999 or 111- when to get help.

For readers from outside the UK 999 is our emergency number and 111 is what we call NHS 24 where you call and get triaged my a call handler, speak to a nurse and then see a GP at an out of hours clinic if needed!

Recently I have seen a lot questions regarding asthma, asthma attacks and when do you call 999 versus 111.

It is a tricky question to answer because if you have fairly uncontrolled asthma and have to go to hospital fairly often you will be reluctant to call 999 because calling 999 inevitably results in hospital which no one wants to go to.

I would always say if your not responding to treatment and in an acute attack then call 999 because 111 won’t be able to cater for you and they would no doubt send an ambulance to you anyway. But that is easy for me to say when I am sitting here typing and have my rationale head on and am not sitting during an attack knowing that things are not good but also know that going to hospital means getting an ambulance, rushed across Edinburgh, into the resus room where you have people pulling your clothes off, sticking a gown on, needles being stuck into you, masks and stickies stuck on you and 101 things happening at once and then there is that dreaded wait when they decide if your well enough for assessment unit or need to go to critical care. But its not just about these steps. These moments are fine. Its what all of this adds up to. It adds up to another week in hospital, another wean from high dose steroids but mostly for me it means more time off work.

For me I hate being off work so will if I can avoid 999. If I can I will go via 111 for a few reasons mentally for me 111 is not as urgent as 999. It means being referred on to a hospital which will send the on call resp team to see you straight away so they initiate treatment quicker as they have experience in dealing with brittle asthma and then hopefully you avoid critical care and go to the ward and can go home quicker.

Is this rational???

NO!!!

Is this sensible???

NO!!!

But when you have an attack it is kind of like trying to be coherent when you have had far to many alcoholic drinks. You don’t think rationally. You need someone to advocate for you. You need your rationale head on when you can’t.

Its trying to separate what you should do with what you want to do. Now I must say I am getting better at dealing with attacks and calling early but as I have read and heard from many asthmatics they say things like:

“the paramedics didnt think I was that bad”

“my sats were fine so they didnt take me seriously”

“I wasn’t wheezing so they left me and said it was a panic attack”

These three examples are just some of the things I have read when people say why they didnt get help early and it is really hard. I have often had paramedics say that I’m ok and they will take me in as a precaution for me to suddenly get worse in the ambulance and end up being rushed in. Which is fine but when they first turn up and you feel like your having to justify why you called them can be really hard. I have never ended up not getting worse either when they are at my house or when we are in transit but it is hard and I can see why some people really don’t want to call for help.

The second part is when others go into hospital under their own steam and go early only to be told they are not wheezy, or they sats are fine and its just panic or VCD. There will be a proportion of those who do panic and thats natural but when a Dr says this and you feel awful its not helpful.

What I have found to be invaluable is having a care plan drawn up which doesn’t dictate how to treat me but it summarises how my asthma presents for example that i do hold my oxygen saturations but when I get tired they do plummet very quickly which is why I may sometimes appear to be ok.

It can be hard and when you feel like you need to justify why you came to get help can be so demoralising and can put you off getting help in future but please don’t wait.

If you do have an action plan. Follow it and get help when you feel you need it. Asthma can be so fickle and even those with the mildest form of asthma can have attacks which can land them in hospital or even worse can kill you. No one is invincible to asthma attacks from the mildest to most severe. If you do feel that you are being judged for getting help early tell the Dr that you know the stats on asthma and that it will be a lot less work for them to treat a miler asthma attack than dealing with you coming in later and needing more invasive treatment, monitoring and more staff to look after you. Nipping an attack in the bud is the way forward.

I guess what I am trying to say is that if you feel you need help then go get it. When you don’t feel well you will take things more to heart and wonder why you bothered getting help but let me assure you getting help early is so worth it. Don’t take the risk or the gamble as your life is not worth it.

If your in any doubt and notice you need more rescue inhaler see your GP or 111 if at night or the weekend but try get seen before you get to the stages of needing 999 and blue flashing lights.

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