Once again I know a lot of visitors here are from America - So I'm going to explain how the L.A.S works on a day-to-day basis. This will either be very boring or immensely interesting - your choice.

Ambulances run out of dedicated stations, we don't share stations with the Fire Service. In fact, some years ago, when it was suggested - the idea was shot down as we would be waking the fire-crews constantly during the night. Each station has it's own call-sign "K1", "J2", "G4" for instance, then each ambo has a suffix that is attached to this - so one ambulance running out of station J2 would be called J201, while another would be J207.
The stations are spaced approximately 5-6 miles apart, and you mainly service the area surrounding the station, however with inter-hospital transfers and other irregularities you can quite easily find yourself across the other side of London.

It's an old joke that when asking if we need to travel so far the dispatcher will ask us if it still says London on the side of the ambulance

There is a main station, and two or three "satellite" stations, the main station will normally have between two and five ambulances running from it, while the smaller stations have between one and four. There is less cover at night - and you can easily find yourself being the only ambulance running from a given station.

Across London we deal with 3000+ calls per day, and with a fleet of 400 ambulances of which perhaps only 3/4 are manned, meaning we seldom get a rest. Where I work we average one job an hour, and are supposed to transport every one of those patients to hospital.

The longest shift we officially do is 12 hours - in which we can expect 10-13 jobs which doesn't sound like a lot - but is enough to keep us busy...We spend 97% of our time away from station (compared to 3% for the fire service)

For this, we get paid around £21,000, the London fire service get around £22,000 and the police get £27,000 (but lets face it - they earn it...)

However, it is a fun job.

Clark Oliver, asked me what "punter" meant and I realised that a lot of people come from the Emergiblog webring or one of the sites that makes up that ring. These blogs are all American so, as we are "two countries separated by a common language" I thought I might give you a list of some words that you may find me using, some are slang while some are official - I think you will be able to guess which are which. You may well know some of these, but not speaking American I'm just guessing what isn't common over there.

There is a big list of "official" jargon Here, while if you are feeling brave, while there is a more general slang based site Here. For a longer list similar to this one, but collecting UK/US terms go Here.

N.H.S. - The National Health Service, the "free at point of access" healthcare system of Britain. Paid for by taxes it is on the point of collapse. Split into a number of "trusts" which include hospitals, GP services and Ambulance areas.

L.A.S., "Da Firm" - London Ambulance Service, the company I work for, also called "Da Firm" by those of us on the ground floor. Run by Da Boss Peter Bradley - who is a top bloke and well liked by the grunts - he is a Hell of a lot better than his predecessors.

EC/NE/NW/SE/SW/C - the sectors of the London Ambulance Service; East Central, North East, North West, etc...

Punter - A patient (or "client" if you want to sound like a twit); from a slang term used by second-hand car salesman, actually meaning a gambler - or one who is about to make a gamble (so therefore an accurate description of our patients).

Bent - Wrong, illegal, corrupt or a derogatory term for a homosexual. Used as... "That car radio is bent", "That bloke is bent" or "All the police are bent". Also used as "running back bent" meaning going for food/back to station without Control knowing about it.

Scrote - An often alcoholic person with more tattoos than teeth, bad hygiene and a poor attitude towards employment. Scrote is also short for Scrotum.

Chav - Like a scrote, only with more money. See www.chavscum.co.uk

Alkie - An Alcoholic.

Tramp Juice - Super strength lager, sold cheap. Examples include "White Lightning" and "Tennents Super". Empty cans of which signify the less salubrious parts of town.

E.C.G. - E.K.G. (Not all strange words are based around scrotes) An examination of the heart using electrical impulses generated by the heart - if you are in an ambulance and the crew start to look worried at the printout you may be in trouble.

Banjotown - Becontree, and areas around it, not called Banjotown because of the apparent inbred nature of the place, but more to do with it's street layout... Yeah right!

"Ambo", "Big White Taxi", "Motor", "Truck", "Drunkmobile", "Barely working shitheap" - Ambulance

Cat "A" - A high priority emergency call - this is the priority that Cardiac arrests get, along with chest pains, children under 2 years old, difficulty in breathings and the like. These are timed with ORCON which I will rant about later...

Amber Call - in contrast with a "Cat A" these are the less serious calls. Stuff like RTA's, CVA's, Epileptic fits.

Green Call - Lowest priority, cut fingers, coughs and runny noses. Often mistaken with Cat A's because people who call ambulances for a cough often complain of chest pain and difficulty in breathing.

T.A.S. - Telephone Advice Service, when someone calls for an ambulance for some minor crap they may sometimes be diverted to the TAS desk at CAC for advice, this saves us going to about 20 calls a day - across London.

C.A.D. Number - Each job has it's own number refreshed each day, because of this I can tell you that the LAS goes to 3000+ calls every day. Stands for Computer Aided Dispatch.

