How Health and Social Workers Assemble in a Crisis.

A community emergency response team is made up of members from different disciplines within the NHS, Social Services and non-government organisations. It tackles the worst, most hellacious scenarios, and are called upon when a patient’s situation has gone so far off the rails that the normal care route is no longer effective.

Each incident may require different team members to best address the problems they encounter.

As a community physiotherapist, I was a regular member in that team in Yorkshire for several years and the following, featuring a physio, a therapy assistant, a nurse, a social worker and two ambulance workers, is just one standout incident from that time.

After a quiet start to the day, a call reached our triager. A lady, with MS, who I will refer to as Sue, said that she could no longer walk and hadn’t moved from the sofa for the last month.

Sue didn't have any urgency in her voice. She asked for some help as it was difficult for her to get food and water, and get to the bathroom.

Ask yourself this question: what would happen to your body if you literally hadn't moved for that amount of time? Think bodily fluids, skin, hygiene, inability to move limbs, and you're on your way. 

Was Sue exaggerating? We couldn't ignore it, and nothing else had yet come in. So, my colleague Ellie and I took the referral.

An assessment should start as soon as you arrive on the street. The area, type of home, the access to the property. And when you go in, you're scanning the environment, checking escape routes, because you never know what you'll find or run into. The first piece of advice I ever received when starting out was to always park the car in the direction you want to drive off. Watch out for your own safety before anything else.

Ellie found the keysafe for entry. No sooner had we retrieved the key and cracked the door open, the smell of rot surged up our nostrils. I could've puked immediately, had I not been relatively hardened to bad smells on the wards and other people's houses. On the whole, you name it, I've smelt it. Ellie was fine by the way. Like she hadn’t even noticed.

Sue was sitting on a leather sofa with a windswept posture. This means one hip sticking outward and turned away, the other tucked in and turned in. She was smiling pleasantly, and not at all coming across as someone who was desperate for our help. But it really didn't take us long to pick up on a few clues. Starting with the carpet, which was completely hidden under a layer of garbage.

Piles of used, Tena Lady pull-up pants, dozens of empty jelly dog food pouches, used tissues, and in the kitchen, Big Mac packaging overflowing from the bin, open food tins lying around and a fridge containing nothing more than a half empty bottle of tequila.

The first thing I wanted to know was, could Sue move? She couldn't. Could we move her with assistance? Not with just the two of us. Sue wasn't wearing any bottoms, and her skin was so damp, that she’’d become fused in places to her leather sofa. Her legs were so stiff that mobilising her would be impossible without equipment. I removed one of her socks. Her foot was bright white and shrivelled. Like when you've been in the bath for too long. Thirty days too long in this case. The skin was that delicate it could’ve burst.

This was beyond a simple moving and handling assessment. I took a minute to make a call to our triager. ‘I think we’re going to have to assemble the avengers.’ 

The emergency response team, assembling.

Within 20 minutes, we had a nurse (to examine skin) and a social worker (because ‘we had a situation’) arrive on the scene.

Between myself, Ellie and the nurse, we managed to turn her enough to see the skin on her bottom. As suspected, a bloody great big hole in one of her cheeks. The nurse did all she could to treat the area, but it was so wet, nothing would stick.

Then we heard a noise upstairs. The dog? Nope. He was hovering around the kitchen. It was her very able-bodied nephew. He came downstairs, pupils as wide as saucers, and that was definitely not because he was surprised. He may as well have floated down those stairs he was that high.

So this was how she was able to get food from McDonalds, but he'd done naff all else. Time for the social worker to step in. Not only to find an emergency nursing respite bed, but to create a safeguarding case against Sue's nephew for neglect.

While the nurse and social worker did their bit, Ellie and I made ourselves useful and filled bin bag after bin bag with nappies, dog food pouches and the rest of the rubbish. We eventually found the carpet.

An ambulance arrived and the workers stretchered her onto the van and took her into a 24 hour care setting. I’ve known social workers to carry baskets around in their cars to bring pets back to the office, but thankfully we found a neighbour to take care of the dog.

From triage to resolution, we got everything done in less than three hours. That’s a pretty amazing effort if you ask me. There was a lot to unpick, a lot to treat, a lot of actions taken, and multiple staff and agencies summoned to make Sue safe. Sue was so grateful for our help and knew she needed to go somewhere to recover, while getting her house in order.

As soon as I left the house and the fresh air hit me, my stomach took an almighty turn, whereas Ellie, whose digestive system was made of sterner stuff than mine, was just hungry and simply asked, 'Subway?'

With foot-longs and rainbow cookies in hand, we headed back to the office to write it all up. Ellie, with tuna mayo all over her face, proclaimed, 'This is lovely.'  Me? I got to the bathroom just in time to barf up not just my sandwich, but what felt like all that putrid air I’d inhaled at Sue’s. 

Once that was over, I completed my notes, breathed out a sigh of relief and sat back in my chair. 

Then the phone rang with our next call out. 

Ellie wasn’t going to miss out. She packed up her cookies for the journey.

This was one morning’s work and ultimately involved a team of 10 people. Triager, physio, therapy assistant, nurse, social worker, 2 ambulance workers, respite bed manager, the neighbour, and the most important part of the team, Sue. No way am I counting Sue’s nephew in the team. He doesn’t even make the bench.

One patient was made safe (two, if you count the one in the afternoon).

One dog was made safe.

One family member reported for neglect.

Two bellies were filled.

One belly was emptied again.