Anything and Everything

I’ve spent quite a lot of time working in A&E recently as I’ve had a few night shifts and even a whole week of regular days there.  It’s one of my favourite places (along with theatre) and I really enjoy the challenges it throws at me. I’m also constantly amazed by what some people class as an “emergency” though (and yes, A&E stands for Accident and Emergency not Anything and Everything) and this can be incredibly frustrating.

The other weekend we had a paediatric trauma call; when a paeds trauma bleep goes out you can see the dread on the team’s faces while we wait nervously in resus for their arrival. Apparently a young girl had fallen quite a height from a tree and landed face down, where she remained unresponsive for a while. These were the only details we had at this point so it was hard not to worry about the state she might be in. The ambulance crew wheeled her in, neck brace, head blocks, parents alongside, and we were all quite relieved to see her conscious; at first glance it was obvious that she had broken at least one wrist so I knew that she’d definitely be coming round to x-ray very soon, and upon further investigation it turned out that she had not been unresponsive or unconscious for any amount of time. Due to this and the lack of any head injury she ended up coming round to x-ray for a full trauma series as well as some extremities.

Our A&E x-ray department has two examination rooms, and therefore we are only able to see two patients at a time; normally this is fine, and people only have to wait a short while, but this particular day was quite busy. Several patients were waiting to be seen when the trauma patient arrived and I heard a few tuts as we whisked her straight in to the examination room. I was honestly quite shocked, as one of the men who tutted was there for an x-ray of his ankle which he injured two weeks ago and had been walking around on ever since; how he got through triage I’ll never understand. Luckily the girl’s parents were too worried about consoling their child to hear such an inconsiderate man making his feelings known, but myself and my colleagues definitely heard him. One of them decided to make things clear by announcing that: “A paediatric trauma patient has arrived so there may be a delay in getting to you- I’m sure you all understand the urgency of the situation, thanks for your patience.” Hurty-ankle man tutted some more and looked at his watch dramatically, and then rolled his eyes when the patient in front of him was called in. I wasn’t there when he was eventually seen, but I do now know that he hadn’t broken anything (what a surprise!) and he was very rude to the radiographer who saw him. Meanwhile I was next door attempting to get some decent radiographs of a terrified child; we had to take x-rays of her neck, chest, pelvis, and both forearms, one of which was visibly deformed. She had never had an x-ray before so was understandably terrified to be strapped down flat to a stretcher and wheeled into a dark room while I shone a bright light at her and made her move her badly bruised arms.

In the end she “only” had a couple of fractures to one arm which was fixed in theatre that afternoon, so all in all a fairly good outcome.

So back to Hurty-ankle man. Someone in the triage stage should have explained to him that better care options are available (it’s possible that they did but he insisted on being seen- that happens too) but for whatever reason he ended up being seen through A&E. Apparently he had twisted his ankle two weeks before but hadn’t been to see his GP because apparently A&E is more convenient to get to.

You may think I’m being overly judgemental (and it’s likely that I am) but the NHS, and emergency departments in particular, are currently experiencing workloads which are simply unmanageable. The government’s answer to this is to add more targets and blame GPs and junior doctors for failing to meet them. The real solution isn’t that simple, but patients can help by choosing their care provider wisely; A&E is for acute illness and injury- things which cannot wait. Unfortunately it’s difficult to get this message across without risking scaring those away who genuinely need help. The elderly are especially at risk- “oh I didn’t want to be a bother” they say, having revealed that yes, they have been walking on a broken hip for a week, while the woman with cystitis calls an ambulance to rush herself to hospital.

NHS Choices is a good starting point for finding out who is best suited to look after you in your hour of need, but you should also familiarise yourself with which services are available in your area before you desperately need them. Some cities and towns have urgent care centres which are essentially diet A&E departments. These are a touchy subject politically, as they have sprung up in recent years, replacing real A&Es. They’re perfect for when you sprain your wrist, or cut your knee, but if you’re having chest pain, call an ambulance or go straight to a proper A&E. Some A&E departments are even able to book same day GP appointments for patients that are deemed suitable, so if your sprained ankle isn’t improving and you can’t get an appointment for a week, there might be other options available to you.

All I’m asking, as a healthcare worker and supporter of the NHS, is that you consider your options before going to (or not going to) A&E.

Thanks.

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