being called a c#@t, (fat is ok) so off we went. Another satisfied customer…..

  5. I’ve heard of herbal tea – but verbal coffee is new on me!!!!! Maybe it had a hot temper.

  6. Wow, interesting story.

    Well handled (I like the way that you made the excuse to go to the car!)

    It’s horrible that timewasters are putting those who REALLY do need the help of an RRV medic or Ambulance crew at risk!

    Hope the CAT A Chest pain patient was okay

  7. Ha its sounds like a typical day in my county. I really have lost count of how many BS calls I have been on where we have to take the patient to the ER. Here are some of my favourites.
    A man wanted to go to the ER for knee pain. ( which he has had for the past 30 years with no change today).
    Nightmares.
    Some guys arm fell asleep whilst he was laying on it. I got yelled at by the nurse for NOT starting an IV?????????
    Unfortunatly we do not have the pleasure of refusing to transport them if there is no need.

  8. […] ‘refusing care’ at the point of patient contact. I have only done this once, and that story is here if you want to read […]


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