I get a call, Cat C, the lowest priority call. Female unwell. I'm working on a response car and arrive within a few minutes. The door is open and I'm faced with an elderly lady sat in her arm chair complaining of abdominal pain. As I get closer I notice the beads of sweat running down her face and chest. This lady isn't well at all. There is no back up available, I'm on my own. A quick examination reveals no radial pulses, indicating that her blood pressure is very low. She has abdominal pain radiating through to her lower back. I don't need a medical degree to work out what's going on. This lady has a leaking AAA (abdominal aortic aneurysm) and the clock is ticking. I call for a crew and start my other observations, ECG, blood pressure and oxygen saturations. She has an enormous vein on the back of her hand which is a dream come true in a seriously unwell person. I place a 14g IV with ease. The crew arrive and another BP is obtained, it's 70 systolic. 500ml of Hartmans is run through by the time we get to the Resus room, pressure now 99 systolic and before we know it the consultant is performing an ultrasound scan. Diagnosis confirmed, leaking AAA.
The last place this patient needs to be is A/E or in the back of an ambulance, she needs to be in the operating theatre or as one of my old training officers likes to put it "She needs to be where the bright lights and shiny steel are".
When I last checked she had gone to the operating theatre (OR for my US colleagues). I don't know the outcome. I hope she made it.
The job came in as a Cat C call, it turned out to be a genuine Cat A. If a Cat A breathing difficulty came in I would have been redirected to that and chances are it would be a 15 year old hyperventilating having a panic attack. My Cat C lady may not have made it.