Interesting England EMS Story From My Sister

[x635 4,066]

So, last night I picked my sister up from JFK airport. She is home for winter break. She is currently in graduate school on a full scholarship at Oxford in England.

Anyways, she tells me a story on the way home that she was at a party (in England), and a friend slammed his finger in the door, and in the process literally amputated it off. So, he's bleeding profusely, she calls 999 (their 911) while another friend puts the fingertip on ice.

The 999 operator says they'll send an ambulance, and hangs up. A few minutes later, the 999 operator calls back, and says there aren't any ambulances available, that they're all out at life-threatening emergencies and they'll have to figure out how to get to the hospital on their own. My sister informs the dispatcher that she's at a party with drunken college kids, this kid is bleeding a ton, in pain, and doesn't look good. The 999 dispatcher suggests someone drive him to the hospital. My sister again requests an ambulance be sent, and the dispatcher refused, saying there wasn't one ambulance within 45 miles that could take the call (in all of Oxfordshire County, which is pretty populated). She suggested they call a taxi (which where they were from experience would take a while and cost a lot), my sister asks them to send a police car, they say it isn't an emergency or police matter. She also informs the dispatcher that most of the kids are American and aren't familiar with where the proper hospital is, and the dispatcher says again to call a cab. So, finally my sister hangs up and finds one of their sober friends to come over, gets the kid, the finger, and brings him to the ED after having to call directory assistance because the dispatcher refused to provide hospital information.

England has socialist health care. Although I did enjoy "Sicko", this wasn't the scenario portrayed by Michael Moore in his movie.

Intresting story from my sister Danielle, just thought you all would find it interesting as well.

Does anyone know who provides EMS in England in areas besides London?

[nycemt728 49]

Wow, thats a far cry from us here in large US cities taking everyone w/ every complaint to the ER. Obviouly neither extreme is the appropriate response. I'm wondering if she had called the police station directy and explained the suituation if she would have gotten a better response. I mean, yes its not PD matter but at the same time we all have had sitauations where there is leeway for disgretion, the mitigating factors should have helped out. I guess there is a legal issue for PD to take charge of an intoxicated, injured individual, but at the same time, its a legal matter (at least we've made it so in the US) when proper, lifesaving care is not provided...

[ny10570 745]

This is another example of how socialized health care doesn't work and our profit based system is flawed but still better. English EMS systems are so over taxed that they regularly treat and release patients because the ERs are packed and there are not enough ambulances. When looking at adding units they look at the number of life threatening emergencies rather than the number of calls. Had your sister called because of a cut, tooth ache, sore throat, or something of similar life threat she would have been told for the get go that she doesn't need an ambulance. Yeah its great that it stops the nuisance runs but it doesn't do anything for the people need an ambulance but cannot get the appropriate information across to a dispatcher.

[Guest WCDES636]

While I was in London a couple years ago, the Ambulance service was called The London Ambulance servcie. I was able to talk to some of the workers. Not only did they have Ambulances but Fly cars and rapid motorcycle units. They were in they process of getting EMD as well. The people we talked to said that they had an average 10 min response time.

Maybe it's a contactor who covers Oxford.

[SHFD781 0]

On a related topic as a co-worker of mine went on a cruise last month. One if his friends that was with him ended up falling and breaking her leg (the found back when they got back to the states). They ended up docking in Jamaica a little later that day. They got off the ship and tried to get to a hospital so she could get her leg checked. They talked to the locals and they told her that she would not be able to get an ambulance. They said that an ambulance will only come for life threatening emergencies. So they tried to get to the hospital by taxi. They get in the taxi and tell the driver where they want to go and he said "sure, as soon as four more people get in." He would not move the taxi till there were 6 people in it. So she ended up not being able to get her leg checked for another 5 days till they got back to New Jersey.

[abaduck 123]

This is another example of how socialized health care doesn't work and our profit based system is flawed but still better.

OK, you've pushed a button. I respectfully beg to differ - as a Brit by birth, American by choice, I've had the chance to sample both systems fairly extensively and I have to say the US system *sucks*. There are good doctors and good hospitals, entirely screwed by the insurance companies. They are a bunch of scamming thieves (I have that on good authority from an insider) - deliberately losing paperwork, denying claims on preposterous invented reasons (recently had a bunch of claims for my son turned down because our only insurers had invented the notion that there was somehow some other primary insurance) - at least some companies deliberately deny a certain percentage of claims for no reason as general policy, in the sure knowledge that a fair proportion of these denials will not be successfully contested. Dammit, the vast overhead costs incurred by all these paper-pushers could pretty much pay for free healthcare for everyone! When I was being treated for cancer, the insurance company wouldn't pay the *actual* cost for the drugs used, only a notional 'wholesale' cost which bore no relation to the price they could actually be bought for - my doc would have been thousands out of pocket if I hadn't volunteered to stump up the difference.

