When you train to be an ambulance technician, you have to do two weeks of 'driving instruction', where you are split into groups of four, get given a 17 seater van that has been hired for you, and you learn how to drive your ambulance using this equipment.
Perhaps the most important difference between an ambulance and the 17-seaters that we are given is that ambulances are automatic, while the 17-seaters are manual (I believe the American term is 'stick'), and that 17-seaters just don't 'feel' like an ambulance.
The training course consists of two days of fun, and the rest is chasing each other around the countryside at high speed.
The two days of fun include driving around a racing track, spinning around a skid-pan and swerving around traffic cones at high speed, both forward and in reverse.
Then for the next two weeks, you learn some theory in the classroom such as the 'limit point' and the forces that act on a vehicle (and why sometimes speeding up when you are losing control is a good thing). The rest of the time is spent driving at high speed around the countryside, making sure that you have the correct gear speed and suchlike for high speed cornering.
There are a few things that make this training course less than effective - the first is that as the London Ambulance Service, it is extremely rare that you find yourself driving in the countryside, it is also rare that you drive at any speed above 40mph and as mentioned earlier, ambulances are automatic vehicles and as such don't have gears.

I drove an actual, real ambulance a grand total of once during training. I sat in the drivers seat, pointed to the lever in the middle of the floor and said 'whats that, and where is the clutch pedal?'

Luckily for me learning to drive an automatic is pretty easy.

At no point during the driving course did we drive on 'blue lights and sirens', something that may have caused my first RTA.

(insert wobbly flashback special effect here)

The first day out on the road, out of training school went well - I was attending (A&E nurse for some years) and my crewmate was driving (previous job? 'Man and Van'). So the driving went well, as did the attending (dealing with sick people). The next day our roles were swapped, I warned our supervisor that I'd never really driven an ambulance before - but he said that we'd be fine if we worked like yesterday.

So on my first emergency job, blue lights went on, sirens went on and people started moving out the way - it was then that I realised that you can't fit a 7'2" ambulance through gap made by two cars which is only 6'6" wide. First (and hopefully only time) I've been called a 'C**t!' by a boss, although to be fair- the only time I think I've deserved it. I learnt how to fill in accident forms that day...and how to judge distances a bit better. (An ambulance is wider, longer and taller than a 1.0L Ford Fiesta).

Soon my training came to an end and I was thrown into the world of emergency driving in Newham...

(End wobbly flashback sequence, cue end title "To Be Continued...")

When you apply for a job as ambulance personnel for the LAS, one of the things that they look for is that you are a competent driver. Therefore as part of the interview process they throw you into the most run-down, barely working 14 seater lump of crap they can find, and tell you to drive around Earls Court. For those not from London, Earls Court is a congested area with fairly small streets, constant roadworks and the sort of people who think it is amusing to leap out in front of a scared looking interviewees on their driving assessment.
Before you see a vehicle you are given a piece of paper that tells you what the assessor is looking for, the crossing over of hands when steering is a big no-no, as is over- confidence - along with under-confidence, speeding, going too slow, incorrect use of gears, incorrect use of signaling and a myriad of other things you haven't worried about since you passed your driving test as a teenager.
When I first went for my driving assessment I noticed the 'overconfidence' bit, so I thought I'd be sure not to come across as too aggressive a driver - so I was a model gentleman, I let people out of side turnings, allowed pedestrians to cross in front of me and didn't hassle people who were driving too slow.
I failed my assessment for being under-confident. 'Come back in three months' I was told.

Three months later and I was determined not to make the same mistake (an additional three months stuck in A&E nursing will make you ever so slightly determined). So I got into the worst piece of crap in the fleet, and off we went. Leaving the yard I hit a kerb, about 200 yards down the road I did the same thing. 'Turn around and go back' I was told - so I slunk back to the yard and vowed to do better in another three months.

Three months later, and I thought - Sod it! Lets drive how I normally drive. So I crossed my hands turning the wheel, sped up to stop signals, refused to let anyone out of a side road and drove as if I were driving my 1.0L Ford Fiesta.
And I passed. Needless to say I was more than happy, and fairly skipped out of the yard that morning.

Of course this double failure didn't help my confidence when it came to the driving part of my training course.

I'm not a big fan of children, they are small, noisy, badly behaved and get under my feet.

Which is why I am ecstatic about having a late shift where I dealt with nothing but children. Children who were 'foaming at the mouth'. or had 'serious head injury following football game' and even the old favourite 'high temperature'. We even had a 'car vs child' accident - the car had run over the 11 year olds foot. With no serious injury, the child now promised not to run across the road again.
We had one job that could have been serious, a 6 year old boy had had an epileptic fit at the top of the Mosque stairs and fallen down all 20 of them. The boys uncle had then carried him home, where he had another fit and we were called. Due to the fall I decided to immobilise his cervical spine (you know the bit on the telly where the patient is trussed up on a board with a collar around their neck? That is cervical spine immobilisation) - I doubted the child had a broken neck, but you can never be too sure. Normally six year olds are a nightmare to immobilise, they scream, cry and wriggle - you are often better just trying to lay them flat because a determined 6 year old will tear off collars and head blocks rather easily. Luckily for us, the child was still drowsy from the epileptic fit, and so didn't complain as we strapped him down. An uneventful transport to hospital, and within the hour he was sitting up on his trolley waving at us as we brought in yet another child.

