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AAs the sun rises on Monday July 19, the day the Covid-19 restrictions in England ended, my teammate and I find ourselves assessing a patient with a new cough to see if he needs to be transported to the hospital. hospital for additional care. We check his observations, listen to his chest, assess the effect of walking on his breathing, and consider the family care safety net he has around him. After three weekend night shifts, it became clear to me that calls to Covid patients, confirmed and suspected, are firmly back in the emergency ambulance repertoire. The break was pleasant as long as it lasted.
I had a hard time getting excited about “freedom day”. With infections skyrocketing and hospital admissions and death rates steadily rising, I found myself feeling apprehensive, tired and in disbelief that we were here again. In the health field, this phrase “getting back to normal” has become a double-edged sword. The pressures of the past 18 months, supposedly unprecedented, have become the new normal.
Ambulance services are already under siege from the fallout of the past year and a half. In addition to the fluctuating impacts of the Covid itself, we have dealt with the increase in mental health problems during confinement, the destructive effects of various addictions, the new phenomenon of the Covid long and even the seething domestic tensions (I have often found doing impromptu family mediation sessions, reminding me to follow my own advice when I get home).
We also felt the effects of a restless population emerging from the lockdown with a crash. Children exchange various infections as if they are making up for lost time, while adults celebrate their freedoms a little too much and in the heat of summer alcohol consumption, assaults and accidents have unfortunately 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 encountered in accessing their GPs. This is something I hear from patients every day, as ambulance teams have to deal with higher rates of low severity calls. Responding to the NHS ‘long-term commitment to accessible and decentralized healthcare, this is a development that ambulance services have in fact embraced – just visit the websites of the 11 regional ambulance services. from England to see how they rebranded themselves as suppliers. urgent and urgent care. But there is an inevitable impact on the response to the most serious emergencies.
This heralded the development of video consultation, and the pandemic has both encouraged the use and demonstrated the value of such innovations. Likewise, clinical assessment by telephone is now well established in call centers, general practitioner offices and ambulance control rooms. However, the complications of remote assessment and a necessarily careful triage system mean that many patients, even after a series of telephone conversations, are deemed to require a face-to-face consultation – inevitably, a visit to a doctor. ambulance team.
It is generally assumed that people with Covid-19 only become a problem for the NHS when they need to be hospitalized, and it is true that many can be left at home to take care of themselves. However, many of these patients have yet to be assessed in person, meaning paramedics often visit multiple Covid homes on each shift. Avoidance of the hospital may be seen as a victory for the health services, but it is exhausting and time consuming work for us down the road.
What worries me the most about the current situation is the number of vulnerable patients I see who are still not vaccinated. Each individual has the right to make their own choice, but over the past few weeks it has been informative and concerning to hear the reasons people have for refusing the vaccine – and the sources of the advice they follow in opposition to the research. published.
Their apprehension suggests that these patients are not decreasing due to a lack of concern about Covid; rather, they are wary of vaccines. Government data shows regional variations in vaccination figures and a disparity of over 30% in care between different ethnic groups. Clearly, more work needs to be done to find out why some of the most at-risk patients have been the least likely to protect themselves from the worst effects of the virus.
I suspect that for some patients the decision to decline the vaccine seemed academic when made, as transmission was low and social contact was limited. But in the coming weeks, as the country opens up and the virus moves unhindered, the consequences of this move will become very real. It is inevitable that my colleagues and I will see more critically ill patients, and this will have effects on the delivery of health care 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 for that choice is about to change – and there is nothing wrong with reconsidering.
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