Although I try my best for my patients, I am not infallible. Sometimes I make mistakes, and writing this blog has taught me to examine those mistakes.

The first job of the day was to an elderly day care centre, the sort of place where the elderly go to listen to music, paint some pictures, talk about the good old days and get fed and watered by the staff. Our patient was a 96 year old man, who was apparently 'confused, falling over with an irregular pulse' - a category A response. We got there as quickly as we could and were met at the door by one of the staff, who didn't know why we were there - however she soon found someone who knew what was going on - and we were led to the patient. On the way to the patient the staff was telling us how unwell the patient was, and how worried they were for him.

We entered the large dining hall to find a group of old folks who were quite happily sitting around finishing off their breakfast. Our patient was pointed out to us, so I went to examine him.

All I can say is that, should I reach my 90's, I'm as well as this gentleman. He was alert and orientated, had no pain, had no dizziness, was not confused and had last fallen over two weeks ago (and he showed me the bruising to prove it). He told me that the staff in the centre had seen a muscle in his hand twitching (he showed me, it was) and they had thought it was his pulse. They hadn't actually taken his pulse at any point, and when asked why just replied 'I can see his pulse, why would I need to feel it'... I ran a complete set of observations, blood pressure, e.c.g., blood sugar, pupil and motor response, mini mental state - the whole shebang.

Everything was normal, actually some results were better than mine, something I'm getting more and more used to.

So I asked him if he wanted to go to hospital - he didn't see the point, as he was feeling no different than normal, and I agreed with him.

But, the staff in the centre really wanted him to go to hospital - they had phoned the GP who had told them that he wouldn't be visiting the patient, but that they should get an ambulance because the doctor wanted the patient looked at by someone in the medical sphere.

And people still ask me why I dislike GPs so much...

I told the staff that, because the patient wasn't confused, and he was refusing an ambulance, I couldn't 'kidnap' him to hospital. So the member of staff who had been with us ran off to tell her boss. The boss soon turned up and basically bullied the patient into agreeing to go to hospital. I started to argue with her, but she just walked off saying that the patient was to go to hospital and that was that. Honestly - if it wasn't in a public area I might well have had a blazing row about her arrogance, and how she thought that she could know what was best for the patient if her staff couldn't be bothered to take a patients pulse. As my crewmate told me later, he saw me bite my tongue rather than start arguing at people.

So...I caved in, and took the patient into A&E. I had a chat with one of my favourite nurses and she looked after him for me until they discharged him later that day.

The thing is, it left me feeling angry. I was angry that the staff in this centre were so useless. I was angry that I let the boss of the centre bully me because I didn't want to cause a scene in front of 30 elderly people. I'm angry that the GP didn't visit the patient, and instead fobbed the patient off onto the A&E department. And I'm angry that I didn't do more to protect the best interests of my patient by not dragging a 96 year old man into an A&E department full of diseased, infectious people.

Now I have a tiny knot of hate in my stomach that I can feel now, just thinking about that job is making me angry as I type this up on my sofa. Perhaps next time I'll take the boss aside and make my position clear, in some scathingly sarcastic fashion.

Our next patient was a GP referral, who had arranged the ambulance without actually seeing the patient. The GP had then faxed a referral letter to the A&E department claiming that the patients blood pressure was 130/90, her pulse was 100, so on and so forth, and that he suspected a collapsed lung. I was very impressed by this GP who could check a patients vital signs over the phone, just by talking to the patient's daughter.

Grrrrr...

And in both cases, the patients and their families were very nice people.

It would have been a good shift tonight, if only I wasn't sitting here blogging in order to stop my mind dwelling over what I saw on the drive home. As you may be aware I tend to prefer animals to people (apparently a sign of madness...). As I was nearing home I saw a young fox laying on the road, so I drove back to see if it was still alive (which it wasn't), only to see another fox watching me. Now the cynic in me thinks that the other fox wanted to eat the dead one, but I'm not so sure.

It has really upset me (daft I know), so I'm blogging to get my mind off it before I go to bed.

The shift itself was rather nice - Our first two calls were 'non-runners', we turned up and the patient decided that they didn't want to go to hospital (A two year old who had possibly drunk some white spirit he was a happy child with no signs of poisoning, and an epileptic girl who is a bit of a regular, who wanted to stay with her mum). Then we picked up a patient who was having mental health problems and drove them the 400 yards into hospital. He was pleasant enough, so this job was no real trouble.

