Posted by: medicblog999 | June 24, 2009

You’ll need your chair!!


Is this a British thing or does it happen worldwide?

I have lost count of the amount of times I have arrived on scene whilst working on the full ambulance (not the rapid response car…..someone would have to be really rather challenged in the neurone area to say that to a single responder who turns up in a car!), to hear the patients relative or carer call out

“You`ll need your chair”

As we continue to walk to the house we get further tit bits of information such as

“he cant walk”

“he hasnt been out of his chair for weeks”

“Ooohhh, youll never get him up”

etc, etc, etc.

My response is always the same.

M999:  “We will just pop in and see him and then decide how best to get him out to the ambulance”

Now, here is my disclaimer straight off the bat, in case someone reading this things I am neglectful to my patients. I will ALWAYS move my patients out of the house with a carry chair or a stretcher if there is a clinical need for it.

If on the other hand the patient has taken on the sick role, (or what I like to call Pyjama induced paralysis) whilst they have been feeling unwell with a heavy cold, and has got their family run round ragged after them, and there is no concern in my mind, what so ever, that walking will in any way worsen a condition, or prove painful, or risk exacerbating a pre-existing condition…..they will be walking out to the ambulance.

This is not uncaring behaviour, it is not neglectful, it does not demonstrate poor standards of care. It does however, show a process of clincal assessment, risk assessment, and maximising the patients independance in a safe and supportive environment (wow, that sounds good, i’ll have to remember that)

If I arrive on scene and walk in to find a perfectly healthy looking patient who appears to have a minor medical problem, and the initial assessment shows no significant problems, I will casually ask the patient if they are okay to walk out to the ambulance. Most patients will say that they are happy to walk out, however, many of their family members have different ideas and often jump in by saying:

‘Dont be silly Dad, you cant walk out, your poorly, the lads will get a chair and carry you down the stairs and out to the ambulance”

I understand that relatives and loved ones care deeply about the patient, but sometimes it would be nice for them to think that this may be the 7th or 8th heavy lift that me and my mate have done during this shift, and if there is no need to lift the patient, then we need to think of our own health, and backs, and assist the patient to the ambulance rather than carry someone who doesn’t need it.

Mind you, there have also been plenty of times when we walk in with the family telling us that we need a chair, and then as soon as I set eyes on the patient, I turn around to my mate and say “Chair!”

Its all an risk assessment process and I will always come down on the side of carrying the patient if I have any concerns to their well being. If you are a 40 yr old fit and healthy man who is a good colour with normal obs and a normal ECG, but you are describing cardiac sounding chest pain, you are getting a chair, even if you offer to walk. If you say you feel fine and the family are just fussing over you by calling 999, but you look like crap, you are getting a chair. If you want to walk to the ambulance, and have a minor medical condition, but you seem to be struggling a bit, you are getting a chair.

However, if you look fine, obs are fine, are sitting in a clean and tidy house, and have managed to get up to go the toliet (upstairs) throughout the day, then you will be getting asked to ‘have a try’ and walk out to the ambulance.

I think thats fair enough…….do you?



  1. Same here 999,

    Just had a fellow today who demanded we carry him down 6 steps. Just before getting him into the chair he asked if he could use the toilet. when we agreed he jumped up, walked down the hall and into the toilet without us. So we took our chair back down and explained he didn’t need it.

    And he didn’t.

  2. No, 999, this is most certainly a global thing. I handle my patients in much the same way as you do. Actually to the point that you or I could probably jump on w/ one another and be able to run calls w/o so much as a hiccough…


  3. Ill never forget the day I got asked to hobble out of the leisure centre on an ankle that the next day was the size of a melon.

    The doctor at the hospital was amazed it wasnt broken. Yes i may be young and yes it mightent have looked that bad and yes you could prod it and i didnt scream but the only reason for that was the bloody 20 black belts who would have had my life for being soft.

    Just a note try and put yourself in the patient position if it was you with that complaint would you have liked to have walked to the ambulance even if yes you could most likely make it.

  4. We are fortunate enough in florida that the vast majority of homes we visit are single story homes…or bungalows as we brits call ’em. So most of the time we can get our stretcher pretty much next to the patient. However what really erks me sometimes is the patient who presents with toe pain for the last 4 weeks and would like to go to the ED via ambulance and the problem is we cannot get the stretcher to the door due to the fact there are 9 cars in the driveway and I guess nobody can drive the family member themselves due to the fact that the new episode of house just came on. Can you hobble to the stretcher?……Lets go

  5. You’re spot on. That’s remembering your ABC’s – ambulate before carry.


  6. I’m much in agreement with Mark on this. If someone needs it they get carried. If I injure my back whilst doing this then so be it. I won’t however potentially ruin my career for someone who is perfectly capable of moving with assistance to the ambulance. My current service was quite clear when I started with them, ‘use the analgesia we’ve given you and get them to float out’. A paramedic with a stuffed back isn’t much use to anyone.
    My favorite chair story is about a young female ambo who got out of the ambulance to be met with the usual ‘you’ll need your chair’. She said back haughtily “I’ll be the judge of that”, the relative shrugged and led them to the patient. This was a WWII veteran who had lost both his legs and was having an angina attack. The driver rushed back to the truck for the chair, while the female ambo red-faced stammered out the apology.

  7. I agree entirely with you Medic. As long as the patient moving themselves is not contra-indicated (such as in vicky’s case, where even the most basic treatments such as RICE advise rest and elevation, etc), then the patient should be encouraged to move themselves. It can be an important indicator as to the patient’s condition too.

  8. On the money 999; it’s all based on the assessment and just for fun don’t forget the “ABC’s”;
    “Ambulate Before Carry”
    and of course you are a “MEDIC”;
    “My Education Didn’t Include Carrying!”…that’s what firemen are for! (Sorry HM…couldn’t resist!!)

  9. I felt sorry for the emergency personnel who had to lift me onto the stretcher (since I am overweight). But, in my own defense, I was having an acute MI. But there was 8 of you (4 firemen and 4 ambulance personnel!) You all did a wonderful job!

  10. Um …. it wasn’t necessary for all 8 people to carry me … I’m not that much overweight!

  11. Sorry didnt mean for that to come out the way it did. I think the guys that turned up were a little bit annoyed as it was a busy friday night in Newcastle and id only done it through my own idiotic idea of fighting for fun.

  12. Ha ha ha, think every ambulance person in the world wll agree with you! I remember back when I used to work on PTS takign a chap home who really stuggled walking/standing/transferring and seemingly stating the obvious that he would a need a chair to get him inside when we got home. Having taken said gentleman in on the chair and settled him in we found we still had a bag of his belongings on the ambulance. Went back into the house and who greeted me at the door and took his bag off me than the same bloke whose legs just wouldn’t work less than a minute before – must of been some sort of miracle cure!

  13. There is nothing I hate more than being told I need a chair when i’m perfectly capable of walking. Okay…I can’t breathe but the six steps down the driveway into the ambulance aren’t going to kill me.
    *Slaps wrists*
    Bad patient…

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