Thursday, January 20

For us NHS paramedics, the increase in calls to Covid cases is eerily familiar | Jake jones

TOWhen the sun rises on Monday, July 19, the day the Covid-19 restrictions ended in England, my crewmate and I found ourselves evaluating a patient with a new cough to see if they need to be taken to the hospital for more. attention. We verify your observations, listen to your chest, assess the effect walking has on your breathing, and consider the safety net of family care around you. After three weekend night shifts, it became clear to me that calls to Covid patients, both confirmed and suspected, are firmly back in the repertoire of emergency ambulances. The break was nice while it lasted.

I have had a hard time getting excited about “freedom day.” With infections skyrocketing, and hospital admissions and death rates steadily increasing, I have found myself feeling dread, fatigue, and disbelief that we are here once again. In the healthcare sector, that phrase “back to normal” has become a double-edged sword. The presumably unprecedented pressures of the past 18 months have become the new normal.

Ambulance services are already beset by the consequences of the last year and a half. In addition to the fluctuating impacts of Covid itself, we have grappled with the rise in mental health issues during confinement, the destructive effects of various addictions, the new protracted Covid phenomenon, and even boiling domestic tensions (I have often found doing impromptu family mediation sessions, reminding myself to follow my own advice when I get home.)

We have also felt the effects of a restless population that comes out of the confinement with force. Children have been trading various infections as if catching up on lost time, while adults have been celebrating their freedoms too vigorously and in the heat of summer, drinking, assault and accidents have sadly increased. .

Then there is the issue of primary care. One consequence of the pandemic that has received little coverage is the difficulty that patients have experienced in accessing their GPs. This is something I hear from patients every day, as ambulance teams find themselves dealing with higher rates of low-acuity calls. Answering to the long-term plan of the NHS commitment to decentralized and accessible healthcare, this is a development that ambulance services have indeed embraced – you just need to visit the websites of England’s 11 regional ambulance services to see how they have rebranded themselves as providers of urgent and emergency care. But there is an unavoidable impact on responding to the most serious emergencies.

That plan heralded the development of video consultation, and the pandemic has encouraged the use and demonstrated the value of such innovations. Similarly, telephone clinical evaluation is now well established in call centers, GP surgeries, and ambulance control rooms. However, the complications of remote evaluation and a classification system that is necessarily cautious mean that many patients are considered, even after a series of telephone conversations, to require a face-to-face consultation, inevitably, the visit of a team of specialists. ambulance.

In general, people with Covid-19 are supposed to become a problem for the NHS only when they require hospitalization, and it is true that many are able to stay home to take care of themselves. However, many of these patients still need to be evaluated in person, which means that ambulance teams often visit multiple Covid homes on each shift. Hospital evasion may count as an advantage for the health service, but it is tiring and slow work for us on the road.

What worries me most about the current situation is the number of vulnerable patients I know who are not yet vaccinated. Each individual has the right to make their own decision, but over the past few weeks, it has been instructive and troubling to hear people’s reasons for rejecting the vaccine, and the sources of the advice they are following against it. published research.

Their apprehension suggests that these patients are not declining due to a lack of concern for Covid; rather, they distrust vaccines. Government data shows regional variations in vaccination figures and disparity of more than 30% in acceptance between different ethnic groups. Clearly more work is needed to determine why some of the highest risk patients have been less inclined to protect yourself from the worst effects of the virus.

I suspect that for some patients, the decision to decline the vaccine felt academic when it was made, because transmission was low and social contact was limited. But in the coming weeks, as the country opens up and the virus moves unchecked, the consequences of that decision will become very real. It is inevitable that my colleagues and I will see more critically ill patients, and this will have effects on health care provision beyond Covid-19. This is the point that I have tried to convey in my conversations with patients over the past few weeks. People retain the right to choose, but the context of that choice is about to change, and it’s okay to reconsider.

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