I have really severe asthma and I'm seen at a tertiary centre, which is quite far away from where I live (about 50mins). I also have a local hospital which is about 10 mins away and one a bit further that is about 30 mins away. I am most often admitted to my tertiary centre, then the hospital that is 30 mins away and most rarely the one that is 10 mins away.
When I have been admitted to the closest hospital, it has been really harrowing. There isn't an asthma consultant or nurse there, although there is a resp doctor. But he keeps trying to change my meds and ignoring my asthma plan. He also doesn't seem to understand that I often don't wheeze, that I am a CO2 retainer and can deteriorate very quickly and discharges me early. As a result I end up bouncing back in. It's also makes me anxious to be admitted to different places all the time. I was wondering if anybody has any experience of asking paramedics to take them to a hospital that is further away from their local? Obviously in an emergency, I wouldn't expect them to take me to the tertiary hospital and if it was really bad, I'd go to the closest one. But I'd prefer to go to the one that's about 30 mins away and who know me better. Does anybody have any experience of this? Is it generally something that is OK to ask for/something that paramedics will do?
Written by
salamander12
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So sorry to hear you have been having such difficulties.
Unfortunately due to the fact that the ambulance services have time targets to meet set by the government they will always take to the nearest appropriate emergency centre unless directed differently by medics/triage/call handlers.
You could try asking but I am honestly doubtful they would.
Is there any chance you could ask your consultant (I'm assuming you are under consultant led care) to provide you with a letter, signed by him/her, stating what to do in the case you being taken to A&E. If you keep that letter (correction, a copy of that letter - keep the original safe) with you, you can then shown it to whichever hospital you are take to. It will be a brave doctor who goes against the instructions of a consultant specialist.
I would think it will be hard to get paramedics to take you further a field. I have an administration letter and protocol/plan for admissions. I carry a copy of both but keep originals safe.
As already said it is hard for others to go against specialist plan. If you had one could a step be transfer to tertiary Centre after initial stabilization? Happens with other specialists e.g cardiac.
Ask your main consultant to write a strict plan (on that hospital's letter headed paper) that starts with information for paramedics. It should include his/her preference to get you to the tertiary centre at the earliest available opportunity wherever possible but this shouldn't comprise your safety in the acute phase.
It should then include his/her 'strict' treatment plan that shouldn't be deviated from unless an emergency situation warrants it. Again, he/she can state that after stabilisation, transfer to the tertiary centre is in your best interests as the relationship between them & you is successful and has proved to be valuable. If this transfer is not immediately possible then no different treatment should be administered unless the tertiary centre has been consulted and they have agreed to this. As your condition improves enough to enable transfer, it should be instigated as soon as possible.
As long as the document is signed by your consultant, and up dated regularly, the receiving hospital have a duty to abide by this. The paramedics will need to make the clinical decision as to whether they opt for the closest hospital or can manage your current health status whilst travelling the further distance. Of course, if you're still able to make competent decisions, you can assist them!
Do you have a set of notes at all three hospitals? You can ask to speak to the clinician in charge of the ED at the other two hospitals and tell them that you have a treatment plan, written by xyz consultant at xyz hospital, who is the consultant overseeing your asthma care, and provide them with this plan to attach to your notes. This way, you're not having to explain it each time you arrive in their ED department and they then in turn have a plan to follow should you have to stay with them/be admitted.
You'll feel more at ease knowing that a generic plan is being adhered to as you'll get continuity of care whichever hospital you're in!
I'm writing this as anecdotal evidence both as a patient & once upon a time nurse.......😊 Maybe worth a try if your consultant is approachable for this?
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Fantastic experience at a&e
Being nebuliser in A &E 
RBH
Continuous bad attacks
