Peter Canning has written another excellent post, this time about fractured hips.

We get a fair few fractured hips (or #NOF for 'fractured neck of femur), most common among the elderly, it's one of those things that I feel that we as an ambulance service don't deal with as well as we should.

Apparently the thought is that this isn't a 'medical emergency', but explain that to 'Doris' when she has been lying on a hard floor for six hours with a broken bone causing excruciating pain.

Part of the problem is how we prioritise calls, using much the same computer triage system as Peter mentions these calls often come out as one of the lowest, or 'green' categories.

This means that they have to wait while our limited resources deal with 'Red' and 'Amber' calls - an example of a recent 'Red' call for me would be the man in his twenties suffering from a hangover.

So Doris continues to get pressure injuries from the floor because every move is agony.

'Green' calls don't need to be attended to on a 'blue light and siren' response unless they are in a public place (because people waiting for an ambulance in view of the public is obviously a clinical risk...ahem).

Personally as soon as I see that there is an elderly person on the floor I'll respond on blue lights, call me old fashioned but I think that leaving old people on the floor, sometimes in their own urine (for many fall after getting out of bed at night to visit the toilet), is just not the right thing to do.

Of course, I also think that a blue light response to a hangover is a bit excessive, but then we do tend to over-prioritise most calls.

Peter talks about the lack of painkillers being given to these patients, like his service we also have Morphine to give and, I would suspect that some paramedics are a little reluctant to give such 'strong' analgesia to a frail patient - but I have no experience or evidence of this.

My pet Paramedic and I are more than happy to dose up little old ladies with some high grade narcotics...

(No prizes for guessing the Prodigy song that runs through our heads when we do this)

When I was a nurse we set up a pathway for #NOF, we would x-ray, give fluids and analgesia, refer to the surgeons and book the orthopaedic bed all in one go - it was designed to get these patients, vulnerable to pressure sores, off the hard A&E trolley as quickly as possible. All of which boosts their chance of survival.

Yet, in the ambulance service we leave them on the floor.

It's one of the things that I've mentioned before - that the government grades us on how quickly we get to calls, but it doesn't grade us on the relief of pain, or the appropriateness of our telephone triage system.

Perhaps that needs to change.