Should self inflicted wounded people use our A&E departments?

Andy From Sligo

Foweva Awone wrote: »

As someone who's ended up in emergency departments after fairly serious suicide attempts, this thread is very sad to read.

Were my complex and serious psychiatric issues going to be solved there and then by the emergency department staff - of course not; however I'm glad they stitched up my slashed artery and saved my life instead of wasting critical minutes arguing over whether they should help me because the wound was absolutely self-inflicted and because I was drunk at the time.

I mightn't have particularly cared whether I lived or died at the time, but over a year since that particular incident, I'm very grateful to the hard-working medical staff, on behalf of both myself and my four-year-old son, who isn't growing up without a mammy.

I suppose the OP would have wanted me to be sent "somewhere else" - I didn't have the luxury of time; I'm just lucky the ambulance journey to the hospital was only a couple of minutes from my house. And yeah I was probably put ahead of other patients and treated immediately - if I hadn't been, I probably wouldn't be alive today.

Would I do it now today, now that I'm mentally stable and have been for quite a while? Of course not. But I'm very happy and relieved that the help was there when I needed it.

sorry to hear of your plight - you actually slashed your artery, you needed immediate attention to treat you save you life ... I said that I heard of a case where the GP had said if you feel suicidal and you cannot get help from somewhere because they were closed / didnt offer 24hour mental health services present yourself at the emergency department . so this is not with an actual physical injury like what happened to you - that was some years ago and things are a lot better these days with the samaritans and other organisations now. - but thats what some GP's advised people .. I dont know maybe some GP's still say that these days too.

Foweva Awone

Andy From Sligo wrote: »

sorry to hear of your plight - you actually slashed your artery, you needed immediate attention to treat you save you life ... I said that I heard of a case where the GP had said if you feel suicidal and you cannot get help from somewhere because they were closed / didnt offer 24hour mental health services present yourself at the emergency department . so this is not with an actual physical injury like what happened to you - that was some years ago and things are a lot better these days with the samaritans and other organisations now. - but thats what some GP's advised people .. I dont know maybe some GP's still say that these days too.

Wouldn't the idea there be to PREVENT injuries like mine, or worse?

Andy From Sligo

Foweva Awone wrote: »

Wouldn't the idea there be to PREVENT injuries like mine, or worse?

of course .. and wouldnt the idea be for Ireland to sort out their terrible history of mental health and put government run centres in place that are always open around the clock rather than tell people to go to ED if other places are shut or you cannot get through on a phone whatever? - and this what used to be 3 months or more for someone to see a specialist psychologist what it used to be when they were referred by their GP's is wrong too - there should be no waiting.

its better than nothing i suppose but the governments want to pass on providing proper mental healthcare by getting people to discuss how they are feeling to their mates/friends (what if their mates are not good listeners or yawn or not interested/compassionate / not qualified in mental health and give some really bad advice that pushes the person more over the edge or makes them more depressed than they were before they started talking to their mates?) and then telling people to go into a busy ED department rather than supply specialist round the clock quiet calm walk-in mental health centres where someone could see a specialist in minutes ?

Andy From Sligo

Andy From Sligo wrote: »

ah see - putting words in my mouth and twisting my words - just for the record I have not said patients should be turned away - i am saying the current situation is not sufficient , it is putting a sticking plaster on a larger problem that A&E (or ED if thats what they are called now) seem to be a onestop shop solution for people that want to go to ED than see GP, to jump the queue and get MRI quicker and to pick up drunks and druggies among other things.

Well you would know if you had any inkling into how ED’s work, you don’t get to just pop in and say ow my head hurts can I have an MRI, skip the waiting list and just get it there and then. In fact you are assessed by a Medical team who’ve seen it all and know when someone’s putting on an act or someone who really does need a scan ASAP. So just cop on, you’ve not got a notion of what you’re on about, as I said earlier.

AndrewJRenko

Andy From Sligo wrote: »

I understand - but what are you saying that only people who post on boards then cannot have an opinion or a suggestion or different outlook on life if they are not qualified in the subject in what they are posting about - i bet i can find a plethora of posts on boards started or contributed by people with an opinion on a subject that they are not qualified in . what do you want? everyone to stop posting/contributing or just me?

What do you do for a living Andy? If I go into to your workplace, spend 10 minutes looking around, and then immediately start lecturing you on all the things you're doing wrong, despite my total lack of qualifications and experience, are you going to do what I say?

AndrewJRenko

AndrewJRenko wrote: »

What do you do for a living Andy? If I go into to your workplace, spend 10 minutes looking around, and then immediately start lecturing you on all the things you're doing wrong, despite my total lack of qualifications and experience, are you going to do what I say?

