Hours of Waiting

While reading an article about the horror stories of waiting up to 60 hours for an ambulance to arrive to someone (in the UK), I read some pretty bleak comments.
Many of them seemed to be from a place of simple misunderstanding.

Of course it was brought up that , in many cases, people call an ambulance for nonsensical reasons, like as a taxi service to get home, or for a cold or flu. There are abusers of every system, and they put additional strain on services like ambulance availability.

One comment that I see frequently (and have even been told, myself) is:
"Well if you could wait several hours, then you didn't need an ambulance did you?"
Or
"If you were capable of waiting 7 hours in the emergency room, you really should not have been there in the first place."

While I understand the general thought process behind comments like the above, it is never as simple as it sounds. Just because something is life-threatening does not mean that it will happen instantly... just because a person will not die waiting for hours does not reduce the danger in many cases.

Sepsis, for instance, is pretty quick, but can still take hours. So, until a person begins to have evidence of organ failure, it can easily be presumed to be a flu. It could take hours - only a couple in most cases - but it can take hours for sepsis to kill someone. Does that mean they should not call an ambulance? Does that mean that they should be waiting, because it's possible for them to wait?

Pancreatitis: inflammation of the pancreas. This can take hours or even days to develop into an emergency situation. I have waited for over a day between in a hospital waiting room and at home with pancreatitis. That does not mean that I wasn't in any danger. It means that none of us knew exactly how life-threatening it was, and since I looked normal, it did not seem as urgent as other situations.

Heart Attack.
Did you know that heart attacks can actually occur over several hours? That if you take a chewable aspirin it is possible to avoid a severe attack for hours? So just because you can wait until it gets to a point where you are flatlining, that does not mean that you should. Someone who isn't positive they are having a potential heart attack could also wait hours in the waiting room if the symptoms present differently... would that still be considered not urgent?

Severe pneumonia.
Flesh-eating disease.
Cancer.
Asthma attack.
Throat/tongue swelling.
Broken bones.
Involuntary amputation.
Bullet wounds.
Appendicitis.

These are all examples of illnesses/situations that can take time to develop. Does that mean people should wait until they are nearly dead from them before seeking emergency treatment? A sliced-off finger does not mean you are going to die within an hour, so does that mean they should not call an ambulance? A bullet may not hit any vital organs and could take several days to cause any real problems depending on the location, so because that person can wait for a week, does that make it wrong to call an ambulance? Do you think you would know, if you got shot, that you were not going to die? Would you instinctively know that it did not do more damage than a severe flesh wound?

One of the most confounding parts of the argument of abusing a system is that somehow people believe that we always know exactly what is wrong when we dial 911. That we already know the diagnosis and we're just going to the ER to, ya know, check....?
I would venture to guess that around 80% of 911 phone calls are pretty frantic - because the person does not know why he/she is feeling so unbelievably ill or feeling that amount of pain. When we hear "I think I might be having a heart attack" we jump into action, but if we find out it was heartburn, then the comments are 'wow you completely wasted resources and called an ambulance for heartburn? Really?" But in moments of panic, uncertainty, injury, or medical distress, we do not know what the problem is. Even further to that, even a doctor cannot know what the problem is without an assessment (unless, you know, someone comes in with their finger cut off or their leg turned backwards).
So the vast majority of people who use medical services are unaware that they *might* be wasting valuable ambulance time.

In my own opinion, the same people who complain that the woman who broke her back should have taken a cab to the hospital instead of waiting for an ambulance are the same people who would have commented on the stupidity if, by taking a cab, moving her with a back injury resulted in paralysis. In that same realm of hypocrisy, if someone is horribly ill (vomiting nonstop, unable to sit up straight or handle movements), would you prefer them to drive themselves to a hospital or to take an ambulance? Even if it does happen to be a bout of food poisoning or even just a flu....

As an extra aside, I recently had to go into the emergency room for a throat swell. Throat swelling, for me, usually happens over a few hours. It is not immediate like anaphylaxis, but it IS extremely serious. There is no standard amount of time before the throat closes entirely and a doctor would have to intubate. I don't really know how long it will take, and I don't always know how severe it is. It could progress over an entire day, it could take half an hour. I have no real way of knowing. Nevertheless, my throat is swelling. Of course, because RJ was home, he drove me to the hospital. By the time we got there it had progressed and my breath was 'catching' and I was beginning to wheeze, and barely able to speak.
What if I had been alone? Should I have driven myself knowing the risk of losing consciousness on the road if it progressed quickly? Should I have called a cab and waited an extra half an hour - not knowing if I would still be able to breathe or not within that time? What if there was an accident, rush-hour traffic, or we just plain could not get there in time, should I still trust a cab driver to save my life and get me there before it got to that point? Should I wait longer just because I might be able to wait a couple of hours before I was really dying?
When we DID get into the ER, I was able to walk (or hobble, really) calmly into the line, calmly to the triage station, and whisper to the nurse through wheezing breaths exactly what was happening. To everyone in the waiting room, I looked FINE. I was giggling at a morbid joke RJ made about my having a hard time talking (he finally got a bit of peace and quiet, ha ha ha), I did not have any physical sign of a serious issue, and no one standing more than a foot away from me could hear the problem with my breathing and my voice.
It was still urgent.
Really urgent.

As always, please try to remember that even if a person does not look like they are in a life-threatening situation does not make that the reality. In many cases, if a person has called an ambulance it is because they are petrified that they could be dying or be suffering from something serious enough to warrant emergent care.

Sure there are the abusers who call as a prank or to get a free ride somewhere, but in most cases (yes, even those who come to learn that they have constipation and not a hernia, heartburn and not a heart attack, bad Botox and not a stroke, a panic attack and not anaphylaxis) are having one of the worst days of their lives and have no idea what to do at the time, so they do what they have been taught to do in those terrifying situations. 

P.S. If I had the capability or the knowledge of a program that would allow me to receive the emergency treatments I often require at home, I would rarely have to visit the ER.
P.P.S. Does anyone really believe that any person in their right mind WANTS to spend hours in an Emergency Department if they don't have to be there??