Get the NHS to contract a taxi service?

Over here we have some patients who always get a Priority 2 or 3 response (non-urgent) because they will call with chest pain 6/7 days a week.

Maybe we need to print pamphlets with the story of "The Patient who cried wolf"

Whatever you do, don't let them die. Keep hold of them and cherish them. Like the heads of the mythical Hydra for every one that disappears two sprout up to take their place.

Well, I suggest you open the back door of the ambulance whilst still moving, give the drunk a push, and then hurry off to the sick child. If the drunk gets hurt in the process, at least they'll have a real reason to phone again...

Maybe standard treatment for anyone who's admitted drunk should be a shot of that stuff they put alcoholics on to dry them out. You know, that makes you hurl if you drink within 24 hours. One or two goes at that and I'm sure they'd find another way to amuse themselves and it _is_ a legitimate treatment for their 'condition'.

I think you might like this article by Malcolm Gladwell in the New Yorker, about the same subject:

http://www.newyorker.com/fact/content/articles/060213fa_fact

This article is a fascinating look at the problem. It's well worth reading, thanks for the link.

It's a great article - I've updated the main post because it is simply that good, and because in my experience it would work wonders.

Thanks!

Very interesting! Never heard about such an approach to the problem...

Hopefully the idea finds enough support although it's somehow unpopular!

Oh that it would catch on... Unfortunatly it smacks a little too much of actually dealing with a social problem rather than ignoring it or managing it as and when it becomes a crisis.

Cynical, me?

NQH

Interesting idea (I think - that writer really takes his time getting to the point and my brain's being slow this morning) but I can't ever see the Powers That Be going for it. It doesn't look like a vote-winner.

Over here the welfare system is a bit different, but I would like to see people with the chronic, stubborn problems assigned ONE case worker to introduce them to all the other organisations and professionals they may have to deal with, but who stays with them, from checking on them daily at the shelter or hostel, through to helping them get a job and a bedsit, then maybe cut back to visiting once a week and so on.

This article in The New York Times describes an attempt in Seattle to implement the approach laid out in the New Yorker:

http://www.nytimes.com/2006/07/05/us/05homeless.html?ex=1152417600&en=e3688915a7ac3af1&ei=5087%0A

I think a drunk tank is the answer. A large empty room with mattresses on the floor. Leave them in there to sleep it off. Just need someone to keep an eye on them, turn them over etc. Keeps them out of the hospital system

Here in Cologne most of the hospitals in the City have this kind of room. So drunks don't block a bed or disgust the people in the waiting room, but it definitely does NOT prevent them from riding in ambulances... rather I've also already met some still waiting in the phone box (usually in winter)...

There is no real solution for the problem, if you leave them on scene you can get into serious trouble (it's not very likely if you consider only the single case but considering thousands of drunks makes a difference) and probably the next call will follow shortly so you're occupied anyhow. I also don't see any reasonable help we could offer.

The system in Germany is a bit different, anyway.
I think it's important for the ambulance trusts to get that lovely "letter"/signature from the hospital/doc in order to receive money from the insurance companies, which means: everyone is keen on taking the punters to A&E. Additionally they are too afraid of making a mistake so every patient is rather taken to hospital no matter how serious their illnesses are because the consequences could be grave if you know what I mean.
And yet the A&E departments in Germany aren't as busy as in England. Why? Because of the insurance companies. No NHS = nothing's for free really and at the end of the day the insurance companies only pay a part of the costs (and can decide if they do so). Sometimes you will have to pay the costs yourself first and then claim it back. Really annoying but the prospect of being forced to pay makes people shy, believe me.
That's my theory.

Don't get me wrong, but I don't think you know the German health system very well.
The funding of the A&E Services differs among the different states but somewhat simplified the usual core principle is: the provider of the Accident & Emergency Service ( usually cities or counties) negotiates about the anticipated total costs in detail (budget accounting) and about the expected quantity of emergency responses with the compulsory health insurance funds. The agreed total costs are divided by quantity of emergency responses and the result is the charge per response. E.g. if the costs are constant and quantity of emergency responses is increased then the charge drops accordingly and the service gets the same budget. Only in order to claim the money from the patient's specific compulsory health insurance fund the mentioned doc's signature is usually required. The Accident & Emergency Service is non-profit-making and is *not* allowed to take profits. In conclusion: crucial for the service are the agreed costs and not how many punters you bring to the A&E Department. And anyhow most EMTs wouldn't care about management's budget issues (in fact I don't think most of our EMTs understand thoroughly how the Service is funded).

