my heart

On 7 Apr, 06:46, Anne Rogers wrote:
That very thing happened to me. I'd been having tight chests and in
the end called NHS direct. Because I complained of chest pains they
were obliged to call an ambulance.

I have a vague hope that just the words "chest pain" wouldn't result
in them sending an ambulance, but you never know, I guess it's a
balance between asking more questions and time, minutes do make a
difference in a heart attack, but if the answer to the next question
determined it was a fall or other trauma, then whilst a hospital visit
may well be advised, you've got time to ask questions to determine if
it's severe enough for an ambulance or if they can make their own way
there. It always amazes me that the first question is "is the patient
concious and breathing", if they aren't then why are you calling NHS
direct, I know they have to cover themselves, but it does make you
wonder...

It was exactly the words 'chest pains' that the woman on the phone
insisted she had to call the ambulance for. I tried to convince her
otherwise, but those were the trigger words she said, so that was
that. The paramedics seemed surprised too, which made me feel worse
for wasting their time even though I said I didn't need an ambulance
and didn't want her to send one. It was my guess too that they have to
cover themselves. I can imagine the margin for error can be huge when
making decisions like that over the phone, so they err on the side of
caution. On the other hand they are now starting to send single manned
paramedics in partially equipped cars to calls rather than two-manned
ambulances, which seems to be not erring on the side of caution at
all!

I hope we hear from Lucy soon and that she's ok.

Indeed, I hope you're ok Lucy.

Jeni

Jeni wrote:

It was exactly the words 'chest pains' that the woman on the phone
insisted she had to call the ambulance for. I tried to convince her
otherwise, but those were the trigger words she said, so that was
that. The paramedics seemed surprised too, which made me feel worse
for wasting their time even though I said I didn't need an ambulance
and didn't want her to send one.

If those EMTs/medics make you feel like you were wasting their time,
they were being unprofessional. Chest pain protocol is immediately,
it's fast, and in hospitals or on an ambulance, it brings a lot of
things out of the woodwork very fast. They can do a 12-lead EKG in the
field to see what's going on, but to completely rule out any actual
cardiac problems, they have to do cardiac enzymes, which can't be done
in the field. The only thing they can do in the field with a 12-lead is
tell you that you don't have a dysrhythmia NOW, you don't have elevated
ST segments NOW (which means your heart isn't occluded NOW and your not
infarcting NOW), and you don't show any ST depression from ischemia NOW.
They surely weren't there long enough to know if you were having
intermittent bouts of dysrhythmias, or to follow up on EKG changes
later. And again, you had no cardiac enzyme profiles done. Presumably
your vital signs were stable, so they didn't feel the need to give you
the cardiac set of medications.

Cardiac stuff is serious, and I've seen a lot of people in the ER and on
the ambulance who were embarrassed or thought they really didn't have a
problem who were having things like complete heart block (MAJOR,
life-threatening problem) or intermittent ventricular tachycardia
(major, life-threatening problem), or other similar things. Now,
likewise, I've seen many more people worked up on chest pain protocol
when it was anxiety, or pleurisy, or indigestion, or something
relatively benign. But yes, when you say "chest pain" anyone involved
in EMS should take that seriously. And anxiety attacks can often really
feel like cardiac problems, it's nothing to feel embarrassed about or
feel like you're wasting the medics' time over. Trust me, we'd rather
you "wasted" our time on this, then end up being called too late and
having to try to bring you back from a cardiac arrest situation.

OK, I'll stop lecturing now. *looks sheepish*

Michelle
Flutist

It was exactly the words 'chest pains' that the woman on the phone
insisted she had to call the ambulance for. I tried to convince her
otherwise, but those were the trigger words she said, so that was
that. The paramedics seemed surprised too, which made me feel worse
for wasting their time even though I said I didn't need an ambulance
and didn't want her to send one. It was my guess too that they have to
cover themselves. I can imagine the margin for error can be huge when
making decisions like that over the phone, so they err on the side of
caution. On the other hand they are now starting to send single manned
paramedics in partially equipped cars to calls rather than two-manned
ambulances, which seems to be not erring on the side of caution at
all!

