It's been two months since I last blogged, and I think that this is nature's way of telling me that this blog is finished.

When I started writing this I never thought that it would take off in the way that it did - two books, a radio play, opportunities to speak to lots of people at once and of course the upcoming TV series.

But all good things come to an end and, since leaving the London Ambulance Service, my life has settled down somewhat.

Which means that I have far less to write about the ambulance service, which is what this blog very quickly became about.

So I've decided to put this blog into a 'Deep Freeze'. So the links, posts and everything else will remain here, but I won't be updating it any more. In a fortnight I'll close down the commenting system so that I don't have to spend the rest of my natural life removing spam comments.

The reasoning behind this is that this blog was supposed to be about anything - but due to it taking off as an 'ambulance blog', I felt that I was 'cheating' if I wrote something that wasn't about working on the ambulances. Now I no longer work full time on an ambulance the number of ambulance posts will decrease to almost nothing.

I'm thinking that it's for the best if this blog stays true to being about my time on the ambulances, and I start afresh somewhere else.

I shall be moving my presence on the internet over to Brian Kellett (dot) net, where I plan to write blog posts about whatever interests me. This means that if you are only interested in ambulance related blogposts as opposed to me writing about whatever tickles my fancy, this is where we part company.

For day to day things I shall be continuing to use twitter @Reynolds

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If you want to read about ambulance stuff, there are a few blogs out there that I read and you might be interested in.

From Scotland you have Trauma Queen, who does indeed seem to be a trauma magnet, he also writes beautifully. Much better than me to be honest.

Insomniac Medic blogs while working for the London Ambulance Service - rather him than me.

Then there is 999Medic, Mark Glencorse, who is much more energetic than me. He's also on a mission to change ambulance services for the better.

From across the pond is Ambulance Driver Files, whose politics I almost completely disagree with. He is a top bloke and has a wry sense of humour.

And finally but not least there is Rogue Medic, another American, who posts incredibly well thought out articles about making EMS better, mostly by the use of science.

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So, that's that. Time to move on to Brian Kellett (dot) net, where I shall be writing about things that interest me - not just ambulance related stuff.

And if this is farewell, then may I wish you safe travels, and I hope that while you've known me I've entertained you, and maybe made you think a little.

I would like to start with an apology.

A little while ago, I asked the question 'What is it that makes an ambulance'. I then went on to inform you that the only equipment that an ambulance requires is a defibrillator and a bag-valve-mask. I may have made the suggestion that this shows the priority that the LAS has on patient care.

But I must apologise, for I made a mistake.

You don't need the defibrillator.

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Yes, on my final shift I found myself on an ambulance without a defibrillator, going to calls of elderly patients with chest pain. Then our tail lift stopped working, so there was no way to use the stretcher.

We we refused our request to go 'unavailable' in order to return to station in order to get replacement kit.

So the last shift continued my tradition of trying to give good healthcare despite management policies.

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The patients were also a fair mix of the normal sorts of patients I've spent the last eight years going to - a fall, a drunken and abusive alcoholic, a homeless chap with chest pain, a runny nose, and two hospital transfers.

My last call was for one of those transfers, an elderly chap that the doctors at a local hospital suspected was having a heart attack that we blue-lighted to the heart-attack centre.

They didn't think that he was having a heart attack, but given his long, complicated and somewhat obscured medical history I still think that the local hospital did the right thing.

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So, no bangs, no whimpers, just a continuation of what my shift has been like since I joined the service.

I'm going to hold off on writing about my new job for a while until I get settled in a bit, I think that it's important that I get the lay of the land, and besides, it's better to reflect than immediately report.

I've still got a few things to write about the ambulance service sitting in my notepad, so that will keep me going for a bit.

(Plus I need to work on a new banner for the blog, maybe a new layout and who knows what else...)

I've not been writing because I've been incredibly busy of late, working my normal LAS shifts (my last shift is on Friday, three more to go and, yes, I'm counting the hours), plus the paperwork for my new job (currently filling out the second Criminal Records Check form because I was sent an out of date one earlier), as well as all the normal stuff that keeps us busy, like laundry and shopping and making sure my Sky+ box doesn't get filled up with too many programmes.