I think his job is making silly threads on boards. :pac:

Andy From Sligo

RaichuMGS wrote: »

Well you would know if you had any inkling into how ED’s work, you don’t get to just pop in and say ow my head hurts can I have an MRI, skip the waiting list and just get it there and then. In fact you are assessed by a Medical team who’ve seen it all and know when someone’s putting on an act or someone who really does need a scan ASAP. So just cop on, you’ve not got a notion of what you’re on about, as I said earlier.

oh for Gods sakes - I had just read earlier on in this thread somewhere that someone jumped the queue where they were on a waiting list for months and decided it was quicker to go into ED department and it got them their scan otherwise they would have been waiting for months - so its got nothing to do with whether I am experienced or not i just read what they posted and thought that that must be what is going on, that some people can jump the queue by going to ED rather than wait months - you mustnt of read that post that someone said its what they done - admittedly it might not be MRI but it was some scan

Andy From Sligo

AndrewJRenko wrote: »

What do you do for a living Andy? If I go into to your workplace, spend 10 minutes looking around, and then immediately start lecturing you on all the things you're doing wrong, despite my total lack of qualifications and experience, are you going to do what I say?

why are you getting personal and arse'y about it?

yes i am in a self employed position in a job whereby indeed sometimes people advise me on some things I should be doing things differently - I listen and weigh up on their advice - sometimes they have some very good ideas and i act on them because i have an open mind and 'expertise' doesnt even enter into things.

Some people have years and years of experiences with certifications that could plaster a wall ... doesnt necessarily make them any better person than other people and no-one should ever think they are more important and high and might than others

Andy From Sligo

RaichuMGS wrote: »

I think his job is making silly threads on boards. :pac:

when i have time I will see if you have started of any interesting threads on boards that interest me - if they dont I will just skip past them, not bother commenting and join in another thread instead

AndrewJRenko

Andy From Sligo wrote: »

why are you getting personal and arse'y about it?

yes i am in a self employed position in a job whereby indeed sometimes people advise me on some things I should be doing things differently - I listen and weigh up on their advice - sometimes they have some very good ideas and i act on them because i have an open mind and 'expertise' doesnt even enter into things.

And do those people who advise you have any experience or qualifications in the matters they are advising you on?

Andy From Sligo

AndrewJRenko wrote: »

And do those people who advise you have any experience or qualifications in the matters they are advising you on?

yep, no experience and qualifications on the matters they are advising me on how to do my job or improve my business , just general members of public - whats the problem? - i am prepared to listen to everyones idea about anything whether they are experienced / qualified or whatever .. then I use my expertise to decide whether I act on their advice ... normally/sometimes

AndrewJRenko

Andy From Sligo wrote: »

yep, no experience and qualifications on the matters they are advising me on how to do my job or improve my business , just general members of public - whats the problem? - i am prepared to listen to everyones idea about anything whether they are experienced / qualified or whatever .. then I use my expertise to decide whether I act on their advice ... normally/sometimes

Remind me never to hire you.

Andy From Sligo

AndrewJRenko wrote: »

Remind me never to hire you.

good - the chances of that I dare say will be slim to zero anyway

AndrewJRenko

Andy From Sligo wrote: »

good - the chances of that I dare say will be slim to zero anyway

Good to see that we can agree on something

Conor84

Andy From Sligo wrote: »

I really really dont know what a solution could be .. but i still really hate the thought of drunks, druggies, prisoners, abusive people sharing the same HSE A&E dept as other people .. am sure there has got to be a better solution out there so they can still get care/medical help if they need it but as I say , when they have to share with others ... and i am still not happy the way even still these days an awful lot of people are choosing to go to A&E which could have been sorted with their GP / local medical centre for one reason or another . and other patients who might be waiting for an MRI scan / CT scan but instead of wating for it want to fast track having one so present themselves to A&E - Then if there was good proper 24hour support of mental health system in Ireland then the people who need help could get it from mental health services and not have to seek it from the A&E (I heard of one instance of a lad who tried to take his life and the GP said if you try to get through to the mental health services and get no answer or any help and still feel suicidal go straight to A&E ?!?)

it all needs sorting out and categorising somehow better than it is now , and then I do believe waiting times could be reduced.

i spent a good bit of time in ED waiting rooms mainly with relatives and would have pretty much agreed with you. The thinks you said I would have thought the same about when you are with a sick relative and see these "undesirables" there taking up time and causing problems for staff and other patients and relatives and thinking its not fair.