You are right: most EMTs consider very carefully if the can leave a patient on the scene even if it's only a minor illness because the consequences could be grave (as I mentioned before). That's a sensible form of self-protection because the prosecutors don't care about the 1000 times you've been right, they only care about the potential mistake / malpractice. And even if the sentence is in the end one of acquittal until then you’ve got a time of horror. I don't think that's special for Germany and I suppose British EMTs aren’t less careful.

It's correct the A&E Departments aren't as busy as in the U.K., but even before the system of out-of-pocket (it's not that old!) was introduced they weren't as busy. Some other possible causes (source: WHO): hospital beds per 100,000 in 2003 Germany: 874.56 UK: 397.65, Physicians per 100,000 in 2002 Germany: 333.61 UK: 212.61, GPs per 100,000 in 2002 Germany: 105.18 UK: 62.84, Total health expenditure $ per capita in 2003 Germany: 3001 UK: 2389.
By the way: estimated life expectancy in 2003 79 years for both countries.

90% of the Germans are insured by the compulsory health insurance funds. In order to opt out of the compulsory health insurance funds salaried employees have to earn more than about 47.000 Euro per year (German average about 40,000 Euro). The benefits of the health insurance funds are statutory (SGB V). Only 4% of the whole benefit package can differ among the different funds. So in the absolute majority of cases the insurance funds can't decide if they pay or not and in case these decisions are usually made before the treatment. The patient doesn't have to pay first unless he decides to make a special agreement with the fund (bad idea unless you're rich) or you have *private* insurance cover, this refers to only 10 % of the population and these ones are for the most part more wealthy and save money by opting out of the funds.
The new system of out-of-pocket payments includes e.g. 10 Euro per quarter of the year in case of GP consultation, same for the A&E Department 10 Euro per day in hospital up to a maximum of 280 Euro and so on... The maximum limit is 2% of the income and 1% for chronically ill patients. Of course these out-of-pockets payments are annoying, but otherwise the health insurance contributions would rise even more. So you are partly right, people start thinking about the need of treatments, but the system is not half as horrendous as you describe it.

The real problems of the system are for example: these 10% mostly wealthy not contributing people and of course the demographic development (retired pay of course less than working citizens). The German health system is already very expensive and starts being hardly financeable.

It's a tough one.

We had a drunk living in our block of flats for a while. To get a flat in our block you need references, but his family faked the references for him as they couldn't deal with having him living with them any more.

Which I'm sure was great, but equally, the other residents of the flats which included two single elderly retired people, a young girl with a baby, a couple of single female night-shift-workers and me who is young, female, disabled and living alone... we couldn't really deal with this alcoholic and his friends causing havoc. Human vomit and excrement smeared all over the shared hallways, and then they would bash at our doors asking us for help. We simply couldn't live with it.

The landlord tried to get the police involved, they said they'd done all they could with him unless he actually physically assaulted someone. And he was loath to evict the guy because Social Services didn't really want to pick up the pieces either. Where should someone in this state go?

Not quite on the same topic but I thought you might find this interesting. They've introduced "drunk tents" in some cities to deal with the after effects of over indulgence, mind we're not talking chronic overindulgence here more binge drinking disorder than traditional alcoholism (if I'm making sence give me a gold star if not, I'm sorry). The articles here: http://postcardfrom.blogspot.com/uploaded_images/The Independent on Sunday - 21-05-06 - drunk tents-708252.jpg

NQH

The problem with drunk tanks is occasionally someone gets put in them who has hypoglycaemia or a subdural haematoma; it can be hard to tell the difference, especially when half a bottle of vodka means you're more likely to fall over and hit your head, or as a diabetic to go hypo. Extreme? It's been known to happen.

Speaking from the perspective of an A&E SHO, much as we get fed up with the frequent flyers, none of us are quite hardened to the point where we actually want them to die. Well, maybe one or two of us are, but the prospect of a trip to the Coroner's Court/Fatal Accident Inquiry is a wee bit intimidating.

I think we're stuck sobering them up, sticking them back together again, filling them up with vitamins and letting them go to live their life their own way. I don't know how they can bear the cycle of drink, fall over, up to hospital in the ambulance, hang around A&E for hours, wander out, drink again, etc etc, but I'm not a chaotic alcoholic.

I respect the meaning of the post, but it makes me sad when I hear anyone suggest that "female fitting" equals a drunkard.

Perhaps it wasn't clear in the post - but it's just that specific location and that specific call. Trust me, we take fitting very seriously it's why we rush around there even if we 'know' that it is our regular.

After the 30th call of the week to ' 45 year old Female fitting, corner of Harry road and Dick road' from the same public phonebox, you learn who it is pretty quickly...

Can't you scoop and run and tell him that all the hospitals are full and you will have to go to the nearest one that is able to take which happens in Truro... etc.

:)