I'm tired now, and am going to bed - stay tuned for tomorrow (erm...actually later today) I bring you the first in the series "Driving For The LAS For Dummies".

So, two nights ago I was dealing with death, people collapsing on the DLR, young men vomiting blood and looking like death warmed up, and women having miscarriages. Basically everyone I attended to on Wednesday night needed an ambulance.

Last night we had...

One patient with indigestion (for two years - FRU on scene when we got there as it was given as a 'chest pain')
One 'gone before arrival' (a drunk who phoned 999 complaining of a broken arm, but had wandered off before we got there).
One Overdose 'acting violent', who also had gone before we turned up (driven to hospital by her brother)
One 'Facial injury' (A woman slapped by her husband, no injury and she didn't want to go to hospital - her husband was taken away by the police)
One patient with Ascites and chronic alcoholism, who was referred to hospital by the GP. Could have travelled in her husbands car.
One call to a police station for an accused who had swallowed some drugs - he denied everything and the police doctor cleared his health.
And one patient with an arthritic knee...

The patient with an arthritic knee was a 70 year old male who had called out his GP. Said GP had then diagnosed arthritis - and decided that the patient needed hospital treatment. We got the call, and had to go out of our area we are supposed to be covering to pick the patient up. The booked hospital was even further out of our area - so much so it was in another sector.
When we got there the patients son was present and as we loaded his father into the ambulance we were told that 'I'll follow up in the car'.
The look of sheer despair my crewmate gave me had me in fits of laughter, thankfully I was outside the ambulance so neither the patient (or his son who had gone to get the car) could see me.
There was no reason why the patient couldn't have been driven by his son - yet here we were, out of area, going even further out for someone who didn't need an ambulance.

Still, after the past few days it was nice to have a shift where no-one was actually 'ill', and so we could spend the shift in a fairly relaxed state.

(What I'm going to post about might come across as being heartless, or myself being lazy - I don't think I'm either of them, but if you disagree with this post, as always feel free to leave a comment)

Tonight we got called to a residential home for an 87 year old female with 'difficulty in breathing', once again it was way out of our area of coverage, but we made good time to get there. I've been to this home before, and it is one of the better homes I've visited - the residents are always clean, and appear well looked after. The care staff know their 'charges', and are always friendly, helpful and courteous towards ambulance crews.

I knew there was something wrong from the face of the member of staff who met us, she had a look of total concern, and I don't like to see that look on someones face - it never bodes well. We went through the clean corridors and busy lounge of the home into one of the residents rooms. There were three nurses there, one of which was crying (something I don't think I've ever seen before) - laying in the bed was a little old lady who was extremely close to death. Her pulse was weak, and thready, something I could have guessed by the patients colour. I very quickly told the staff that, yes, she was extremely ill and that she would have to go to hospital unless she had a 'Do Not Resuscitate' order. The staff said that it would be best to take her to hospital. We scooped her up, and her heart and breathing stopped in the lift to the ground floor.

I don't believe in a 'slow blue' (where CPR is performed by 'going through the motions' knowing that the patient will not survive and that the CPR is for the benefit of the relatives), so I started active, aggressive treatment while my crewmate drove us the five minutes to hospital. The patient remained in Asystole (no heart activity at all) and on reaching hospital the doctors there declared her dead.

I may have previously mentioned the study that showed that "out of'185 patients presenting with out of hospital Asystole arrests, none survived to be discharged". Both my crewmate and myself, and the hospital staff knew that this patient had no chance of survival - and that the reason we started CPR was because of our policy to commence resuscitation except in certain tightly defined circumstances.

If we had got there a minute later, the patient would already have died - in her bed surrounded by people that cared for her (although not her family) as opposed to being hoisted out onto a chair and then suffering the indignities of CPR in the back of an ambulance. While trying to resuscitate her during the transit to hospital I found myself looking into her dead blue eyes, apologising to her and hoping that she couldn't feel anything that I was doing to her.

I don't know if it is because I've had one and a half hours sleep in the past thirty eight, but it made me feel bad to put her through the indignity of pointless CPR. I know the policies are there to protect us (and members of the public), but sometimes I wish we could use some discretion.

Now I'll see if I can get some sleep.

I didn't sleep well last night, I think a total of an hour and a half - so if I'm a bit incoherent I'd like to register that as excuse number one. No real reason for the lack of sleep, it's a disadvantage of rotating shifts that every so often your body clock just throws up it's hands in despair and goes to sulk behind the sofa - leaving you suffering insomnia and/or intense fatigue.