Vut it must be hard on the staff. Imagine what would be said if they turned away a drunk who later died because he was refused treatment or somebody who came in threatening to harm themselves and wasnt treated when nothing else was open or available.

Haye to say it but I was one of those "undesirables" a few years back. I was arrested for assault one night and the Guards were going yo be interview me . When I was getting arrested I got a hit on the head and had a headache. The doctor saw me in the cell and said I should go to hospital to have it checked out. I spent a few hours there getting it checked ot and got brought back to the station
.
Maybe I brought it on myself but if had been something serious and they didnt bring me to hospital and I was brought back but if they hadnt and I was found collapsed in the cell it would have been more serious for everybody.

While I was in the ED waiting I could see people staring ay me sitting there handcuffed with 2 Gardai in uniform, It was horrible sitting there like that and feeling people were talking about me. And some drunks and junkies coming up to us alike they knew you and asking what were we in for!There was also another "real" prisoner there with prison officers so am sure people were giving out about us taking up hospital time. I dont think we got seen quicker because of it but dont know.

Should say got treated well by the staff in the hospital

Big Bag of Chips

Andy From Sligo wrote: »

I can hardly be blamed myself for the failing because this country hasnt got an accessible mental health service available 24hrs all year round.

It has. It's called "hospital". Wouldn't it be great if every suicidal person could be talked around with a cup of tea and a biscuit. Wouldn't it be great if all was needed was someone to talk to. Very sick people need hospital treatment. I don't understand why you find that so difficult to understand.

Your entire thread has been how to get genuinely sick people out of A&E, for what? To make A&E "work properly" and clear the way for those who are not particularly sick but who don't want to wait? Those people you mentioned who decided not to go to A&E because they'd be waiting hours?

By the way you can't just show up in A&E and get an MRI or other scan. The doctors who have years of training and experience will decide whether or not a person needs a scan when they present to A&E. And yes, someone who is on a waiting list for a specific scan might end up very ill in A&E and be scanned. But they won't have "jumped the queue". Their condition will have deteriorated and emergency investigations are deemed necessary.

Anyone on a routine waiting list for anything in any hospital are told if their symptoms get worse to go back to their GP to send in a new letter and they might be moved to the urgent waiting list. Or if their symptoms get very bad to come to A&E.

Andy From Sligo

I know what you are saying - but i still maintain that a stretched service such as A&E / ED department is stretched further. I am still pretty sure when the health service was devised years ago and A&E departments were introduced the original premise was not to be set up a department as a one fits all service and to accommodate drunks and drug users every weekend that have been intoxicated for their own recreational delights or people with an alcohol problem(s) and other things but more like public that have fallen off ladders, hammered a nail into their fingers, been in a car crash, have suffered a stroke or heart attack and the list goes on - again I am not saying that everyone who turns up to A&E / ED should be turned away with no treatment ... I am saying that sometimes they maybe should not even be brought to HSE ED department even in the first place and if/ when picked up by ambulance be transferred to other emergency places and if that means its a private hospital or some other place where they can get treated then that might be a solution and if needed be pay through the nose for their treatment if it is proved beyond doubt that their injuries are self afflicted and could have been avoided .... although most probably even them places dont even want their departments over-run with drunks and druggies and rowdy people either.

Big Bag of Chips

But ED works. It treats emergencies such as you've described above, and non emergencies are treated once the emergencies have been dealt with. People waiting on trolleys are not waiting to be seen by ED. At that point the over stretched ED have done their job and are waiting to move the patient out of ED into an inpatient bed. That is why people are on trolleys, to free up ED cubicles to treat the next emergency that comes in.

Your suggestion of charging "self inflicted injuries" through the nose in an alternative location... What happens if a person can't afford it?

Andy From Sligo

Big Bag of Chips wrote: »

...

Your suggestion of charging "self inflicted injuries" through the nose in an alternative location... What happens if a person can't afford it?

you dont solve a problem by causing another problem - there are vay'z of paying ....

ohnonotgmail

Andy From Sligo wrote: »

you dont solve a problem by causing another problem - there are vay'z of paying ....

But that is exactly what you are doing. You are trying to solve the problem in EDs by moving some patients elsewhere.

