Friday, November 24, 2006

AMPDS Strikes Again

We were sent to a green call (one of our lowest priority calls) the other day for an old lady who'd fallen downstairs. That raised my eyebrow a little, but I assumed that she'd just slipped a couple of steps. Even so, I thought it ought to have been an amber call at least. We were just round the corner, so rather than waste time questioning control over it, we just made our way there, arriving literally just as the caller was putting the phone down from control.

It turned out the lady had lost her balance when one of her legs "gave way" and had fallen down eleven carpeted stairs. She insisted she wasn't hurt, but we didn't take any chances and examined her very carefully. Indeed, we couldn't find any tender areas, and she had full movement in all four limbs. She was adamant she hadn't hit her head and didn't have any neck or back pain.

We got her onto our trolley and took her out to the ambulance, where we did all the usual checks. The alarm bells started ringing when we took her pulse. It was 31. They were ringing loudly by the time we took her BP, which was very low. We were amazed the woman was conscious at all, let alone fully alert, and began to strongly suspect that these findings were probably the real cause of the tumble downstairs.

My crewmate took bloods and started a bag of fluid to try to raise her blood pressure, and gave her a drug to speed up her heart rate. It only raised the pulse by 10 beats per minute, so we "blued" her in.

That was a call that was categorised as none-life threatening. It was fortunate that we had been sent on it straight away, as it could easily have been held onto for half an hour or more while calls categorised as a higher priority got the ambulance.

Our next job was a Red 2. A male apparently unconscious. He was drunk, and not unconscious at all. We saw the irony that a very ill woman got a low priority category, while a drunk got one of the highest priority categories.

I don't know if it was the system or the call-taking. I assume it was the system, as I don't know enough about the call-taking to comment on that. Perhaps a control bod would like to comment?

As an aside, the young lady from a couple of posts ago had broken her arm - right at the joint with the wrist, and apparently a quite nasty break too.

9 Comments:

Anonymous Anonymous said...

Don't wanna teach you to suck eggs, but if you were surprised that this lady was conscious, able to give a good history, and apparently not compromised by her low heart rate and BP, why the panic?

Sure, it's a likely cause for her fall but from the AMPDS triage and the way you describe her presentation to you, she sounded stable. Why the fluid bolus and (i'm guessing) atropine?

12:08 am  
Blogger Steve said...

Perhaps you should ask the A&E consultant who had already started externally pacing her (using a machine to stimulate the heart to beat faster) and ran at least another 2 litres of fluid into her before we'd left the hospital.

I can't believe you're suggesting that an elderly lady with a pulse of 29 and a systolic BP of 71 is not cause for concern.

I know I hadn't put the values in the original post, so I accept that may have affected your comment, but a low pulse coupled with a low BP on anyone should be enough to start raising some concern - even if it does turn out to be normal for the patient in the end.

12:24 am  
Anonymous cc said...

It's been a long time since I did any calltaking, but I believe the question "How far did you fall?" Will automatically make it Cat A if the caller gives information about falling 11 steps.
(The options for the calltaker to enter are "less than 6 feet" "more than 6 feet" and "unknown" I believe.)

The other questions on the "Fall" card that can make it Cat A relate to Bleeding, Alertness and Injuries, and if the patient answered these over the phone as she did to you in person, none of which would flag it as anything other than a green call.

So either the calltaker doesn't think 11 steps is more than 6 feet(Worrying) or the caller/patient didn't know how far she had fallen(Likely).

AMPDS is shite.

1:12 pm  
Anonymous Mark Myers said...

Even "more than 6 feet" only gives an amber. The only things that would trigger a Cat A for a fall would be an injury to a "dangerous" area, Not Alert or our old favourite Not Breathing Normally. I'm guessing that there were a lot of "unknown"s in there, which would have made the call a green.

Agreed that AMPDS is pants!

1:44 am  
Anonymous Anonymous said...

Why didnt you take her pulse before.

ABC after all

4:34 pm  
Anonymous Anonymous said...

having been a paramedic for over 30 years i would ask why you need to publish things like this on the web?
there is so many people putting stuff like this on here and writing books on the subject it becomes boring.
the job has and always will be something we do not for praise but because we want to help people and as such should be kept within the confines of the service.
i notice your a member of st.johns in which case this type of thing is best suited to telling your mates there and not on here.

1:03 pm  
Blogger Steve said...

Fair question mate. Frankly, I do it as a release for frustrations - like on this job. I'm not after praise - if I did I'd hand out cards for thank you letters from the patients (I know some people do - that is just sad!).

If in the process it helps to go some way to educating those that call us unnecessarily for stubbed toes and back ache for 3 months, then why not?

If people find it boring, then simply go and read something else :)

4:21 pm  
Anonymous Kermit said...

I have seen that before and it is very frustrating for us EMD's. The problem is, although we know a person is intoxicated and not unconscious (just really drunk), we still need to go with what the caller says, and not what WE think it is. Same for the first case. It could have been that when asked if the pat was completely awake, they said yes, and it changed the dispatch code completely!

1:23 am  
Blogger WBAP said...

Falls on the most up to date version of AMPDS are graded as:

Ground Level - fall from standing
Short fall <10 feet
Long fall 10-29ft for an adult or child or 6-29ft for an infant
Extreme fall 30 feet or higher

Unfortunately unless the caller says that the adult patient has fallen further than 10 feet down the stairs and has not hit/landed on the stairs on the way down, falling down the stairs is classed as a series of short falls.

Further to this if the 1st party caller appears to be 'completely alert' or if a 2nd part caller says they are completely alert and they do not have obvious injuries to a potentially dangerous body area they will get an amber response at the most.

It is a shortfall of AMPDS (pun not intended) or perhaps a mistake for ambulance services not take to into account the amount of stairs.

It sounds that you are surprised that a first party caller who is alert but has a low pulse and low blood pressure would get a green call.

Obviously the EMD cannot take the pt's blood pressure but would you suggest the caller takes their own pulse?

I'm guessing you are more surprised that an elderly person who has fallen down 11 stairs would ever get a green response.

AMPDS does has its failings. I was instructed by 'the system' to pass a choking case to NHS Direct because it was a partial obstruction and the caller advised the pt was alert, talking and breathing normally. I was not happy to do this and in this case the caller was the pt's son and was quite young. At this point I heard her talking but every now and then coughing/choking in the background so reconfigured the response to not breathing normally.

The system isn't so rigid that common sense can never be used but at the same time you are supposed to take the information at face value.

6:54 pm  

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