There’s a big push in the emergency services to get information out to the front line, to the people who really need it. PC Copperfield has emigrated to Canada where the police seem to have a better handle on process and communications to the front line. Access to all kinds of data is useful when you’re on the front line – like when a patient shows you what drugs they’re on but you don’t recognise them, you can look them up in the BNF. When a patient has a rare disease that you’ve not come across but you really need to know what it is, you can look it up in a whole variety of places, like Kal once did. And last week, I used it several times in a shift, twice to satisfy my own thirst for knowlege, a couple of times to find care homes who weren’t well signposted and once to find an important piece of information.

The two not-so-important things were to look up what a bruit was and the second to find out what Tramacet is (a strong painkiller). The second resulted in an interesting conversation with the A&E nurse after we’d booked our patient in.

The other use was a little more…immediate.

A job came through to us around midnight, asking us to go to the local A&E and pick up an elderly lady from a corridor and take her home as she’d been waiting for some time. These kind of jobs are lovely because they’re simple, there’s little or no medical problems to worry about (and while I’m in this for the medicine, it’s occasionally nice to know that your patient isn’t going to die on you. Probably.) and people are supremely grateful. So we tromp into A&E, find our patient and sit her in the ambulance to driver her home. She’s a lovely old lady with a cracking black eye and mild dementia – she’s lucid but isn’t too good at remembering things.

So we get to her address and park up. There’s some talking from the back as I fiddle with the radio for a second to let control know we’ve arrived. A head appears next to me as my attendant sticks her head through the partition. “We can’t find her key.”

We help her look through her pockets. We help her look through her bag. Twice. No key. I run down and check the door, yes it’s locked. Shit. Wait – that’s a keysafe, great. I run back – does she remember the number to her keysafe? No. Shit. Any relatives? No. Son or Daughter? No. Do the neighbours have a key? No. Does she leave one under the mat or a plantpot? No. Carers? Yes, but they’re private and she doesn’t remember the company name.

Right, contact control who have nothing on the incident record. However, she was taken in earlier in the shift so the controller goes to dig around to find the original incident. Right. We empty her bag out. Still no key. Control get back to us saying they’ve spoken to the original crew who mentioned a son. Wait, a son? So I jump in the back and skirted around the earlier questions with a more direct approach.

“What’s you’r son’s name, my love?”

“Chris.”

My colleage stares at me open-mouthed.

“Where does Chris live?”

“In LittleVillage.”

This is bad news – LittleVillage is about 90 minutes West of where we were at best. Still, let’s try for his address to see if I can get his phone number. She remembers the house number and can describe the street where he lives but doesn’t remember the road name. So I get my phone out. Luckily LittleVillage is about 2 miles from where I grew up and her description of the street is one I recognise, so I don’t bother with Google maps.

Onto the BT directory enquiries page. I look up the details. Hrm, nothing in that street. Check google maps – the house number is quite large, almost 200 and there aren’t that many long streets in the village. Try this one instead – aha!

I call the number. “Hi, this is the Ambulance service here…”

“Oh, thank God, you’re taking my mother home?” Right, sounds like we’ve got the right one then.

He knew the keysafe number. And knew where she normally kept her key. So we got her in, put the fire on, made a cup of tea and helped her warm up.

Would we have got her in without the internet? Probably – control could have looked up the number for us, but it could have taken longer. Did the internet help? Yes, without a doubt – I could use the information that I had to find the address quickly and confirm it easily with the patient. Is this the most important use of the internet that we will have? No, without a doubt. I’ve already had twitter increase my knowledge of chest pain in adolescents (thanks Kal!) and teach me about conditions I might come across. We’re humans, not encyclopedias – we will come across things that we don’t know or need reminding of.

I really do think that with the arrival of Airwaves in the Ambulance service we should see smarter devices being rolled out with access to medical databases for looking up medications and conditions or illnesses. I’d like to see medical records being accessible to the front line as well – though I understand the privacy concerns. We have to be careful not to overload the guys on the front line, but access to the information when they need it really can save lives. We need to make sure that we have sources that are definitive and trustworthy and not just wikipedia.

People said that the end of the last century and the start of the new millenium was the information age. Is this the age that we see information being distributed to every person wherever they are, whatever they’re doing?

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3 Responses to “Where’s the key?”

  1. Ingvar says:

    I wonder if it would be worth investigating translation rights for FASS, the initial job would be HUGE, but it should be possible to do updates on a differential basis. I have, however, no idea who to start asking.

    FASS started out as a paper-based reference, published every 6 or 12 months, but has for the last 10-odd years been available on-line. It describes every medication in two forms, “Patient FASS” and “FASS”. The latter should be all the information a prescribing doctor needs (indications, contra-indications, side-effects and their commonality, pathways touched and other pharmacogenic information, interactions and so on and so forth) and is, for me, a most excellent reference when I wnat to figure out how a given substance reacts.

  2. Aled says:

    That’s pretty much what the BNF is, except it’s restricted to healthcare professionals. It’s also published in paper form fully updated every 6 months IIRC.

    It’s a great resource and not only lists the essential indications/contra/side-effects etc but also things like alternative names for commercial preparations, whether the medicine is PoM and also narrative sections on general use of that class of drug. Also, it is specific to the UK since drug classes and uses vary from one country to the next.

    In summary, it rocks. :)

  3. Ingvar says:

    FASS is (I believe) also available in paper format and if I needed access to it day in and day out, I’d probably shell out for it, but as I don’t need a physical copy (for bookmarking and the like), I find the web-FASS good enough for my needs.

    Searching on “substance” fentanyl on FASS gives three results, “fentanyl”, “fentanyl citrate” and “fentanyl hydrochloride”. Looking further at the hydrochloride, I can see that the only (for Sweden) approved medication is Ionsys, manufactured by Janssen-Cilag.

    Looking at the fentanyl result, there’s a veritable plethora of different preparations available on the market (all under prescription, I am sure).

    So, yes, it seems like something similar exists, I am just slightly miffed that it’s restricted. Part of my speculation about a translated FASS would be the same level of access (that is, the info is spearated into intended audiences, but NOTHING stops anyone from looking at it).

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