What to say in A&E

If you have any symptoms of infection, you need to get medical help. Infections can lead to sepsis, which can be very serious if not treated quickly.

Your hospital team should give you instructions about who to call and what to do if you think you have an infection.

You should be given a 24-hour emergency number. This might be called a chemotherapy hotline or cancer treatment helpline or something similar.

• Call the emergency number you have been given and follow the advice.
• If you can’t get through to the number you have been given, call 999 or get someone to drive you to your nearest A&E.

• Call your GP or hospital team.
• If you can’t speak to your GP or hospital team, call 111.
• Follow the advice you are given.
• If you are told to go to A&E, call 999 or get someone to drive you to your nearest A&E department.

If you don’t feel right and can’t get medical advice, go to A&E straight away. It’s better to be cautious.

See our information about the symptoms of infection and who is at risk.

If you can, take someone with you to A&E. If you’re not feeling well, it may be easier for someone else to talk to medical staff.

There are things you can say and do to help the staff in A&E understand more about you and what you might need:

• If you have a cancer alert card, show this to any staff you talk to. If you have not been given one, we have an alert card you can use.
• Tell staff you believe you are at risk of sepsis because you have a blood cancer diagnosis.
• If you are neutropenic (you have a low number of neutrophils in your blood), tell staff that you are at risk of neutropenic sepsis. They will understand what this means.
• Describe how you are feeling as clearly as you can. Tell staff about all your symptoms, when they started and whether they are getting worse.
• If you have been taking your temperature, using a pulse oximeter or a blood pressure monitor at home, tell the staff what the readings were. They will test you again, but this information will give them an idea if things are changing.
• Tell staff if you are allergic to penicillin or any other treatment.
• Tell staff when you were diagnosed, whether you are having treatment, or are in remission, or are on active monitoring. Give them contact details for your consultant and clinical nurse specialist (CNS) if you have one. Our free alert card will help with this.

A&E departments are busy places and you can feel like you’re not being heard. Some people report that they didn’t feel staff were taking their blood cancer diagnosis seriously enough.

• If you are worried about being in a crowded place because you have a weakened immune system, ask if there is somewhere else you can sit.
• Wear a mask – you can ask for one if you don’t have your own.
• Ask to see the haematologist (blood cancer specialist), oncologist (cancer specialist) or cancer nurse on call.
• If it’s within normal working hours, ask staff to contact your consultant or clinical nurse specialist.
• You can ask for a second opinion from a different clinical team. It’s your right under Martha’s rule, also known as Call 4 Concern.

A&E staff will examine you and may order blood tests and/or blood cultures. They will also perform regular checks of your:

• pulse rate
• blood pressure
• respiratory (breathing) rate
• oxygen level
• temperature
• level of consciousness or confusion.

If you are having anti-cancer treatment (for example, chemotherapy, targeted therapies, steroids, stem cell transplant or CAR-T therapy) or are at high risk of sepsis for another reason, you should get antibiotics quickly, ideally within the hour.

In other situations, medical staff may continue to monitor you for signs that the infection is getting worse before they prescribe antibiotics.

You may never need to go to A&E, but it’s a good idea to plan for it, just in case.

Make sure you know where your nearest A&E is.

Think about who could go with you to A&E, and how you would get there. Ask people if they are happy to be on standby for an emergency, share your cancer alert card with them and send them a link to our infection information for family and friends.

Have a bag ready just in case you have a long wait or need to stay in hospital. Here are some ideas what to put in it:

• your cancer alert card, or a letter from your haematology team
• details of your latest blood test results if you have them
• a face mask, ideally FFP3
• some cash
• a soft blanket or extra jumper in case you feel shivery
• night clothes
• spare underwear
• something to read or listen to
• bottled water
• snacks – you may not feel like eating but someone with you may need energy.

> Infection, neutropenia and sepsis