Table 3 Clinical condition

1

The paramedic and emergency care assistant started to take physical observations. They were all within normal parameters except the blood sugar which was 30 + mmols.

Call 5, field notes

2

We were led into a small room where four elderly women sat around eating breakfast and watching the TV … We could immediately see this was not a cardiac arrest.

Call 8, field notes

3

He was alert and responsive. And complaining of some pain in his lower back … from what I could gather, superficial injuries, he had a cut to his face. Complaining of this lower back pain, but it seemed that it was probably sort of lying on the floor that was causing it. He had quite a lot of mobility, so we managed to get him … off the floor … and managed to do a full assessment. Once we’d got him up, he was in no pain, he had a superficial [cut] and that was it.

Call 11, P13 interview

4

I think the longer we sat with him, the more reassured I was that actually, it wasn’t like a severe, life-threatening exacerbation.

Call 3, P3 interview

5

I think the final straw was when I did the ECG and there were some quite significant ECG changes, which I couldn’t really ignore. They didn’t necessarily imply that she was having a heart attack, or anything like that, but certainly it could’ve indicated that she had some cardiac ischaemia or some kind of electrolyte problem

Call 4, P5 interview

6

If she hadn’t had a high blood glucose level, and it had just been a UTI, I would’ve questioned why she was being sent to hospital … the fact that her blood glucose level was so high … I think she had undiagnosed diabetes … she did have to go in. So there wasn’t really any choice.

Call 5, P6 interview

7

If it’s causing you a lot of pain I think that’s a good indication that it’s not necessarily broken, but you’ve gotta suspect a fracture. Then it’s just pain relief and get them comfortable and convey.

Call 6, P7 interview

8

When the despatcher said it’s a broken hip … so you need an ambulance … I said to her, well I can at least go and administer pain relief.

Call 6, P7 interview

9

The paramedic inserted a cannula and administered IV paracetamol.

Call 8, field notes

10

As far as NICE head injury guidance go [sic], [patient]‘s on nothing that requires her to have a CT scan in hospital. She’ll be cared for, she’ll be monitored by staff. We can give them head injury advice with a view to then contact further services, either [an] NHS one or [the] treble nine services again, if [patient] deteriorates in the next seventy-two hours.

Call 2, P2

11

The wound was suitable to be sutured in situ and the paramedic was satisfied he had no further injury. So he proceeded to clean the wound, administer local anaesthetic and suture it.

Call 9, field notes

12

He did have a mild increased work of breathing. But he was fully alert and was interacting well. And [paramedic] had provided treatment with the nebuliser. ... Once distracted in conversation, his breathing wasn’t audible, it didn’t sound like an issue. And he walked across the room; it didn’t sound like it was troubling him.

Call 3, P3 interview