This is a terrible story, in which a 16 year old boy waited for two hours for an ambulance to transfer him from the ward he was on into the ITU ward. The reason for the wait? The three ambulances parked outside the A&E department couldn't offload their patients onto hospital trolleys, because the department was too busy.

I'm curious why the doctor couldn't arrange to push the patient the 300 yards to the ITU, granted the patient was on oxygen, but I've personally done longer and more critical transfers than this.

A Staffordshire Ambulance Service NHS Trust spokesman said: "We are supporting a complete investigation.

Which sounds familiar...

...there was an extensive investigation into events of that day. Doctor goes to patient, doesn't recognise a heart attack - calls for an 'Urgent' (not Emergency) ambulance patient then has to wait seven hours for ambulance - Ambulance trust is blamed for her death

...and said the incident was being reviewed Ambulance not available, so fire fighters (who have a defib) are sent - patient ends up dead

...and are holding an investigation. No one should have to wait half-an-hour." Patient collapses and dies, waits 30 minutes for an ambulance

...said the service was investigating the matter. GP calls for 'Urgent' Ambulance, leaves patient and patient waits 8 hours for ambulance

They have said that an investigation into the incident is planned. Elderly woman in nursing home cuts her leg and waits 7 hours for an ambulance

Your homework is to find more of your own - just type "ambulance investigation" into your favourite news-site search box.

Investigation is underway, is normally a euphemism for "The crew have been suspended", whether it is the crews fault or not. Gps call for a non-emergency ambulance for patients who are critically ill - then leave the patient alone in their house. Community Psychiatric Nurses refuse to visit patients, Midwives send home women who are about to give birth, nursing homes have no idea how to treat minor injuries and illnesses, people can't get to see their GP, so are told to phone for an ambulance - and the government expects us to reach children under the age of two who have runny noses before 70 year olds who have just had a stroke.

Realise that most of these complaints are because of delays in getting to patients. There is a reason for this - we are getting 'overflow' from other health services...

All the other health services have someone else to call, at all hours of the day,

GPs who are busy tell their patients to call and ambulance.
CPNs who finish their shift tell their patients to call an ambulance.
NHS Direct tell people to call an ambulance because they are scared to offer decent self-treatment advice.
GPs no longer have to go out at night, so guess what - call an ambulance.
Catheter blocked? District Nurse won't come out? Don't worry, they'll call an ambulance.

Unfortunately we don't have this luxury, the ambulance services and A&E are the 'safety net', every bad job comes down to us, and because we are the last to see people it is often seen as 'our fault'. We are overworked, underfunded, understaffed and don't have the vehicles we need. We are seen as being 'always there', both by the public and other health care providers and they can always pass their jobs down to us.

Is it any wonder so many things are 'our fault', and that our management are always 'investigating'?

Mozrat, over at Beer And Speech wrote about the NPfIT, which is the National Programme for Information Technology in the NHS.  It's a good post, in which he explains that the the cost has soared to £30 billion pounds which will make patient care suffer.

The idea behind the programme is that modern computers, networking and databases will enable GPs and hospitals to become more linked, allowing GPs and hospitals easy access to the normally separate medical notes.  It will also mean that operations and consultations over an electronic booking system.  It will also provide an centrally managed email and directory service and will eventually mean that GPs can electronically send prescriptions to pharmacists.

But there are problems... 

A lot of GPs are unhappy with the system, in fact only 7% of the 500 GPs asked felt they had been adequately consulted.

As mentioned before, the original cost was estimated to be £6.2 billion, now the cost is expected to rise to between 18 and 31 billion pounds.  It has gotten so expensive, the National Audit Office is to investigate the way in which the contract was awarded.

I am personally worried about the security of the system, and my personal experience in the new system at Newham hospital doesn't inspire me.

Newham has currently implemented an EPR system (Electronic patient record from Cerner. This means that when the patient enters through the doors of A&E they are booked onto the computer, and all treatments, tests, x-rays and the like are recorded on the computer system. Instead of having to manually track the patient through the department there is a huge monitor on the wall that lets the nursing staff know where each patient is.

This was the first thing that I noticed, that the computer screen in the main area had the patients name, and what was wrong with them, which isn't too good for patient confidentiality. I told the nursing staff this, and a little later that day the 'complaint' field had disappeared.
I'll not mention how it is taking over a month for the nursing/medical staff to get used to the new system, for the first two weeks after it was implemented our Control were so distressed at the amount of ambulances sitting outside the A&E, they kept calling us up to make sure that we were 'alright' (for 'alright', read 'ready for another job'). We had to keep telling them that it was taking us much longer to hand our patients over to the nursing staff because the staff were unfamiliar with the new computer system. Extra trainers have since been brought in, and things are running a little smoother.
Finally, there is the thing that amuses me the most... Security for such a system must be high, mainly for patient confidentiality reasons, but also because you don't want some bright spark hacking the system so that they get seen out of order. The system has a number of laptops, so a wireless network has been used to link the various systems together. Admittedly I'm no hacker, or even a wireless network expert - but a little investigation with Ministumbler and my Pocket PC has shown that they aren't broadcasting their SSID, and I can only assume that they are using WEP. But, and this is the problem with any system where non-geeks are expected to use it. Every computer has magically grown a sticker, upon which is the Username and Password to log into the system.

