Non-urgent

The London Ambulance Service used to have three categories of calls, in descending order of importance. The first was Red calls, originally given out as ‘Call Red-Accident.’ This was the highest priority, requiring immediate attendance, the use of blue lights and two-tones, and denoting something potentially very serious. The next, still considered serious, but not an emergency, was designated ‘LA4’. This was named after the form that was completed as a report on the job, and the Service had a duty to arrange a response within one hour of receiving a request.  Conversely, these calls were usually more serious than most of the emergency calls, as the patients requiring an ambulance had frequently been diagnosed with a serious illness, by a GP, or hospital doctor. They did not require the use of lights or sirens, and often ‘queued up’, until the delays had well exceeded the allowed 60 minutes.

The last category of call was a ‘non-urgent’ call, known as a White call, to show how it was the opposite of a Red call, so not remotely serious. These calls were varied in nature, though consisted primarily of conveying patients to clinics, for routine tests, and taking them home afterwards. The patients given this service, were supposed to be unable to attend hospital by any other means, whether because of illness, or because they were immobile as a result of injury, or a chronic condition. In reality, many were as able to make their own way as we were, and had managed to convince someone at the hospital that they needed an ambulance to get them there. The others might be amputees, or be grossly obese (it’s not a new thing), or suffer with dementia, or illnesses that made it unsafe for them to be out alone. The non-urgent label also applied to the countless hospital transfers that were ordered every day. This is long before part-privatisation allowed hospital trusts to arrange their own transport, or actually run their own fleets of vehicles, as is common today. Thirty years ago, most Central London Hospitals operated on many sites, and would transfer patients around from one to the other, like pieces on a gaming board. Because of the huge demand on resources, the Ambulance Service ran a dedicated, completely different fleet of vehicles, together with crews at various levels of training and experience, just to do all these White calls. When you were new, or did not want to work on the emergency side, this was your initiation into the work of the LAS; driving coaches, minibuses, and partially-equipped vehicles, to move all these people from home, and back again, and from one hospital to another, day in, day out.

However, this service finished at around 6pm, and did not run at all at weekends. During these times, the non-urgent work transferred to the emergency vehicles, and fully-trained crews.

We did not want to do these calls. Most of us had joined up to do the ‘glamorous side’ of the job. Driving fast, on the wrong side of the road, blue lights flashing, sirens wailing. We had been upset to have to do this non-emergency work when we first qualified from training, and had simply endured it (in my case for almost a year), waiting for the chance to get a full-time position at a station that just did emergencies. So, having served our time, the last thing we wanted to do, was to go back to doing White calls, which were considered boring, unnecessary in the most part, and more than a little beneath us, to be truthful. Of course, we were wrong. With maturity and experience, you begin to realise that a lonely old lady, brought in at 11am for an X-ray on a suspected fractured hip, becomes a virtual prisoner of the system, just as deserving of an ambulance as anyone else. Wheeled around from department, to clinic, and back again; tea shoved in her hand, perhaps a thin, floppy sandwich if she is lucky. After spending a day in a busy A&E department, being mostly ignored, a doctor finally decides that she has no fracture, and that she can go home. She is clad only in a nightdress, has limited mobility, and no money. She will not be able to contact relatives, as they are usually only too happy to get her off their hands. The doctor orders an ambulance at about 7pm. He agrees that it is non-urgent, and is told that it is a busy Friday night, and that it may take many hours to arrive; that is of no concern to him, as he has moved on to the next emergency, with other problems to solve.

So, the evening drags on into the night. A kind nurse has given the old lady more tea, but then she needs a commode, as she cannot manage to walk to the toilet. The nurses, trying to deal with stabbings, heart attacks, and road accidents, cannot really give her any time. She sits alone, behind a closed curtain, listening to the noisy symphony of a busy night in casualty. By midnight, she has been in the hospital for 13 hours, had two cups of tea, one half of a tasteless sandwich, and her temper is beginning to fray. By now, the night staff are so busy, there is no chance of more tea, or anything else to eat. The old lady drifts off to sleep, as well as she can, with bright overhead lights, and the shouting of the injured and the drunks, together with the interminable bleeping of monitors. When things calm down a bit, at 5am, we are given the job, a non-urgent call, to take someone home. We have been out since 10pm without a break, dealt with all sorts of aggressive people, numerous serious jobs, and we are hoping to finish our shift by 7am. The last thing we want to do, is to take home some old lady, who is going to be moaning and grumpy, because she has been in the department all night.

We remonstrate with our Control, telling them that it could be left until the day shift. They tell us to do it, as they have held it for too long. I turn to my good relationship with the hospital staff. If she has been there all night, surely another couple of hours won’t matter? They agree to hang onto her until the day shift arrives at 7.30am; I inform Control that she is going home later that morning, and they release us from the call. The old lady has now been on the trolley for almost 19 hours, and there is still no definite prospect of her transport home. We drive away, considering that we have won a small victory. It did not occur to me at the time, but we all of us neglected that old woman, showed her no respect, and did not care for her properly. I still feel bad about it, almost half my life later