G.P. - Family health provider, We only get to see the crap ones who sit "?MI" out in their waiting room and don't even give them an aspirin.

C.P.N. - Community Psychiatric Nurse, an often useless person who visits people with mental health problems in the community. See this previous post for more info.

Wanker - Technically someone who masturbates. In reality a fairly mild insult.

Bloke, Fella - Male person.

I.V.D.U. - Someone who injects illegal drugs intravenously.

Popper - Someone who injects drugs subcutaneously, a handful died in Glasgow a little while ago from an infected source; leading to much merriment for the local ambo crews.

"Native" - In East London a person from an ethnic minority, mainly because there are more ethnic minorities than "white British". This isn't actually an insult, more a running joke.

C.T. - A CAT Scan.

M.D.T. - Mobile Display Terminal; installed in the ambulance the computer screen that, running Windows in-between crashing gives us the details of jobs.

C.A.C. - Central Ambulance Control, full of people who actually take the 999 calls, and others who actually dispatch us to the jobs. They have air conditioning and don't actually smell the patients that they send us to.

999 - The number you dial to get the ambulance. Equivalent to the American 911 or European 112.

Watersquirters, LFB, Mobile Drip Stands, Trumpton - The Fire Service, A bunch of part-timers who get to sleep all night as there are very few fires in London and no-one cares if cats get stuck in trees during the night.

Plod, Boys in Blue, Old Bill, Fuzz, Coppers - The Police, a bunch of folks we tend to get on well with, especially when they let us off speeding when they find out who we work for.

Purple, Purple Plus - A dead body, the "plus" indicates a body that has been dead for some time; often recognisable when you walk in the front door and are hit by the smell.

R.T.A. - Road Traffic Accident, the British version of a MVA.

G.B.H. - Grievous Bodily Harm, an assault that breaks a bone or other serious injury. Someone who is going to bleed over the back of your motor.

Matern-a-taxi - What an ambulance turns into when transporting a near term pregnancy who is having contractions every "two minutes" yet you don't see anything approaching a contraction during the thirty minute journey.

N.H.S. Direct - Another telephone advice service, staffed by nurses they will tell you to call an ambulance for having a cold. Ring 0845 46 47 for 24 hour advice. Often disparagingly called "NHS Re-Direct".

There is something deeply disturbing about walking on a sticky carpet - especially when the flat is in a complete mess and the punter has called an ambulance four times in the last two days for a pain in the chest that has lasted two years. I'd like the jury to note that the pain hasn't changed in any way, it's not worse, or moved around the body, he has no other symptoms. But the fella just seems to like calling ambulances. I wanted to wipe my feet on the way out of the flat.
It also doesn't help when the patient smells so bad I want to leap out the side window. We also don't have any air freshener, and neither does the hospital.
When we got to the hospital the triage nurse took one look at the patient, muttered "Not him again" and sent him out to the waiting room. I suspect that it may just be a ploy to use this biological warfare to empty the waiting room.

Not only do we have young lads being stabbed in broad daylight (as blogged about earlier), but we are now having police targeted in drive-by shootings with automatic weapons. It's gotten so bad that the government is thinking about making the wearing of body armour compulsory outside the few places in London where this is already the case. This thought is also helped by the fact that the police officer shot was saved from more serious injury by her body armour.
The L.A.S has given us all body armour - which I have worn perhaps three times "in anger" but have worn on a couple of nightshifts just because it makes a nice body warmer. I can see our management making us wear our armour all the time, in one of those knee-jerk reactions that we all know and love from working for the N.H.S. It'd be a shame not only because they are heavy, uncomfortable and restrict your movement; but also because by trying to squeeze into it, I can see how much weight I've put on in the last few months.

Sorry folks, bit of a rant here...but I last slept 22 hours ago...

We got a call to a patient who was "Depressed - not moving", normally it's some teenager having a strop, but this time it was a little different. Basically the patient suffers from depression, was discharged from the local psychiatric unit three weeks ago and has recently had her dose of anti-depressants reduced. Yesterday she was crying all night, and tonight she was just sitting staring into space, refusing to make eye contact and not talking at all.
One of the things that we as an ambulance crew cannot do is physically remove someone to hospital if they don't want to go - that would be kidnapping and is frowned up by the law. This young girl wasn't going anywhere despite my best attempts to persuade her - she just wasn't communicating.
The solution would be simple - call the Community Psychiatric Nursing Team to come and assess her, and if needed arrange her compulsory removal to the psychiatric unit ( called a "Section" under the Mental Health Act). The problem? It was 11pm...
First off I phoned the psychiatric unit that she had received treatment under, after talking to two idiots who had trouble understanding plain English, I finally managed to get the number of the CPN team. Now the LAS is quite smart; when we want to arrange an outside agency we go through our control and all the telephone conversations are recorded...so if someone says they are going to attend they damn well better. I got onto Control, passed the details to them and waited for them to get back to us.

