HEALTH FORUM MEETING ON EMERGENCY FIRST AID

Bob Welchman (BW) introduced the panellists: Irene Jeary (IJ) from Epilepsy Action, Dr Robin Roberts (RR) a consultant heart surgeon, Karen Barrett (KB) from St John Ambulance and St. George’s Hospital and Suzette Simon (SS) from Mascot.SS started by telling the audience that Mascot is based in Merton Park and runs the Community Care Line service for LBM. The equipment they use is a hard wired machine which is installed in the home. Most of the users are elderly, but when advised by a hospital discharge team that anyone needs the service they will install it. Mascot in Merton has been working with twelve other Boroughs in a major publicity campaign and the system is offered to, amongst others, those suffering from domestic violence, racial harassment and to vulnerable shopkeepers.

The user presses the button and the call comes through to the control room. The operator know who is calling and will firstly phone the user and if there is no response to this call will then make a visit. Mascot holds keys for all users to enable entry. Every call they receive is monitored.

KB is the Divisional Officer, in charge at the local St. John ambulance service. They provide first aid cover for a large number of local events of all sizes, from Mitcham Festival to local school fetes. She pointed out that all of the staff are volunteers and greatly appreciate being thanked for the work they do. All the volunteers are trained first aiders and training is provided for local guides, scouts, youth groups and others who wish to gain a certificate of competency in providing first aid.

KB’s paid job is as Discharge Nurse at St George’s where she provides discharge packages for those leaving hospital.IJ is a volunteer for the newly renamed Epilepsy Action. Epilepsy is the second most common neurological condition with migraine being the first. It is the collective name for over 40 types of seizures and 1 in 125 people suffer from it. It is surrounded by misconception and stigma and IJ said that there is no need to panic if you see someone having a fit. It is not necessary to call an ambulance or to put something into the fitters mouth. If the fit appears to be continuing then put the individual into the recovery position.

RR described himself as a physician, specialising in cardiology which is the interface between surgery and medicine.

Heart attacks are the number one killer. Coronary disease affects one third of the population with 400,000 heart attacks a year, 50% of these occur without obvious signs.

Angina is one of the typical signs but it is frequently misdiagnosed as heartburn because it manifests as a dull ache behind the sternum but pain could be felt in an ear lobe or in the thumb. It is a warning sign that there may be a problem with the supply of blood to the heart. A heart attack is a ventricular fibrillation and within 3 seconds it can produce loss of consciousness without suffering. The bystander has a number of options to restart the heart. There is a National Service Framework which is training an army of people to use defibrillators that are becoming increasingly widely available at Railway Stations, shopping centres and other public places. An alternative is to punch the sufferer’s chest to restart the heart.Ann Dixon asked the cost of the Mascot alarm and SS told her it was means tested and where people are on Income Support there is no charge, but the full cost is £6.33 a week. Recipients of the Attendance Allowance are required to pay from their allowance. Ann asked another question about the range of the alarm and was told that whilst it might work in close proximity to the house it does not normally work outside the home. If there is a power cut then it continues to work. Ann said she had costed the system and that it is cheaper to use a mobile phone.

Audrey Wood pointed out that Help the Aged have a similar scheme but SS said she was not sure that they responded in the same way to emergency calls. When the responder goes to the home they will make sure that the caller is comfortable and will call an ambulance. They do not pick people up from where they have fallen.

Deborah Bishop said that when Mascot is called out the phone line is blocked but SS said this is because the responder is reassuring the caller whilst the home visit is arranged.

Another member of the audience was advised that Mascots clients are advised not to bolt the door but to make their homes safe but accessible using the keys deposited with them.

Helen Spiro asked if there was a support system for those who lived with sufferers from epilepsy? IJ confirmed that there are groups but not enough and this was echoed by RR who said that there is inadequate support in the NHS for sufferers.

