Dr Ben over at Badscience proves why I'll never be out of a job...

I've mentioned before about how we in the ambulance service have procedures in place for the elderly who we suspect of being at risk. If there is a risk of abuse or violence then we can fill in a form, fax it off to Control as soon as we reach a hospital and the team in Control will make sure that Social Services are made aware of our concerns.

It works pretty well to be honest - I've done a couple of these 'vulnerable adult/vulnerable child' referrals and have gotten good feedback on most of them.

Unfortunately there is no easy way to alert social services to a 'non-emergency' cause for referral.

We were called to an elderly lady who had gotten out of bed and had slipped. She had fallen on the floor and couldn't get up. Also in the house was the woman's sister, also in her eighties. Her sister had tried to help, but the patient was heavy and the sister was frail. Our patient was stuck.

I'm more than happy to go to these sorts of calls (a 'Nan down' call) mostly because if the cause of the fall is a simple trip or slip we can pick them up, check them for injuries and more often than not leave them at home. The patient is happy to be off the floor and not being dragged to hospital, and we are happy because we feel that we have done something useful for a change.

In this case it was a simple slip that had caused the patient to fall and she had not hurt herself. We picked her up off the floor and after an examination were more than happy to leave her at home.

I asked the patient and her sister if they had any carers, anyone who came in and helped them with the day to day stuff. She replied that there was a district nurse once, but that she had disappeared without doing anything.

With my inexpert eye I looked around the flat. I could see where some handrails could be useful, where some modifications to the bath could improve safety and where a better bed could prevent a recurrence of the fall. The patients could also do with a community alarm.

(Community alarms are great, the person wears an alarm around their neck and if they fall over or get into trouble they can activate it and we turn up to help them).

So it appeared that someone had been there once, but since then the sisters had dropped off the radar.

There was no way that I could justify filling in a 'vulnerable adults' form for this, they weren't 'vulnerable' they just needed a proper assessment to provide some things that would make their life that little bit easier and safer. If I filled in one of those forms it would take time and resources away from those who really did need immediate action.

Unfortunately I'm stuck - we have no pathway in place to involve social services in any way other than in an emergency fashion. Our Emergency Care Practitioners can refer patients to social services, but only if they live in certain postcodes (where PCTs fund the ECPs - it all gets horribly complicated).

The LAS could do with improving this - we need a way to bring patients to the attention to the social services that doesn't require it being an 'emergency'. Lets face it, we see hundreds of people each day (around 4,300 calls each day at the moment), who better to keep an eye out for people who might be at risk, yet who haven't yet had any social services input?

Maybe the social services don't trust us to to their job for them? Maybe they are so over-stretched that they can't deal with a raft of new referrals that we would make?

Well - in this case I've 'cheated'. I gathered the patient's details, spoke to a friendly receptionist (actually all the receptionists at the hospitals are friendly) so I could get the GP details and I've now written a letter to the GP detailing my concerns. I've done all I can do about this situation which means that I can sleep at night, but wouldn't it be better if we didn't have to 'cheat'.

I hope that the GP/social services doesn't get snotty - I hate having to shout at people...