My kids just had to get blood drawn for a lead test. Trival - lancet in the finger, took one minute during their annual physical. But I had to pay for it; the insurance company wouldn't. Well... they *would*, but not if it was done during their physical. They would only pay if I made another appointment, put the kids back in the car, drove to another town, and took them to an insurance-approved lab. Complete and utter BS rules. Moronic.

Ever seen a movie called 'John Q'? I don't think that was ever released in the UK; Brits would just not comprehend it at all, it would have been 'What? That just can't happen... this is nonsense'

Both systems *are* flawed, but the US one is verging on 3rd world, barbaric, and run by robber barons to boot.

English EMS systems are so over taxed that they regularly treat and release patients because the ERs are packed and there are not enough ambulances.

The EMS system is pretty much entirely seperate from the rest of the healthcare system - don't draw any conclusions from what was, I admit, a pretty shoddy experience. As for ERs... well I haven't noticed US ERs being exactly quiet as the grave, come on...

Mike

[ny10570 745]

I have to say the US system *sucks*. There are good doctors and good hospitals, entirely screwed by the insurance companies. They are a bunch of scamming thieves (I have that on good authority from an insider) - deliberately losing paperwork, denying claims on preposterous invented reasons (recently had a bunch of claims for my son turned down because our only insurers had invented the notion that there was somehow some other primary insurance) - at least some companies deliberately deny a certain percentage of claims for no reason as general policy, in the sure knowledge that a fair proportion of these denials will not be successfully contested. Dammit, the vast overhead costs incurred by all these paper-pushers could pretty much pay for free healthcare for everyone! When I was being treated for cancer, the insurance company wouldn't pay the *actual* cost for the drugs used, only a notional 'wholesale' cost which bore no relation to the price they could actually be bought for - my doc would have been thousands out of pocket if I hadn't volunteered to stump up the difference.

You are absolutely right. Best insurer I ever dealt with was kaiser permanente. They were a California based non-profit that was chased out the east several years ago. At the same time I've never had a friend or relative have to leave this country so they can get necessary medical care nor have I ever met anyone who had to wait till they got home to be treated for an illness or injury. On 2 separate occasions I've had to leave Canada to get someone seen by a doctor. Once for a badly broken arm and the second time for a ruptured appendix. Now that is truly criminal. I have a good friend who is British and has traveled to the US and Holland for his cancer treatment so he didn't have to wait up to 6 months to begin treatment. I'll admit that just about everything I know is hearsay and obviously I'm never going to hear about the times the system worked, but in this country while they are going to break you stones mercilessly and run you through hurdle after hurdle there are ways to get what you need in a reasonable amount of time.

[20y2 43]

Are we faulting the 999 Operator for telling the truth? An 'Amp Minor' as it is called in the NYC EMS system is a relatively low priority BLS call, in other words something that cam be driven to the hospital in a car with no other medical care besides VERY basic first aid. Would you have rather had the 'patient' wait 3 hours to wait for an ambulance come? There are a host of 'medical emergencies' that are not medical emergencies in 99 percent of the cases. Nosebleeds, broken fingers/toes/hands/wrists/arms/clavicles, headaches, nausea, vomitting, general malaise, abdominal pain, diarrhea and a host of other medical 'emergencies' that are usually dispatched with a paramedic first response are, in fact, no even something that needs to be seen at a hospital. Have we become so complacent in our jobs that we are not allowed to tell someone that they don't need an ambulance? Medical Control is there for purposes like this and I have used them many times to get a 'NO need for EMS' from them.

[x635 4,066]

I have a correction to make after my sister pointed this out.....the 999 dispatcher called back 10 minutes AFTER my sister made the call to say the ambulance wasn't available. So they were waiting for an ambulance for 10 minutes BEFORE finding out that one wasn't coming.

And the party was mostly British kids, not American.

[ckroll 101]

I have to admit, the first time I read the account of the drunken party and the missing finger I thought "Wow, that system really works." Unless it's a thumb, an amputated finger isn't a big deal. [ so long as it's someone elses, obviously] Reattachment is dicey, certainly not a life threat. That said, a dispatcher should have told the callers immediately how the system works and maybe called them a cab.

Putting drunks on the road is a really bad idea, but how far is a society supposed to go to protect citizens and visitors that don't care to protect themselves? A cab might have been good middle ground.

The one time I got caught doing something really stupid.... and it was really stupid. .... I was, A. sober [ double shame on me] and B. embarrassed enough by it to drive myself with the one good hand to the ER.

OK, the second time I got caught doing something stupid....also sober... I recall a sign posted in the ER that read, " Stupid is supposed to hurt." Which it did, and when it gets cold, still does.

If an AMI got the same treatment, that is not good. A finger might have been a decent call.