I'd just like to say that in eight years of medical experience I have never had a simple referral to a psychiatric service, they always seem to try shirking any form of work - by "forgetting" you or by being just plain obstructive. Maybe I'm just lucky and get the idiots every time.

Needless to say we waited...and waited...and waited...from 22:20 until 23:00 we waited; then at 23:02 Control got back to us. Apparently the CPN team all goes home at 23:00 and hadn't answered the phone until 23:00 on the dot. So they refused to visit the patient - the moral so far is if you are going to have a psychiatric breakdown in Newham - don't do it after 22:00.
So we switched to plan "B" which is to arrange the out-of-hours Social Worker to come and visit as they double as Psychiatric liaison. Again we went through Control and waited...and waited...and waited...Finally we heard back that the social worker would ring the family and would like to talk to me. (Outside agencies try this trick, as they know the patients phone isn't being recorded, and so can say whatever they want with any disagreement being my work against theirs) The social worker explained that she was very busy and so would prefer not to come to see the patient and have I tried the out-of-hours GP?
Back to Control I went and got them to try and contact the out-of-hours GP (A GP for those not in the UK is the patients "Family Doctor") Can you guess what we then did? We waited...and waited...and waited... Finally Control got back to us and informed us that the out-of-hours GP hadn't arrived for work yet and that when they did, they would have to see two other patients first.
All through this time the patients family were very understanding and were happy when I explained that the GP would call at some point in the night. All I could do was advise them to remove anything that the patient could use to hurt herself, and keep an eye on her - calling us back if they felt the need.

Total amount of time an Ambulance was tied up trying to get outside agencies to DO THEIR DAMN JOB - Two Hours and Nineteen Minutes. And not the worlds most satisfactory outcome.

As I mentioned to our Control - sometimes you feel very lonely out there on the mean streets of Newham.

Much fun and games last night, working out of Poplar. Not only did some German bloke graffiti on the back of one of the ambulances - but he also called the crew from a payphone and ran off, repeating it twice.
There are a lot of strange people out there...
MacMedic gives a rundown of what his shifts are like, so I thought I'd do the same, in honour of our brothers in foreign climes.

All these people called an ambulance by dialling "999".

(a) Fractured Wrist - Young lad at the Boat show.
(b) "Frequent Flyer" who has just been released from prison...We thought we'd got rid of him for good.
(c) 15 year old with a runny nose.
(d) Very minor R.T.A.
(e) Domestic Assault, with no actual injury, but police already on scene.
(f) "Facial Injury" which turned out to mean "Some bloke kicked my door".
(g) Assault with a cut hand, actually a decent injury with tendon involvement (which means surgery and physiotherapy).
(h) Varicose Vein that had burst, plenty of blood everywhere.
(i) 29 year old with chest pain, hyperventilating with very upset relatives.
(j) Overdose in a house filled with young men with short hair and tight t-shirts (ifyouknowwhatImean).
(k) R.T.A with a traffic light pole coming off the worse in a two car collision.
(l) 8 month pregnant "lady" who had fallen earlier that day.
and...
(m) A fitting 9 year old, only one of the parents spoke English, and so decided to stay at home and send the father who doesn't speak English with us, because "The hospital has interpreters..."

Now, out of these thirteen jobs, only five actually went to hospital...a prize if you can tell me (via the comments) which five went to hospital

Occasionally you get a job that makes you laugh, normally because the person who you are picking up is an idiot. We got called to a chip shop in one of the main roads in Newham, unfortunately there are about 20 chip shops on this road, but we managed to find it by looking for the shiny white police car parked outside. The call had been given as an "assault" which can mean anything from a slap on the face to a fatal stabbing.
In this instance it was a young lad, the spitting image of "Ali G", who was complaining that he had been hit on the nose, needless to say there wasn't a mark on him, and it turned out that he had been hit by his girlfriend. The police wanted to take statements, but he wasn't interested and when I tried to look at him he told me that I wasn't needed as "I'm St John's innit, and a security guard". This fella wouldn't scare a kid just out of Primary school, so I suspect he was telling a little bit of a lie. As he wasn't hurt and "refused aid" my crew-mate and I retreated to a safe distance to do our paperwork...
In the course of the night we found ourselves at the local hospital (dropping off some ill person or something) when who should walk in with another crew from my station, but our earlier "Ali G" lookalike. I asked him why he decided to call an ambulance when he'd already sent us packing, and it turned out that another woman had hit him...
...The prostitute he'd hired after his girlfriend had slapped him. Turns out she had hit him and then robbed him of his "bling", and he couldn't have put up much of a fight because he only had one scratch on him.

It's wallies like these we have to put up with...and call "sir"...