Last night was actually quite pleasant, the first job of the shift (at around 4pm) was given as an 80 year old male collapsed in the street. Making our way there we were beaten by not only the police and fast response car, but also by a Duty Officer who had taken an interest in the job. It turned out to be a drunk Russian, actually in his early fifties who had decided to lay down and sleep it off in an alley. I suspect he was very surprised when he woke up to find himself surrounded by three police officers and four ambulance bods of various ranks. He was a pleasant enough fellow, who didn't speak a word of English, so to be on the safe side we loaded him onto the ambulance and took him to sunny Newham hospital. When we got there (and remember that this is around 5pm) the crew before us, and the crew who followed us, both had people who were worse for wear for drink. Luckily for both our patient and the hospital; a Russian nurse was working, so he could translate that the patient had indeed just drunk too much, and would very much like to be left alone so he could go home. I'm always impressed by people who can speak another language, two people talking what sounds like utter gibberish, yet making complete sense to each other never fails to entertain.

When taking this gentleman to hospital I drove past six known drunks in the space of one street. Alcohol, and alcoholism is a big blight on our society - some shifts the only jobs we have are those influenced in some way by alcohol. Most assaults can be attributed to alcohol, frequent callers (sometimes six times in one day) are very often alcoholic, and the amount of "collapse ?cause" jobs that turn out to be drunks is frankly astounding.

My personal view (and not the view of the LAS by any means) would be to prohibit alcohol, but legalize cannabis. Not only would it cut our workload by, at my estimate, 60-70% but I've never had anyone high on cannabis try to hit me. Cannabis users are very rarely violent, tend to be generally easier to handle and seldom get loud and annoying. It's true that there are long term health consequences, and that heavy 'stoners' can waste their life away - but the same holds true of alcohol and alcoholics.

On the rare occasions that I get called to someone on cannabis, it's normally because it is their first time and they feel 'dizzy' - often a pat on the head, and an explanation that this is what is supposed to happen is enough to calm them down, and they will rarely require a trip to hospital. Because the intoxicant effects are fairly self limiting, people tend not to overdose on cannabis, unlike alcohol - which is why you find people collapsed in the street.

There is one problem with the use of cannabis - I'm never sure what to call it in order to sound 'hip to the kids', the slang just befuddles me. Is it 'green', 'pot', 'hash', 'reefer' or 'draw'? At least alcohol is just 'booze'.

The second night-shift of a batch is always the hardest, your body clock doesn't know whether it is coming or going and you really aren't emotionally equipped to deal with people who want to give you a hard time.

This might explain why the desire to run over the patient who decided to run out in front of the ambulance and 'collapse' was really rather strong.

It might explain why, after a twelve hour shift, when you call up with 15 minutes to go because 'I've had a cold all week', you may get a less than friendly EMT.

And it might explain why, given our recent diabetic death, we 'Blue' in a 47 year old with a blood sugar of 24mmols, one kidney and a respiration rate of 42.

One bizarrely enjoyable job was an alcoholic Indian who had fell, while drunk, between two cars - his wife was on-scene telling him off, while he lay in the pouring rain, splashing around in a puddle. In March he had broken his hip, and now it looked like he had possibly dislocated it. But he was so intoxicated he was waving it around like it was just troubling him a bit, rather than writihing in the excruciating pain that you would expect. When we managed to scoop him up and get him in the back of the ambulance his hip looked 'wrong' - unsure whether it was due to his operation, and given the amount of alcohol he had on-board, we treated like a fracture and took him into hospital.
All throughout transport the patient, his wife and myself had an enjoyable chat - mainly about his drinking and how he is 'daft'. An enjoyable job despite scrabbling around in the cold, wet, cramped conditions that he found himself in.
The hospital x-rayed it and said 'something is wrong - but we don't know what' - an admirably vague diagnosis.

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The night started with a feeling of impending doom, as I had forgotten that England was playing a fairly important football match against Croatia - I live in a block of flats with a load of Croatians so I wonder if they are still standing, and will the night-shift be full of people injuring each other over a game?

As it turned out the night was remarkably free from people beating each other up - one call to a family who'd had a fight between husbands/boyfriends and sisters with a 18 month baby getting in the way of a punch as well. Luckily the baby was fine, and the man who hit the baby was rather battered, in a minor injury sort of fashion. We'd also gone to an nurse who'd taken an overdose and was very drowsy - she initially refused to travel, but after half an hour of persuasion (including me asking her that if she really wanted to kill herself, why did she phone her work up and tell them what she had done? And where was the suicide note?) she travelled to hospital where she spent the night on a cardiac monitor.
We had one 'matern-a-taxi' to the Homerton hospital where the mother was booked in - even though Newham hospital was half a mile away. It was one of those jobs where the patient tells you she is having five minute contractions, but as soon as they get in the ambulance time dilates and you don't see one contraction during a 15 minute transport...
And finally we got a 23 year old female who had vomited once, and had a touch of diarrhoea - she decided not to transport to hospital so we left her in the care of her boyfriend - an easy job all round.

We did a total of five jobs during the night, which counts as a very quiet night for us. Three of the jobs were off one street - we just kept getting sent to the same area. It sometimes happens like that, you send ages without visiting a place and then get called there three times in a night.

Other crews reported that there were not as many violent incidents following this game - I even found my flats still standing when I returned home this morning.

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