Hopefully this will all soon change, giving me more time to put finger to keyboard.

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I've been talking to a lot of people about my upcoming change in jobs to the local hospital - both ambulance and nursing staff, and the thing I've noticed is that sometimes people just don't get on.

For example - I explain to one of my ambulance friends that I was talking to Nurse Smith about my upcoming job change and that she was very happy for me. 'Ergh', says my ambulance colleague, 'Nurse Smith? I can't stand her...'

And I find that on both sides, nurses and ambulance staff that I consider good clinicians and good people looked on with some disdain.

I think I've worked it out.

It's because we don't know what each other does.

Many of the nurses that aren't liked by ambulance crews are those nurses that expect more. They forget that, for a great number of us, our training is 16 weeks in a classroom. We've never been taught 'reflective practice', or how to read a research paper, or learnt the meaning of the word 'holistic'.

These nurses get annoyed when an ambulance worker doesn't know about a certain obscure disease, or something happens that highlights something that was lacking in our initial training.

And if nurse gets annoyed, then you can be sure that the ambulance worker concerned will get annoyed as well.

On the flip-side, there are the nurses who think that we are little more than removal drivers - we pick people up, wrap them in a blanket, and take them to hospital. They can't see the reason why we bring to hospital some of the dross that we do (personal favourite call from last night - '33 year old male with cold'). These are the nurses who have asked me in the past 'can you do a blood pressure'.

To be fair, that is from a ward nurse, A&E nurses have a better idea of what we do, but can still have some strange ideas of what our work is really like. Some don't realise that we refer vulnerable children and adults to social services. They may not realise exactly how many patients we leave at home (endless panic attacks, diabetic hypoglycaemia and epileptics). They also may not know that if someone wants to go to hospital then we can't refuse them.

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It's not particularly anyone's fault - certainly it works both ways, ambulance staff don't really understand the pressures that A&E nurses are under. I know that I have a privileged knowledge, coming from both worlds.

What is annoying is that the solution is very simple - nurses spending some observation shifts with ambulance staff, and ambulance staff spending some time in A&E, but it'l never happen because of those self-same pressures. Ours to hit eight minute arrival targets, and A&E to cope with understaffing and having too many patients to deal with.

And our free time is precious - spent sleeping rather than volunteering to go rattling around London in an ambulance, or being asked to do ECGs on endless patients in A&E.

Besides, it's not that important to deal with little episodes of misunderstanding brought about by not knowing each other's jobs.

Is it?

'Male, collapsed in street - cannot see if he is breathing'.

Once more I found myself speeding towards a drunk in the street. It's *always* a drunk in the street, except of course on the one occasion when we don't whizz to scene - then they will be dead.

The Sod's Law of collapsed or deceased patients.

Like many of the drunk calls, we also had the information that 'caller will not approach patient', of course not, because the 'possibly dead' person is drunk, smelly, and possibly violent. That, after all, is why we are called to wake them up and move them on.

In this case however, it was much more reasonable, the caller was a CCTV operator.

So we rolled up and found our man snoring gently in the middle of the pavement. Hopping over the fence between us and the patient I went up to him and woke him up.

The man was apologetic (or at least I think he was apologetic, but then sheepish smiles and a bowed head are pretty universal despite the patient not speaking English). He then walked off to catch a train.

I looked around to see which CCTV camera had 'caught' him, and spotting the only one I could see I gave the camera a thumbs up, and then mimed drinking from a bottle.

The operator obviously got the message as the camera nodded up and down in acknowledgement.

I recently had my last ever night shift, I would have written abut it earlier but the effects of the shift work had basically knocked me on my arse and made me incapable of doing anything except sleeping and dozing on the sofa.

It was, ultimately, a not unusual shift - no jobs that leapt out as being anything out of the ordinary.

My first job was to a woman who was intensely isolated because of her being unable to speak English, the only person she knew was her daughter who has a full time job. We were called because the woman was 'behaving strangely'. We arrived with the police to find her crying on the floor. We did the only thing that we could do, take her to hospital to see a psychiatrist.

