I think that it's Ambulance Law #17 that states, 'In a fight with a 90 year old patient, the ambulance crew will always come off worse'.

Our call was to a ninety year old woman described as, "Not getting out of bed, not eating, not washing. Suffers from dementia".

Now, this might not actually require an emergency ambulance but I'm getting soft in my old age and am more forgiving of certain types of 'non-emergency' calls.

It was the patient's daughter-in-law who had called us, normally her husband looked after his mother (our patient), but he'd had to go into work that day and had delegated the task to his wife.

The first thing that I noticed was that the daughter-in-law looked to be at the end of her tether, the patient was soaking in her own urine and was resisting all attempts to change her clothes. The daughter-in-law told us that the patient's dementia had become worse over the past few days. My highly trained nostrils suggested that the reason behind this sudden deterioration may well have been caused by a urinary infection.

Urinary infections can cause all sorts of symptoms and, especially in the elderly, can cause people to become confused. With the already demented patient it can increase their confusion.

As our patient was quite happy to sit in urine drenched clothes I wasn't hopeful that she would happily toddle off to the ambulance to go to hospital.

I wasn't wrong.

She refused *everything*, we tried persuasion, we tried reason, we tried bribery. None of it would work.

The daughter-in-law suggested that we leave and 'go help someone more deserving'. I let her know that this patient, and her, were our concern right now. I promised that we would get something 'sorted'.

I wanted to take the old woman to hospital for two reasons. The first, and most obvious was that if our patient did have a urine infection, and it was left untreated, then there were serious concerns for her health.

Secondly and thinking more long-term, I wanted her to go to hospital because then the hospital would help her. The patient's family were unable to care properly for her, so they were looking for a care home place for her. The social services had promised an assessment, but that it would take over a month to arrange. Then there would be the waiting while a suitable place was found, etc, etc...

It would take a long time.

By taking the patient to hospital, and hoping that they would admit her, we would be forcing the social services to deal with the patient a lot quicker than they otherwise would.

I imagine that the social services do their own prioritising. As this patient was 'safe' in her own home and is being looked after by her family she is a low priority. If she is 'bed blocking' in hospital then they will arrange the care she needs more urgently, probably because of some governmental target.

And why was I 'cheating' the system this way? It was because I could see the eyes of the daughter-in-law as she told me the strain that it was placing on her and her husband. It was because I could hear the tone of her voice as she explained the trouble they had in caring for the patient. And it was because I could see the bruises on the wrists of the patient where she had been restrained from attacking the people caring for her.

So taking her to hospital was the only real option. But how? We had already spent an hour trying to talk her into coming to hospital.

We'd have to kidnap her.

It is legal for us to forcibly remove someone to hospital if they are deemed 'not competent' to refuse and if they have a serious illness. As I mentioned earlier, a urine infection can become very serious in the elderly. In addition she was refusing to eat. This, in my view, means that her well-being was in danger. Her dementia was so far advanced that I considered her unable to understand the consequences of remaining at home.

So legally and ethically we were on safe ground.

I don't like forcibly removing people, it's a lot of aggravation and there is always the fear that someone will get hurt. Sometimes we will get the police to attend in order to help us remove the patient. In this case I didn't think that police would be able to do anything different to what we would do.

But...

Any confrontation would be rather one sided. Us, as an ambulance crew, are trying our best not to hurt the patient - it'd look bad if we broke her arm. Our patient on the other hand is more than happy to punch, bite, spit, claw and go for my testicles.

Which she did even though we had wrapped her in our blanket. Never underestimate the strength of a demented patient.

She managed to draw some blood from me (an inconsequential scratch on my arm), but at least we managed to safely get her downstairs into the ambulance. When she got in the vehicle she calmed down a little and she didn't seem hugely upset to be in the hospital.

The daughter-in-law couldn't thank us enough.

I knew that the patient would get medical care, I'm just hoping that she also got the social care that was desperately needed.

I've been a bit slack posting of late due to that nasty old 'black dog' that comes around in these shorter months. With a bit of luck I'll shake it off soon.