For those who are interested in my ORCON post, which is coming soon I thought you might want to see how the "Advanced Medical Dispatch System" (AMPDS) works.
Each call, when answered is categorised by the call taker using this computer based system. It is supposed to ensure that the most serious calls get an ambulance first. To be honest it doesn't seem to work "on the streets" as we get sent as a "Cat A" to someone who is upset, and yet someone who has had a stroke is only an Amber response. The fact that we use AMPDS is alright, but the Department of Health felt that it needed changing, and so the instruction from them is children under the age of 2 need a "Cat A" response. Which as this forum tells us results in fast cars being sent to children with constipation.

CAT A CALLS :

RED 1 - Actual death imminent (Unconscious not breathing)
RED 2 - Possible death imminent (Unconscious/not alert but breathing, or with other signs like mechanisim of injury)
RED 3 - Risk of imminent death (breathing and conscious but at high risk)

N.B. All calls to children aged 2 and under automatically get a "RED 3" regardless of diagnosis.

CAT B CALLS :

AMBER 1 - Definitely serious (not immediately life threatening ,but requires urgent on scene assessment ,treatment and conveyance)
AMBER 2 - Possibly serious (not immediately life threatening and no specific gain from immediate treatment on scene or in an A&E)

CAT C CALLS :

GREEN 1 - Requiring assessment and or transport (not life threatening or serious, but needs assistance)
GREEN 2 - Suitable for telephone triage and or advice (probably no need for transport telephone consultation can be used to determine the health care needed)

Recent news shows that the UK is the centre of a global asthma crisis. We see a lot of asthma in Newham, it seems that every other person we pick up has the disease and carries around their blue Salbutamol inhaler. You can normally tell when it is going to be "asthma season", either the temperature drops or there is a thunderstorm. On those days you tend to carry the asthma medications in your shirt pocket to save you having to open your response bag every job - and then having to repack it.

I am often heard moaning about the NHS, but compared to the "must make a profit" attitude the Americans have to put up with I guess I'm spoilt. MacMedic is having problems based around his companies need to make a profit.

This is what happens when you swerve to miss some idiot and drive your ambulance into some scaffolding.

Luckily no-one was hurt.

I heard the crew report it over the radio, it went something like...
Crew:"Control, you better send another ambulance on this job, we've had an RTA".
Control:"Anybody hurt?"
Crew:"Nope, we're all alright here".

This happened a little while ago, but I just happened to visit the fitters where it is being stored. Apologies for the big pictures...

Sorry, I know I keep flogging this dead horse...

Yesterday we picked up Phil. Phil has mental health problems in that he his schizophrenic, and sees the Devil and Jimi Hendrix. He is known to be a rent boy and is homeless. It's been a bit cold this week and we found him sheltering in the lea of an office block. Obviously the office workers didn't like seeing Phil so they called us.
Phil is normally very scared and has difficulty determining his hallucinations from reality, so it involves a bit of work on our part in order to make him feel safe enough to travel with us.
Anyway - the hospital discharged him around midnight last night - after psychiatric review. He has nowhere safe to go.
Dropping off another patient we saw him waiting in A+E again today. This is the third time he has attended A+E in as many days. At least it's warm. I doubt that psychiatric services will admit him in order to get the medications that he needs. Instead he will be discharged as part of "Care in the Community". This is the same process I saw when working in A+E, unless he is a specific danger to himself or others, people like Phil just don't get the care they need. Even being a danger to themselves is often not enough; I can count on the fingers of one hand the number of patients attending A+E because of an overdose and then going on to be admitted under the psychiatric services.
Sometimes it feels that no matter how hard you bail out the water the ship is still sinking.

I'll try and post something more upbeat later.

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.