It was handy to have the police there, because initially the woman wanted to refuse to come, but as she was distraught and had threatened suicide it was important that she see a professional.

The next job was to someone who'd been minding their own business and then been punched in the face with a knuckleduster. Often you can tell when someone is hiding something (because, let's face it, a lot of assaults in my area have a reason behind them. Not a good reason mind you, but there is normally a reason). In this case he didn't seem the type to be in a gang, he didn't appear to be a drug dealer and I don't think that he was secretly sleeping with someone else's girlfriend.

We took him to hospital in order to rule out a fracture of his facial bones.

The next patient had been indulging in some cocaine, some cannabis and a lot or alcohol. So had his friend. We had been called because he was 'off his legs', or as it was described to us 'he had been on his hands and knees like a dog'. I may have resisted the urge to ask if he had taken to barking.

As he got to the doors of the ambulance he let forth a huge spew of vomit, simultaneously passing flatulence. 'Better out that in' goes the old saying, and truly it is better out than in, as in outside the ambulance and not inside it where I need to mop it up.

During this he had developed a bellyache, so we assessed him and took him to hospital where, a few hours later, he was feeling much better.

(Seriously, is Red Bull and whiskey a sensible drink?)

Our next patient. Oh dear, our next patient...

The short version is that she was faking a panic attack in a pub. Once more I'm left wondering why people think that they can fake medical conditions in front of people who've seen them all before. This patient was very trying as she refused to get onto the ambulance (until she realised that her audience were bored and going home), then she alternated between not telling me anything and telling me about everything.

At the hospital she refused to get out of the ambulance until I had sweet talked her, then she refused to enter the hospital, then she refused to go to the toilet while crying that she needed to pass urine.

She was put into the waiting room (eventually) where she then argued with one of the nicest nurses in the unit...

I'll be the first to admit that it was very hard for me to remain the consummate professional that I am.

The last I saw of her she started by telling her new audience that her four year old child had called the ambulance (rather than the bar manager who'd actually called us), and that everyone was against her. She then went on to try and damage a police car before drunkenly disappearing off to the local bus stop.

I think it's called 'personality disorder'.

A much simpler job followed - a man who was stuck in the bath. The FRU had got there before us and had already solved the problem. We didn't even see the patient, as he'd gone to bed, so we caught up on some gossip with the FRU responder and made ready for our next job.

A nightmare job. Not because of the patient (who was confusingly suffering from a mish-mash of symptoms that had us blue-lighting her into hospital). No, the nightmare was the spider on the wall of the staircase that was the size of my hand. Garden spider or escaped tarantula in disguise, who knows what it was?

One of the elderly relatives saw the look on my face and managed to dispose of the creature in a piece of kitchen roll - as he walked into the kitchen with the ferocious monster I listened out for any screaming as the spider broke free of the paper and tore the old man's throat out...

An interesting job as there was a mix of heart problems, probable sepsis and undiagnosed diabetes - the best thing for the patient was for us to treat her symptoms as best we could and get her into hospital as quickly as possible so that the doctors could sort things out.

And a nice family, adept at dealing with the sorts of giant spiders only seen in horror movies.

Then I had a nap for twenty minutes in the passenger seat of the ambulance as, for a few minutes at 5 a.m, it seemed that people were getting some sleep and not filling their time calling ambulances.

Our final job was a transfer of a patient from our local hospital to the heart specialist unit. A nice patient, a nice family member and an uneventful journey finished the night off lovely.

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And that was it, my last night shift. I drove home with a huge smile on my face - no more would I need to feel sick in the stomach after a long night shift, nor would I need to batter my body clock into submission any more.

No more night shifts means that I will be able to rejoin the human race, no longer will I have the constant feeling of jetlag dragging me back.

As I write this I have another stupidly big grin on my face and an urge to dance a little jig around the room.

To whom it may concern,

I wish to resign from my post as an EMT-3 in the London Ambulance Service. If possible I would like to go onto a bank contract so that I may work the occasional shift.

I would appreciate it if you could tell me my last working day as soon as possible as I am moving elsewhere in the NHS and they would like to know the earliest date that I can start.

Many thanks in advance.

