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I was left unsupported for 80 minutes in a life-threatening situation

Dr Mark Ironmonger

While dining recently, my friend nudged me that I might be needed. A commotion was coming from a few tables away, where an elderly gentleman had collapsed onto the floor and been dragged back onto his seat by his family.

The patient was unconscious but breathing, so my first reaction was to clear the banquette that he was sat on, and check his airway, breathing and circulation whilst laying him into the recovery position and elevating his legs.

Initially, I couldn’t feel a pulse at his wrist or neck, but he soon started to regain consciousness and I could feel a thready, irregular fast pulse at his wrist.

His wife said that he’d previously had three heart attacks and was on an array of drugs. Having alerted the manager to call 999, I, as the only clinician onsite, and felt a responsibility to not leave him unattended as we waited.

The call taker also insisted on taking me through all the emergency care triage questions, before reassuring me that there would be an appropriate response.

But after 25 minutes of no action, I made a further 999 call, reiteraring my concern that this could be an MI in a patient who already had a history of three.

I was again taken through the triage questions I’d already answered, and the call taker couldn’t tell me if a paramedic was on their way. Insisting to speak to a manager, I was eventually told that a clinical practitioner would be in contact. This was followed by a further attempt to repeat the questions, and only after my adamance that the patient needed extremely urgent attention did I receive confirmation that an ambulance had been dispatched.

The irony of the DGH being only two miles away and that there was a shortage of ambulances seems to have been lost

All in all, there was a one hour and twenty minute delay separating the first 999 call and arrival of an ambulance. In the meantime, I’d been left in charge of a life-threatening situation unsupported, equipped only with a set of cutlery, drinking straw and my fingertips.

At one stage, I was informed of a shortage of ambulances and personnel able to attend, even though we were within two miles of the nearest district general hospital (DGH).

Despite doing my best to reassure the patient and his relatives throughout, this was a highly distressing scenario all round. 

It was extraordinary that the details of the first triage weren’t registered by the second two responders, and that my initial concern that this was an MI carried no weight, as it seemed to not be included in the NHS Pathways protocols.

Later and with the patient’s permission, I subsequently raised my concerns with the South Central Ambulance Service NHS Foundation Trust, who stated that the first two calls were marked as category three – the urgent call status for incidents not considered life-threatening.

Only after I spoke to a clinician was this case upgraded to a category two - a condition requiring urgent on-scene intervention, and/or urgent transport, such as a probable heart attack, and they felt that they’d responded correctly, according to the national ambulance response standards determined by NHS England.

According to the patient’s relatives, the ambulance was at the restaurant for 45 minutes, and he was subsequently allowed home. The irony of the DGH being only two miles away and that there was a shortage of ambulances available seems to have been lost.

I felt unable to accept the explanation offered; that there was something clearly wrong with the urgent ambulances supply; and that the protocols should be revisited. The patient’s family also complained, while I conveyed it to the senior patient experience office, who replied that this is now an official complaint and I should hear the outcome imminently.

 Dr Mark Ironmonger is a GP partner in West Kent

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Readers' comments (12)

  • Intolerable.

    A totally rhetorical question, did you partake of alcohol with your meal?

    (Note to self- time to do the BMA Burnout Questionnaire again).

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  • Similar in Scotland. If there is a doctor with the patient, the call urgency is automatically downgraded. The ‘so-called GP hotline’ is in fact a ‘slow boat to China’. We have to state ‘Immediately Life Threatening’ and explain ourselves. As many of us have discovered, to get appropriate attention for the patient, we just have to get family/friends to phone ambulance service and not mention that a doctor is present (pragmatic but unprofessional?)

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  • Same in England. It will be quicker for the relatives to drive him to A+E. The moment they hear a GP is present you can bet it will be over an hour.
    However all the useless questions tick the CQC box for safety and having processes in place and the directors/managers use it to cover themselves for a lack of staffing and the CQC pretends it is safe and give others the illusion too.
    They system is not breaking. It is broken.

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  • My husband, an anaesthetist, waited with a guy who had collapsed with a respiratory arrest In central London. He was brought around confused but no ambulance for 50 minutes. In the end the fire brigade came after 1 man in some kind of emergency car initially responded and was saying he would take him in car to hospital ( husband suggested this not a good idea as could arrest etc again).
    It was a cluster f***. And that is central London with major hospital around the corner.

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  • Better getting a taxi for anything not including spillage of body fluids. To be fair to the ambulance service, if there was a charge for each use, they would be engaged in far fewer calls.

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  • Sometimes you just have to sit it out! All that was necessary, after your effective first aid, was to watch over a patient who was conscious and not bleeding until the scarce resource of an ambulance became available. Sometimes the the ambulance staff are dealing with ill or injured patients in an even worse condition.

    If there is a problem here, it is the result of inadequate investment in service and staff for the past twenty years. Don't blame the overstretched ambulance service, which cannot afford to employ enough qualified staff to manage calls efficiently and effectively.

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  • DecorumEst - What is pragmatic, in being lifesaving, IS professional, don;t worry!
    Ambulance service needs more responsible management, who will own up to being short-staffed, and get funding increased; AND ALSO stop hospitals who muck up the system by refusing to unload 999 ambulances at the door, causing lost lives down the line.

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  • As GPs we know about the pressure on ambulance services we don't call them unless its emergency. We put people in taxis call on relatives to transport and when we ask for an urgent ambulance it means the patient is at serious risk if not transferred immediately. In the past couple of months I have been left with a 4 yr old fitting for 40 mins as it wasn't deemed life threatening_- child ended up on ITU. Having seen an extremely ill and psychotic man this week I can report there is no emergency response for mental health patients.The patient wouldn't get in a car but felt they would be safe in an ambulance 5 hours later we were reduced to calling the police. The patient was restrained forcibly which was extremely upsetting and sectioned, a 136 and later 2. In 30 years I have never called on the ambulance to come out for a mental health problem. As mentioned before when you ring back they cant tell you when or if an ambulance has been dispatched. I will expect more deaths in surgery or as a failure to dispatch. The ambulance algorithm is a farce perhaps we should take a note from our frequently transported patients' and drop in random key words that automatically lead to a blue light response. I'm both disillusioned and worried for my patients and the ambulance service.

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  • shut down ambulance "service" fire can do the emergency stuff--minicabs can do the rest

    works very well in france

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  • Having worked as a GP and Pre-hospital care doctor for over 30 years, I have seen both sides. I see the pressure my ambulance colleagues work under and the frustrations of GPs who have very sick patients in front of them but cannot translate that clinical concern into the prompt ambulance they feel they need. The solutions are not quick or painless for either side?

    How many GPs make the call themselves?
    How many GPs have ever been trained to make an emergency call or understand what is happening in an ambulance control room?
    Do ambulance services understand the resources unavailable to GPs when managing an acutely unwell patient?
    Does the urgency of an ambulance request change the nearer we get to GP surgery closing time?
    Education, Working towards better processes that include judgement and physiology (NEWS2) and proper monitoring of incidents and outcomes all seem like a good idea to me but none of them are cheap or easy.

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