Gah!

Hardly secure, and the implementations for patient confidentiality is terrible - can you imagine this system rolled out across the UK, with the full functionality of the NPfIT system up and running? Break into a GP's office, use the password that is conveniently stickered to the monitor, and gain access to nearly anyone's medical records. I mentioned this to the staff in the department, but they seem happy to let this huge security flaw continue.

So I'm now sending a letter to the hospital directors - hopefully they will get the message.

We were asked go to the local police station to help with arresting someone. The arrestee (is that a real word?) was an 80+ year old male who was accused of recently committing a crime that I would suggest required some amount of physical strength. We were to follow along because the person had heart and breathing problems - so much so that he had bottled oxygen in his house.
We met with the police officers (9 in total, and all rather scary looking plains clothes types) at the police station, before following them to the address in question.
Once the police had made their entrance we were called forward to give the patient a clean bill of health. We watched as this frail man slowly dressed, needing help from his son to tie his shoelaces, we watched as he struggled around the house and wondered how he could possibly be guilty of any crime that needed any form of physical exertion. The patient’s son was also a bit put out by the allegations, and promised to have a good laugh at the police's expense when the truth came out.
Throughout the arrest the police were polite, helpful and behaved in a thoroughly professional manner at all times.
The patient/arrestee was also calm throughout and the whole thing went, as far as I could see, very smoothly, and our ambulance followed the car in which he was taken, until it entered the police station and the police F.M.E took over.

Then the next job we went to was to outside the same address, a woman had been mugged and the police who were searching the address had called us as she had a rather large bump on her head. Unfortunately the mugger managed to get away. It surprises me that you can get mugged outside a house full of police and the mugger can still escape.

There were two interesting jobs today, I'll tell you about one now and let you wait until tomorrow for the other one.

We got called to the very common "Male Drunk - Police on scene", I'll not moan about how often we get called to this type of job, you've heard it all before...
We arrived on scene and were met by a policeman who firstly apologised before leading us to a man who was approximately 30 years old. The man was obviously drunk, and smelt heavily of alcohol, along his arms were the scars of a "cutter" - something else we are seeing more and more of these days. The policeman told us that the patient was refusing to give his name or medical details, only that he was called "John". We approached "John" and he agreed to come to hospital with us. I got him into the back of the ambulance and he refused to let me touch him - so I couldn't do my usual battery of tests (Blood pressure, pulse, blood sugar, oxygen saturation, respiratory rate). In fact he didn't want to talk to me at all, and sat in the back of the ambulance not talking, at one point he threatened to leave the ambulance - but I managed to persuade him otherwise. Don't ask me why, I normally let drunks go as soon as they say they don't want to go to hospital.
All went as normal until we rounded the corner to the hospital, where he got off of the chair and laid on the trolley-bed. One hundred yards later and we pulled up to the hospital and I told him to get up, then I told him louder, then I did a sternal rub to wake him up - and there was no response! I then slipped an oropharyngeal airway into his mouth, this would wake anyone up - but not a flicker...he was deeply unconscious. This meant he was due for the resus room.

We rolled him (rather quickly) into the resus room and was met by a rather angry Sister - she wanted to know why we hadn't pre-alerted the hospital, I explained that he had just lost consciousness outside the department. She then asked me why he didn't have oxygen on him, again I repeated that he collapsed as we were outside the hospital. We got him onto one of their resus trolleys while the doctors in the department ran into the room.
For the third time I explained what had happened, and that I had no vital sign observations - and this time they paid attention, and accepted what had happened.

To be honest I don't blame them, the A&E department rarely has any surprises - the hospital is forewarned about any "nasty job" we are bringing them - to suddenly have a seriously sick patient turn up without any warning is always a bit of a jolt

Now the patient was unconscious the nurses were able to do those vital observations that I was unable to do - and they were all normal. His pulse, blood pressure and blood oxygen levels were all better than mine, his blood sugar was also well within normal limits and there was no obvious reason why he was in such a deep state of unconsciousness.

He was quickly intubated, and we left the department. I've spent some time thinking if I missed anything, if there was anything I would have done differently, but to be honest I don't think there was. Even if I had managed to get a full set of vital sign observations, they would have all been normal and there was nothing that indicated his condition changing so quickly. I can't 'assault' a patient who has refused a procedure (like observation taking), and all I could do was exactly what I did do - watch him while we took him to hospital.

