Nursing Times’ student nurse blogger Katrina Michelle Rowan on her four week placement with paramedics
I have just finished my first four week elective with the paramedics. I absolutely loved this placement, being out and about and never knowing what was coming next was something I relished.
I got to see patients in a variety of situations, with a broad range of illnesses and was exposed to vastly differing situations that tested my knowledge and communication skills to the limit.
However, in four weeks I can count on one hand the number of people who genuinely needed an emergency ambulance.
My mentor and I discussed this after being called out to an elderly gentleman who wanted to have someone to stay with him and keep him company. My mentor was rather annoyed at being called out to this (the call had come through as a fall), which I fully understood. My mentor’s point was an emergency ambulance had been diverted from real emergencies to deal with a lonely elderly man - not exactly appropriate use of resources.
My mentor said he wished the ambulance service charged for calls such as this as it was a massive misuse of the emergency services. Superficially, I can agree with this. If you just look at the fact that someone had called an ambulance because they were lonely then charging them for misuse of resources can be justified.
But if you scratch below the service, a little bit of questioning showed how the man’s wife had died two months earlier. They had been together 50 years; he was quite literally lost without her and unable to cope. Is it appropriate to charge a man who was obviously grieving and depressed?
It is easy to understand why paramedics question whether people should be charged for inappropriate use of resources when they have been called to someone who was lonely. But where do you draw the line? Who makes the decision about what is appropriate or not?
A large number of the calls I attended during my four weeks seemed to be a result of social problems rather than medical emergencies. We were called to a girl who obviously just wanted her mother to pay her some attention, we were called to a family gathering that had got out of hand and punches were being thrown. We were called to countless drunks. I spent a lot of time in police company as they also got called to many of the situations I was attending.
We were called to many cases where the patient didn’t need an ambulance at all. These calls tended to be out of nine to five hours. The patient could have easily got a relative to take them to A&E, or even waited to the morning and contacted their GP, or gone to a walk in centre.
From my short experience, those patients who had called the ambulance when it wasn’t necessary seemed to have an unrealistic belief and expectation of the service. There was an expectation that a solution to the problem, condition or situation would be offered immediately, that they would be given priority and offered immediate treatment once in A&E.
When told they could be waiting four hours they seemed quite surprised.
Yet those calls that were a genuine emergency – and we did have some – was when I was completely blown away by the skill, professionalism and quick thinking of the paramedics. Out of hospital care at the best of times can be challenging. The situations we found these patients in ranged from having to trek through a muddy field in pouring rain, to attending an assault victim with head injuries in a tower block.
These situations highlighted to me the expertise of the paramedics. They can go from a mundane job to a job where their skills are tested to the limit.
For those patients I attended who genuinely needed an ambulance, the care was outstanding. I don’t have an answer for the inappropriate use of the ambulance service, and in many cases I do believe this service is used inappropriately.
One paramedic believed a zero tolerance policy should be enforced. I personally couldn’t envision how that would work effectively. Perhaps more appropriate screening of the calls that are made to the emergency service?
I think education and charging are options that could be considered, but the paramedics deal with situations that are multi-faceted and in many cases are not as simple as they firstly appear. It is a difficult situation to resolve but one that certainly needs looking at.
I loved my four weeks with the paramedics and if other students can manage to facilitate a paramedic experience, or even spend a day with them, then I totally recommend it.