Andy From Sligo

Big Bag of Chips wrote: »

But ED works. It treats emergencies such as you've described above, and non emergencies are treated once the emergencies have been dealt with. People waiting on trolleys are not waiting to be seen by ED. At that point the over stretched ED have done their job and are waiting to move the patient out of ED into an inpatient bed. That is why people are on trolleys, to free up ED cubicles to treat the next emergency that comes in.
..

have a look at the bigger picture though - 2 things / issues that spring to my mind and I am sure there are more issues when an ED gets overloaded on a busy night

you have children , they are not feeling well or they have swallowed something or broken their arm or something and you find yourself waiting in ED ... it could be a friday or saturday night and the drunks walk in or are being brought in by ambulance and for a certain amount of time you are sitting their with your child waiting and something kicks off , a load of shouting , swearing , punching , staff being abused and shouted at, drunks puking up on the floor and eventually they might be man-handled out by hospital /ED security or the Gardai called - can you imagine how frightening this could be for children in the waiting room and seeing and hearing things they do not need to hear or see - yes I understand you cannot wrap your children up in cotton wall but come on ...

secondly if someone did go into ED /A&E with depression / suicidal / autism /phsycosis /aspergers whatever - presumably they will still have to do a bit of waiting to see someone until they are free presumably .. what a bloody depressing/frightening environment to be in and just make them agitated more than what they are already


If people are in the ED in excruciating pain (which a lot of the time) the most thing you want to do especially if your not numbed by the drink is just sit there in peace and quiet and wait for your turn

AndrewJRenko

Andy From Sligo wrote: »

you have children , they are not feeling well or they have swallowed something or broken their arm or something and you find yourself waiting in ED ... it could be a friday or saturday night and the drunks walk in or are being brought in by ambulance and for a certain amount of time you are sitting their with your child waiting and something kicks off , a load of shouting , swearing , punching , staff being abused and shouted at, drunks puking up on the floor and eventually they might be man-handled out by hospital /ED security or the Gardai called - can you imagine how frightening this could be for children in the waiting room and seeing and hearing things they do not need to hear or see - yes I understand you cannot wrap your children up in cotton wall but come on ...

EDs for children are generally separate to EDs for adults. Why are you scratching around looking for problems that don't exist?

Andy From Sligo

AndrewJRenko wrote: »

EDs for children are generally separate to EDs for adults. Why are you scratching around looking for problems that don't exist?

i dunno about the ED's where you are - but not the ED's i have been to - everyone shares the same waiting room from all walks of life

Obvious Desperate Breakfasts

Andy From Sligo wrote: »

i dunno about the ED's where you are - but not the ED's i have been to - everyone shares the same waiting room from all walks of life

It’s already been pointed out in the thread that there are pediatric EDs. I’ve been unfortunate enough to have spent a lot of time in EDs and I’ve seen teenagers waiting but never children.

henryforde80

OP Lets all wrap ourselves in cotton wool, not drive a car, play sports, do any pastimes we like, don't get drunk, don't get up on a ladder at work, walk down the stairs, don't drive motorbikes, don't use sharp knives to cook dinner, don't go swimming, don't use the gym.

Comparing someone climbing a mountain and falling is the same as someone up on a ladder at work.

Do you have a brain?

Andy From Sligo

Obvious Desperate Breakfasts wrote: »

It’s already been pointed out in the thread that there are pediatric EDs. I’ve been unfortunate enough to have spent a lot of time in EDs and I’ve seen teenagers waiting but never children.

sorry i have missed something .. where? - where in the country?

whelan2

Andy From Sligo wrote: »

sorry i have missed something .. where? - where in the country?

Olol in drogheda has a paediatric a and e. Great job. Was in there Monday night with one of my kids. Had to walk through adult casualty to get there-there were drunks, indeed when I was swapping over care of our child with my husband at 6am I met 3 lads with beer cans walking into casualty. Great to have kids out of that environment

Lucyfur

Andy From Sligo wrote: »

i dunno about the ED's where you are - but not the ED's i have been to - everyone shares the same waiting room from all walks of life

Sligo's ED has a separate paediatric waiting area. And if at all possible, suidcidal patients are brought to a private family room.

Andy From Sligo

henryforde80 wrote: »

OP Lets all wrap ourselves in cotton wool, not drive a car, play sports, do any pastimes we like, don't get drunk, don't get up on a ladder at work, walk down the stairs, don't drive motorbikes, don't use sharp knives to cook dinner, don't go swimming, don't use the gym.

Comparing someone climbing a mountain and falling is the same as someone up on a ladder at work.

Do you have a brain?

well done resulting to insults ....

Big Bag of Chips

Most ED's will do as much as possible to get children out of there quick as they can. Most children once triaged will be sent to the paeds ward to be treated there if it is appropriate.

Do you know much about hospitals, or EDs, Andy? You seem to be basing a lot of your opinion on what you've heard on the news or on what you've heard others have said. Hospitals and EDs generally work very efficiently with what they're presented with.