I seem to recall when that became wider policy that pretty good
evidence from trials was given that it worked. IIRC they were trying
to emphasise that it wasn't slowing down the dispatch of an ambulance
at all, though obviously it means money is being directed differently
which could have been used to improve ambulance response times and
long term it might reduce the size of the ambulance fleet, but that's
a different issue. So it's not that they send a guy in a car and he
then calls an ambulance, but that they send both, the guy in the car
gets there sooner and gives emergency treatment sooner and can
feedback if an ambulance isn't necessary, or has changed priority.

The one time we had to call an ambulance (I'd blacked out and falled
down the stairs), the paramedic in the car seemed to be their before
DH even got off the phone and was able to deal with basic stuff like
actually getting in the house - road access was to our backdoor and
I'd landed right in front of it and it opens inwards, so he climbed in
through the window! The ambulance was there minutes later. So it seems
like it was rolled out with strong evidence that it was an improvement
- getting oxygen and a defibrillator to a heart attack patient sooner
without delaying transport time is a good thing, but it is going to
need long term auditing to make sure it's not a cover for other
weaknesses. Plus you have to make sure emergency hospital services are
matching it, no good getting the right patients to hospital and then
not treating them, there are heart attack treatments that are really
helping outcomes, but aren't universally available and there are
probably numerous other examples in other areas of emergency
medicine.

We've become rather too target focused in the UK, I've read numerous
doctor accounts of cases when spending more than 4 hours in A&E would
benefit the patient, but the 4hr target means they are transferred to
a ward unnecessarily when taking an extra hour in A&E might have led
to discharge.

Cheers
Anne

On 8 Apr, 17:10, "Michelle J. Haines" wrote:
Jeni wrote:

It was exactly the words 'chest pains' that the woman on the phone
insisted she had to call the ambulance for. I tried to convince her
otherwise, but those were the trigger words she said, so that was
that. The paramedics seemed surprised too, which made me feel worse
for wasting their time even though I said I didn't need an ambulance
and didn't want her to send one.

If those EMTs/medics make you feel like you were wasting their time,
they were being unprofessional. Chest pain protocol is immediately,
it's fast, and in hospitals or on an ambulance, it brings a lot of
things out of the woodwork very fast. They can do a 12-lead EKG in the
field to see what's going on, but to completely rule out any actual
cardiac problems, they have to do cardiac enzymes, which can't be done
in the field. The only thing they can do in the field with a 12-lead is
tell you that you don't have a dysrhythmia NOW, you don't have elevated
ST segments NOW (which means your heart isn't occluded NOW and your not
infarcting NOW), and you don't show any ST depression from ischemia NOW.
They surely weren't there long enough to know if you were having
intermittent bouts of dysrhythmias, or to follow up on EKG changes
later. And again, you had no cardiac enzyme profiles done. Presumably
your vital signs were stable, so they didn't feel the need to give you
the cardiac set of medications.

Cardiac stuff is serious, and I've seen a lot of people in the ER and on
the ambulance who were embarrassed or thought they really didn't have a
problem who were having things like complete heart block (MAJOR,
life-threatening problem) or intermittent ventricular tachycardia
(major, life-threatening problem), or other similar things. Now,
likewise, I've seen many more people worked up on chest pain protocol
when it was anxiety, or pleurisy, or indigestion, or something
relatively benign. But yes, when you say "chest pain" anyone involved
in EMS should take that seriously. And anxiety attacks can often really
feel like cardiac problems, it's nothing to feel embarrassed about or
feel like you're wasting the medics' time over. Trust me, we'd rather
you "wasted" our time on this, then end up being called too late and
having to try to bring you back from a cardiac arrest situation.

OK, I'll stop lecturing now. *looks sheepish*

Michelle
Flutist

You're quite right and in a way I'm glad they did take me seriously. I
had no idea you can get chest pain from a viral infection. To me it
felt like a panic attack except that it had been going on all day and
when I've had them in the past I can control them with visualisation
techniques. So deep down I didn't think it was a PA, but had no idea
what it was. I guess if it had been something serious and they had
missed it then I would probably be sat here saying 'why didn't they
err on the side of caution'. It just didn't help that they made me
feel like I wasted their time - although to be fair their comment was
aimed at the NHS direct woman rather than me. It just didn't help as
the whole episode had upset my child and even freaked my DH out a bit.
FWICR I just had the 12 lead thingy where they stick pads on you, so
it was clear there were no immediate problems. They didn't even
suggest it could have been a viral infection though, just took my word
for it that it must have been a PA.