[OnTheWheel 43]

I think we need to say No more! I've said it before, transporting for an upset stomach or nose bleed is completely obsurd! I dont care about "liability" or any of that, we tie up ambulances in this county for stupid so called "injuries" and it has to stop! What happens when a Cop gets shot and theres not ambulance in a 45 mile radius because theyre all transporting upset stomachs????? Sure theyll be transported by a Police car but what about critical initial care that could be provided? Ive seen our ambulance corp running two ambulances (one BLS and one ALS) and a fly car. Minor stuff gets the BLS and the other two stay in service, the minor trivial stuff should be handled by a third response vehicle, one thats yellow and has a meter in it! Maybe if the local jurisdictions worked something out with local cab companies and stuffed these whiners in a cab then paid the bill for them it would free up the rigs for REAL problems! This two ambulance system appears to be working, but what happens when you get two people with the runs in a row? Now youre back to NOTHING!

[ny10570 745]

London recently won a media award for their advertising campaign attempting to inform the public that there are some calls that deserve ambulances and others that deserve taxis.

Onthewheel, you're preaching to the choir. I have yet to hear someone on this board suggest that the system is not broken. I know I have my efforts at educating people one by one but the people who are really in charge are so far from addressing this its almost funny. We can't even get tort reform that would prevent the growing decline of of certain medical specialties because of the crushing pressure of malpractice insurance. That is having a real time affect on people the issue of EMS system abuse is more abstaract and not even on the radar of politicians.

[abaduck 123]

I think we need to say No more! I've said it before, transporting for an upset stomach or nose bleed is completely obsurd!

Hmmmm. Generally I would agree with you. But about 5 or 6 years ago I had the 'upset stomach' from hell. After over a week of being able to keep pretty much *nothing* down (or 'up' - anything that did stay down ran straight through me), I decided it was time to drag myself to doc. Only to discover I was so weak I was basically incapable of walking. Alone in apartment (wife was away on business), I called an ambulance and I'm not ashamed of it. Spent quite a while in ER - was pretty dangerously dehydrated, naturally. Never found out exactly what bit me.

Mike

[OnTheWheel 43]

Hmmmm. Generally I would agree with you. But about 5 or 6 years ago I had the 'upset stomach' from hell. After over a week of being able to keep pretty much *nothing* down (or 'up' - anything that did stay down ran straight through me), I decided it was time to drag myself to doc. Only to discover I was so weak I was basically incapable of walking. Alone in apartment (wife was away on business), I called an ambulance and I'm not ashamed of it. Spent quite a while in ER - was pretty dangerously dehydrated, naturally. Never found out exactly what bit me.

Mike

\\

Thats not even close to what im refering to. You were a legit case, im talking about the minor belly ache or "I gotta cold" calls. We've all been on them. I think we need to empower our medics more and let them make a judgement call, sure there's liability, but make a protocol and checklist if need be and let them make the call. If someone has had an upset stomach for half a day and its the day after Thanksgiving then let the medic tell them to go scratch!

[Monty 35]

I know that over the last 20 years or so, health care has changed a lot. It's a lot more metrics and target driven. I did find the link http://www.southcentralambulance.nhs.uk/ - from that you can see they cover quite a large area. Oxford, is relative rural - especially compared to London. I also see they were rated against their targets as fair (could be poor, fair, good, excellent).

I don't believe there are any private emergency response ambulances, there is a very small percentage of private health insurance. In general, the EMS (& fire for that matter) coverage is a lot more sparse than it is over here. You certainly do hear cases in the news of problems with response times at time- I don't how common this kind of incident is though.

[NYMedic37 22]

Does anyone know who provides EMS in England in areas besides London?

England EMS is covered by NHS - National Health service.

[NYMedic37 22]

Are we faulting the 999 Operator for telling the truth? An 'Amp Minor' as it is called in the NYC EMS system is a relatively low priority BLS call, in other words something that cam be driven to the hospital in a car with no other medical care besides VERY basic first aid. Would you have rather had the 'patient' wait 3 hours to wait for an ambulance come? There are a host of 'medical emergencies' that are not medical emergencies in 99 percent of the cases. Nosebleeds, broken fingers/toes/hands/wrists/arms/clavicles, headaches, nausea, vomitting, general malaise, abdominal pain, diarrhea and a host of other medical 'emergencies' that are usually dispatched with a paramedic first response are, in fact, no even something that needs to be seen at a hospital. Have we become so complacent in our jobs that we are not allowed to tell someone that they don't need an ambulance? Medical Control is there for purposes like this and I have used them many times to get a 'NO need for EMS' from them.

Abdominal pain could be an MI, headaches could turn into a CVA, an elderly with a broken clavical may need EMS due to severe pain and poor mobility, Nausea & vomiting could be an MI........If my father was having any of these problems and was denied EMS there would be a serious problem with myself and the dispatcher. Are there system abusers.....yes, of course there are but you can't deny service to people. If you start telling callers that they are not entitled to EMS then you are gambling with people's lives. The "headache" that suffers a CVA will sue your a** off.