Brian Kellett

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I handed this letter to my immediate boss today.

People who follow me on Twitter will have already heard that I have a new job, one that I'm due to start in approximately one month. In one month's time I shall be going back to nursing where I am taking a post as an Urgent Care Nurse Practitioner at Newham hospital.

I've been led to this by a number of factors, a majority of things that have pulled me towards a career change as well as more than a few things that have pushed me away from the LAS.

My AOM described it best when she gave me my reference, she said that I was bored and that I needed new challenges. We both agree that in most cases the job that we do turns our brain to mush.

So, I'm going back to nursing because I want to develop my clinical skills, I want to learn new things, I want to be more responsible for providing people with the best healthcare that I can.

It's pretty much impossible to do this within the LAS because, for example, our ECP (Emergency Care Practitioner - our top clinically trained people) programme is effectively being shut down. There is nowhere to progress to and... well... you have been reading all about it on this blog for the past few years.

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So, some big changes - one of which being that I'm going to go to writing under my real name, Brian Kellett, rather than the helpful pseudonym of Tom Reynolds. At the moment I'm in the process of changing this on all the social network profiles that I can remember belonging to.

If you take a look at the top of this very blogpost you should see that it no longer says 'By Reynolds'.

As for this blog... well... I'm unsure of what form it's going to take in the future. WIll I be still writing about ambulance stuff? Will I be documenting my journey into urgent care? Will I just natter about whatever interests me at that moment in time? I'm not quite sure. Certainly I'm not going to stop writing and in fact, later today, I'm heading into town to have drinks and a chat with a friend about something we are planning together.

So I'll keep blogging, but I'll no longer be the 'ambulance blogger', I'll be 'that annoyingly nerdy blogger', which I think puts me in good company.

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So there you go, a change in career, a change in direction, a change (of sorts) of name. I'm looking forward to it and will be writing about it in the coming weeks.

It would be a lie to say that I'm not at least a little bit nervous about this, but nervousness is just a form of excitement - and while this is a big step for me it's one I'm looking forward to taking.

The NHS White Paper is out and I've read pages and pages of analysis, although I'm yet to read the White Paper myself. It's sitting in my reading queue waiting to be read.

The big change is the PCTs who currently 'purchase' healthcare will go the way of the dodo to be replaced by 'consortia' of GPs. The thought being that GPs know better the needs of their community.

While I am sure that there are plenty of conscientious, well trained, thoughtful and management minded GPs out there, certainly in my part of London they seem a bit few and far between.

As an example, my crewmate and I were sent to a patient who had seen the GP who had thought that she might need hospital treatment. The patient was described as 'ambulant'.

She was 'ambulant', in that she had walked to the GP surgery - at least one mile away, and the GP had sent her home to await the ambulance.

As soon as I walked into the room I knew that we would be wheeling the patient out on our chair. She was so short of breath she was breathing forty times a minute, her oxygen levels were way below what they should have been (86% - even with someone with chronic lung disease, this would be a worry), her pulse was racing at over 120 beats per minute.

She was a very sick lady - and yet the GP had sent her to walk home.

Similarly I've been to patients in the later stages of shock who have been sat out in the waiting room for the ambulance and I've had patients who the doctor has, correctly, diagnosed a heart attack sitting on the wall outside the surgery.

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Now, I understand that not every GP is like this and that I only tend to go to the patients that are seen by these worryingly poor GPs, but how many of them will be holding onto the public's purse strings in the future.

In some places they can't even arrange decent out-of-hours coverage with GPs who are able to speak English.

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The other worry is what happens if a GP consortia decide that they don't want the LAS handling emergency calls in a certain postcode? Will we be refusing calls because privateambulanceservicecompany will hold that contract? Will we no longer be London-wide, but tasked to only cover certain areas.

Given yesterday's announcement about 'Big Society', will the ambulance service be broken up to be replaced by volunteer services? I heard rumours that the Olympic planning people wanted LAS staff to volunteer to cover the Olympics as they didn't want to pay them, was that just the start of this?

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Still, lets wait and see what happens in the consultations before we start panicking. After all it's not like consultations in the past have ignored all the good points in opposition to what the government want to do...