The current idea is that he had taken an overdose of some sort along with the alcohol, and that it had started to work. Because the patient hadn't spoken to me, I had no way of knowing if he had taken an overdose.

It's one of those jobs that you want to find out what happened to the patient, and tomorrow I shall be asking exactly that - and I'll let you know.

Yesterday I had two jobs that were both dealing with someone who wasn't physically ill, but were driven to illness by their emotional state - and if they could swap places they would both be much happier.

First was 'Betty', Betty is 92 and lives in a nursing home where she feels tired and generally depressed. She wants nothing more than to go home and live independently - but her needs have been assessed and she requires nursing home care. Because of her depression she has been refusing to eat or drink and the nursing staff at the home have eventually realised that this is not good for Betty's health - so we are called and Betty is sent to hospital - all Betty wanted to tell me is that she wanted to go home as she doesn't like the nursing home.

Our next job was for 'Gladys', Gladys is 95 and lives on her own, she is partially blind, a bit deaf and craves company, because of her sight she cannot read or watch television. We were called because Gladys was having chest pain, and Gladys told me that her chest pain stops when she talks to someone and has something else to concentrate on. She was very happy when we told her that she was going to hospital, and I had a good chat with her in the back of the ambulance during which her pain disappeared, and she explained how lonely she is.

I don't know if it's because I'm tired or because the weather is bad - but I felt a great deal of sympathy for both of these patients, neither of them were happy, yet after 90 years of life shouldn't we have at least some small measure of contentment? One is surrounded by nurses, who see her as another body, few of which are of Betty's culture and she desires a more independent life. The other is isolated in her home, desperate for some human contact, whose only friend is the schizophrenic who lives next door - she would be happiest where there are other people around.

If I had a magic wand to wave, I'd swap these two women and give them, in their twilight years, a chance to be happy again.

One of the jobs that we find ourselves going on (perhaps once or twice a day) is that of vaginal bleeding, in a woman who is around eight weeks pregnant. This invariably turns out being a miscarriage. Unfortunately it is normal, for foetuses which have no chance of developing into a full term baby, that the body 'rejects' the foetus. I would suppose that this stops a woman from carrying to term an infant which would not survive outside the womb.
While dealing with such patients (some of which have been trying to get pregnant for some time), I always try to be sympathetic, and explain that what is happening is not anyones 'fault', and that it is a normal happening.
Due to the amount of people who we have with this problem, and the rate at which hospitals deal with them (when working in A&E we would have about 12-18 cases of this every day) we have all become a little blasé about this. We feel some sympathy, but deep down in our hearts, we know that there is nothing we can do, and that it is a good thing that this is happening now, rather than in six months time. But none the less, we are worn down by the sheer numbers, and at the end of the day we stop caring that these women are losing babies.

I have no intention of getting into the whole abortion argument, I've seen them done, don't like them and would rather have the whole thing stay out of my worldview

I first thought that it was just me, and that as a male I wasn't best placed to pass comment - but after having a chat with some female colleagues, it seems that they feel the same way I do, that it is natural, and that it isn't worth worrying about.

But it worries me a little that I seem to have come to care so little for the little dead babies.

I got assaulted yesterday, which made me smile...

We got called to "Male collapsed outside park", which immediately set my 'drunk-o-detector' bleeping. This is the sort of call that is nine times out of ten, a drunk who has decided to have a sleep in a public place as opposed to going home. In a case like this we tend to wake them up, and get them to move on before another 'good samaritan' calls us out again.

We woke him up, so he stood up and started moaning that we had woken him up. Both my crewmate and myself we actually being quite nice towards him - mainly because it was towards the end of our shift and being nasty to people takes energy that we just didn't have.

Then he decided to take a swing at my crewmate - he then decided to have a swing at me, the next thing that I knew, I had him in an armlock up against the side of the ambulance. My mate called on the radio for urgent police assistance, and the radio controller asked if we were both alright, to which my crewmate replied "I'm alright, but my crewmate is restraining him".

The police were quick to turn up, and I had just enough time to tell them that he was drunk and had taken a swing at us before he was under arrest and carted off to the local police station. It was then I realised that he had managed to hit me in the chest, right where I've got a broken rib. It was a bit painful. It had already gotten a whack from a heavy trolley yesterday, so I'm wondering if it will ever manage to heal.

I can tell you what went through my mind as I was pinning him to the ambulance; the first thing was "Oops, I hope I haven't overeacted", the next thing (about five seconds later) was, "By the time I return to station and fill in the 'incident form' my shift will be over...Result!". I'd imagine that, by the speed that the police arrested him, that they were close to the end of their shift as well.

I'm just waiting for a team leader to read the incident form and call me into the office to ask if I need counselling...