Jeni

On 8 Apr, 17:38, Anne Rogers wrote:
It was exactly the words 'chest pains' that the woman on the phone
insisted she had to call the ambulance for. I tried to convince her
otherwise, but those were the trigger words she said, so that was
that. The paramedics seemed surprised too, which made me feel worse
for wasting their time even though I said I didn't need an ambulance
and didn't want her to send one. It was my guess too that they have to
cover themselves. I can imagine the margin for error can be huge when
making decisions like that over the phone, so they err on the side of
caution. On the other hand they are now starting to send single manned
paramedics in partially equipped cars to calls rather than two-manned
ambulances, which seems to be not erring on the side of caution at
all!

I seem to recall when that became wider policy that pretty good
evidence from trials was given that it worked. IIRC they were trying
to emphasise that it wasn't slowing down the dispatch of an ambulance
at all, though obviously it means money is being directed differently
which could have been used to improve ambulance response times and
long term it might reduce the size of the ambulance fleet, but that's
a different issue. So it's not that they send a guy in a car and he
then calls an ambulance, but that they send both, the guy in the car
gets there sooner and gives emergency treatment sooner and can
feedback if an ambulance isn't necessary, or has changed priority.

The report I saw this week said that they would just be sending single
manned cars and *if* the situation needed an ambulance then one would
be called. The paramedic they interviewed suggested that it was
possible more lives could be at risk because when an ambulance was
needed valuable minutes would have been wasted while the first
paramedic arrived, assessed the situation and then called for an
ambulance.

Jeni

Jeni wrote:

You're quite right and in a way I'm glad they did take me seriously. I
had no idea you can get chest pain from a viral infection. To me it
felt like a panic attack except that it had been going on all day and
when I've had them in the past I can control them with visualisation
techniques. So deep down I didn't think it was a PA, but had no idea
what it was. I guess if it had been something serious and they had
missed it then I would probably be sat here saying 'why didn't they
err on the side of caution'. It just didn't help that they made me
feel like I wasted their time - although to be fair their comment was
aimed at the NHS direct woman rather than me. It just didn't help as
the whole episode had upset my child and even freaked my DH out a bit.
FWICR I just had the 12 lead thingy where they stick pads on you, so
it was clear there were no immediate problems. They didn't even
suggest it could have been a viral infection though, just took my word
for it that it must have been a PA.

See, that is a problem. We usually transport people with chest pain
even with a "normal" ECG or 12-lead, because you really just don't know
what's going on without some further diagnostic testing. I've had
pleurisy this winter, after being sick quite a few times in a row. It
HURTS.

Michelle
Flutist

"Jeni" wrote in message
...
On 7 Apr, 06:46, Anne Rogers wrote:
That very thing happened to me. I'd been having tight chests and in
the end called NHS direct. Because I complained of chest pains they
were obliged to call an ambulance.

I have a vague hope that just the words "chest pain" wouldn't result
in them sending an ambulance, but you never know, I guess it's a
balance between asking more questions and time, minutes do make a
difference in a heart attack, but if the answer to the next question
determined it was a fall or other trauma, then whilst a hospital visit
may well be advised, you've got time to ask questions to determine if
it's severe enough for an ambulance or if they can make their own way
there. It always amazes me that the first question is "is the patient
concious and breathing", if they aren't then why are you calling NHS
direct, I know they have to cover themselves, but it does make you
wonder...

It was exactly the words 'chest pains' that the woman on the phone
insisted she had to call the ambulance for. I tried to convince her
otherwise, but those were the trigger words she said, so that was
that. snip
NHS direct is like that though. They like to make sure. Our GP says "they
always send you somewhere". That was the time I phones up with #1 (aged
about 10 months) having been sick several times, wondering if I could
breastfeed her. The books all said "no milk". That was all I wanted to know.
They asked if she was floppy, and I said "a bit" (who wouldn't be after
being sick 7/8 times) so they wanted me to rush to the A & E. Eventually I
said that I'd take her to my GP straight away. (he's 2 minutes walk away).
So I took her down and she was, as I thought, nowhere near needing to go to
A & E.
Debbie (in case anyone is wondering, you can breastfeed a baby who's being
sick)