Hilary Gunn asked RR if he really meant a punch in the chest? RR said that if someone were to collapse in the street you might use ABC which is; are the airways blocked, is there breathing, and is there circulation? If a blow to the chest is used it should be to the left of the sternum.

KB reported that the Resuscitation Counsel currently advises that the public should not take action when someone appears to be having a heart attack.
Christine Richards said that during her involvement with the Guides she did a first aid course and she felt disappointed that guidelines discourage people from the ABC method. She asked if she could go to St John for a refresher course and KB confirmed that this is possible as is defibrillation training.
There followed a discussion about salt in the diet. The subject is controversial but salt levels are relevant in hypertension. Generally, salt should not be completely avoided.

Ann Dixon asked the panel if they would say it was usual for a dying man, expected to live weeks, not months, to come out of hospital with full care and then to have it withdrawn so that they died without full time care? 

Doreen Welchman reported that if someone comes out of hospital needing nursing care it comes under the banner of health care but if they need personal care it comes under the remit of Social Services but there does not appear to be a clear definition of what is health and what is personal care. If a hospital deems a patient needs care they are handed over to Community Nurses.
Ann was advised to take her case to the Community Health Council.

RR said that the NHS is the largest employer in Europe and the most inefficient. At Kingston Hospital there are people waiting for 4 weeks on wards for routine surgery such as pacemakers. The surgery for pacemakers costs £5,000 but every patient day in hospital costs £500. 

 The Government is not looking to the 10 to 15 year situation. 85% of the increased budget will go on salaries and administration and not on patient care. Where are the 15,000 new doctors going to come from?
Bob Welchman asked what we can do about this on a local level? The PCT is intended to get carers and health workers to work together.
KB said we should go to local hospital Board Meeting and find out what is going on.

A questioner asked if we should use Private Health Insurance which gets more expensive as you get older. RR said that in acute cases the NHS is brilliant and the private sector does not offer the same cover but the shortfall in NHS funding is currently £270 thousand, million pounds. The result of this is that Kingston is putting 7 beds in a 6 bed unit so people are too close together and are catching the super bugs which threaten all hospitals.

KB told the audience that she had been redeployed 3 times in 15 years of nursing as a result of hospital closures. Her advice was for individuals to make the local MP aware of their dissatisfactions with the NHS.

Helen Bramsted does not believe that it is possible to have the NHS and private medical care running side by side. The two cannot successfully coexist. In Europe people pay more to their medical services but in the UK they pay the money into private schemes.

RR replied that the private sector gives to the NHS rather than the other way around.

On the question about asylum seekers receiving medical care RR replied that emergency treatment is given for the first 24 hours and then the hospitals decide whether to charge for the remainder of the treatment.

Ann Dixon said that she had had initial anxieties about the reorientation of the Nelson but she now feels that they are doing a marvellous job, keeping the elderly out of hospital, with their day care facilities.

It was proposed that we need to talk up the NHS rather than constantly criticise and the Roehampton Treatment Centre came in for praise.

Helen Spiro commented that she had twice called an ambulance when someone had been having an epileptic fit, possibly unnecessarily. Could Epilepsy Action provide local training for people who want to know what to do? IJ confirmed that such training is only offered by some Boroughs. KB said that St John would be prepared to train volunteers.

Jean Casale asked for guidance in what to do in drink and drug related cases. KB stressed the importance of looking for danger, shout first to see if there is any response and then gently tap on the shoulder. If the person is not responding then tilt the head back slightly, check breathing, check circulation, if they are bleeding heavily use direct pressure and elevation to stop it.  As long as the helper has no cuts of their own they would be unlikely to catch anything but should wash carefully afterwards.

Ann Dixon requested the improvement in signage at St George’s. KB said it had been improved but BW reported that he had recently asked 5 times before finding the department he was seeking.John Gunn concluded by saying that he was very satisfied with the treatment he had received when he needed bypass surgery. RR said the current waiting time in a non emergency is 12 months.
BW thanked all of the participants for an interesting and informative evening.