"Experience of Emergency Care delivery"

I had a sudden unexpected PV haemorrhage at home on a recent Sunday 3 weeks after a LLETZ procedure. I prepared to self transport to VHK ED (minimum 35 min drive plus significant roadworks en route) & called Gyn ward ahead who advised to call 999 based on level of bleeding. I had saturated 3 pads in 20mins & was bleeding rapidly through clothing. I called 999 and SAS refused to send an ambulance, arranged NHS24 call back instead. I'm a health professional with experience of caring for patients with post partum haemorrhage, so I knew the bleeding was potentially life threatening. I got in the car on 2 towels (which were soaked), my partner drove at speed towards VHK, however I started feeling faint & said to partner to pull over at QMH MIU (which was en route) to get help.

The fantastic ANP Lauren on duty at MIU whisked me into the treatment room as I was tachycardia, and rapidly gained IV access & started IV fluids, took bloods & called for ILT ambulance - SAS advised response time was 45mins-1 hour. (Despite QMH not having the facilities to treat me). I continued to bleed steadily but heavily but IV fluids brought my pulse down and I felt a bit better. Call back received from NHS 24 an hour later, informed of inappropriate decision by 999 call handler.

Lauren was brilliant, she kept me calm with her professionalism and good humour & care, paramedics arrived within 30mins from Lauren's request (I think) at this stage estimated blood loss (although very difficult to quantify) was around 1L or more. The lovely young lady paramedic (newly qualified 1 year, I don't recall her name) was so professional, kind, caring and concerned, she sought advice from ED to give Tranexamic acid (TXA) as I didn't fit protocol, the go-ahead was given by a senior clinician over the phone and the paramedic administered TXA as I was transported to VHK ED. 

It wasn't until arriving at ED after 6pm (don't recall exact time) that the bleeding slowed then stopped, which I attribute to pre-hospital administration of IV TXA. My observations were surprisingly good, which I attribute to ANP Lauren @ MIU gaining IV access & administration of fluids early on & calling an ambulance. The nurses and ED consultants & drs who made me finally feel safe & briefly cared for me in resus were so efficient, lovely and reassuring.

Gynaecology Doctor Lisa attended quickly in ED, with a colleague, and was fantastic - she examined me with dignity and utmost care, was so kind, supportive and reassuring and very clear with her communication and plan of care throughout. Thankfully the bleeding had now settled, but my EBL in ED alone was 380ml. I was rapidly transferred to Ward 24, and was met by lovely S/N Shelley and her colleagues, who obtained further bloods, administered more IV TXA & fluids and monitored me closely overnight. The next day also received an iron infusion, ultrasound, and avoided needing a blood transfusion at this time. The care I experienced in Gynaecology Ward 24 was fantastic, all the nurses, Drs, HCA's, Student Nurses, USS staff porters and domestic assistants were so kind, professional and supportive, I felt safe & cared for. Student Nurse Emma brightened up my day with her conversation and care, and thanks to S/N Rebecca for settling my anxiety and encouragement to stay 1 more night (without feeling guilt) due to my fears around access to emergency care (due to my experience with SAS refusing ambulance) and length of travel to hospital if needed. I was informed by 1 Dr that my total EBL was likely 1-1.5L, my Hb dropped from 132 to 95 (which supports approx estimate of EBL of 1295ml). I was advised it would have been better to have come to hospital earlier/call 999 - I had to clarify multiple times throughout my stay that I was refused an ambulance by SAS otherwise I would have been in hospital much sooner.

I am so incredibly grateful to all the staff who cared for me during a very unfortunate rare complication, and quite frightening experience. I thank ANP Lauren especially as I think her intervention bought me some time, and I sincerely apologise for unexpected chaos I brought & the bloodbath I left in her treatment room! I commend the paramedics professional decision to ask for support to give TXA as I didn't fit protocol, which was the right thing to do and I believe ultimately stopped the bleeding. My only concern & complaint is the fact that I believe I would have got the care I needed much(!) faster with less blood loss, (and less risk to my life!) and ultimate effect on my wellbeing and recovery if I had been sent an ambulance as requested when called. I can't understand why I didn't qualify for an emergency ambulance. If I had been alone, or didn't have access to alternative transport, the outcome certainly would have been much worse, and doesn't bear thinking about. I would ultimately have tried to drive myself, and almost certainly would have collapsed en route. I can't describe the sensation of knowing you're bleeding uncontrollably, over what feels like the longest time, and not being able to get to the right care quickly to stop it.  I'm slowly processing my experience but do think this will leave a lasting impression on me. 

My poor partner understandably quite shaken by witnessing me bleeding extremely, and our difficulty getting the right emergency help when needed. I can't reiterate enough how grateful I am to everyone at NHS Fife involved in my care, who were all so incredibly professional, responsive, supportive, caring, and kind during a fairly traumatic experience.

Well done all involved NHS Fife - you're doing your level best under challenging circumstances, and your efforts, care and professionalism are endlessly appreciated.