Then we got a call to another hospital where they needed us to do a 'blue-light' transfer to another better equipped hospital. This is a fairly common job, and I started to drive us there. But, as we were getting some speed up, my crewmate and I both started to smell burning. The smell got stronger and stronger, and we got more and more worried...

I'd love to tell you how the engine burst into flames, how I wrestled the vehicle under control and how I saved both our lives...

...But I've sworn to tell the truth, so I just pulled over, had a look under the bonnet and called up Control on the radio and told them that we weren't happy to continue. We soon had a RAC man out to have a look, and finding nothing he told us to drive back to station while he followed us. So we crept slowly back to station, luckily we didn't burst into flames - but we did get to go to another call once we had changed onto a spare ambulance...

Only a short shift, and I now have two days off, followed by two days on and then it all gets turned upside down (more of which later...)

As an 'on-the-road' update, it appears that the hospitals in East London are all full to bursting. Newham hospital A&E is full, and there is an extra bed on each of the wards. I'm guessing that this bed is in the day room, or somewhere similar . Other hospitals are in the same state.

Apparently there is a strain of Influenza 'A' doing it's worst in the community.

Newham hospital has been admitting 60 people a day, rather than the more usual 45.

Oh dear...
Update: And then the suspension on the ambulance breaks and we end up bouncing around the motor like Mexican jumping beans. My crewmate is now searching for a spare ambulance for us to use.
Posted from my mobile

For those that are interested in my plans to rule the world - E-Health Insider has just published an article which contains an interview they had with me late last year. There may also be some interesting news in my next post... Stay tuned on how you can best serve your Future Benevolent Overlord. It seems that Urdu would be the language of choice for best being able to communicate with the people of Newham. Of course I may well give it up as a bad job - but I'm at least willing to give it a try.


Last night was a fairly easy shift - once more we didn't get to see the ambulance station, but then again this is getting to be the normal state of affairs. We didn't go to anyone who was particularly ill in a life-threatening way, and very few people tried to dive in front of the ambulance while we were speeding around on blue lights.

However we did quickly spot the trend of the night. It's often true that you will have runs of a particular type of job, you'll have lots of people complaining of chest pain, then you'll do nothing but children who have fallen over and so on and so forth.

Last night was the turn of the "Hot Asian".

Yes...I know that sounds like one of the magazines you can get from the top shelf of your local newsagent.

I'm not sure if there is a specific infection doing the rounds at the moment, or if it is just because people's immune systems are lowered, or even if family visits have been spreading infection over the holiday period, but fully half of the calls we went to last night were for Asians with high temperatures.

All these patients had one thing in common, despite having ragingly high temperatures, they were all wrapped up in multiple layers of clothing, two quilts thrown on top of them and the central heating blasting out at maximum. The reason for this is quite simple - when you have a high temperature, your body gets confused and makes you feel cold, you may even start shivering. So the patient complains that he is feeling cold, and the family despite knowing that the patient is hot decide to try and cook them.

I often get looks of shock and horror when I tell them to remove the quilts, remove (most) of their clothing and throw open the windows. "But", they say, "He says he is cold!". Well, when your temperature is 39.8 Celsius (103.6F) you really should be cooling them down, rather than trying to roast them. It is the same with children, a child gets a temperature and feels unwell, mother decides to wrap them up nice and warm.

It is a happy side effect of travel in an ambulance that, if you open a window and drive fairly slowly to hospital, the patient will have had time to cool down and will be feeling a lot better by the time they reach hospital. I've lost count of the times I've told disbelieving people this, only to have them become firm converts to the "Keep 'em Cool" school of thought. Lets just call it health promotion by demonstration.

Oh - and all the patients and their families were really nice and pleasant, even the two teenagers who we picked up from a motel who had obviously had their night of nookie ruined by a temperature of 39.1 Celsius (102.3F).

It was the usual type of busy last night - we heard rumours that there is such a thing as an "ambulance station", a mythical building where one might use the toilet or partake of the life-giving "cup of tea". It must be a myth, as we never saw it at all.

As I have mentioned, we get our calls sent down to a computer screen in the ambulance cab, sometimes you wonder how the Control crew have entered it, while keeping from laughing down the phone at the patient. A case in point was one of our calls last night which was given as "53 year old male, taken 3xCrack cocaine, cold and lonely, needs to be put back together".
Avoiding the rather obvious "Humpty Dumpty" jokes, we soon realised that the complaint, and the location he was calling from fitted one of our semi-regular callers. By the time we got there he had left the phone box and neither us, nor the police could find him after a search of the area. Obviously I was distraught...

Our other stand out job of the night was a 57 year old male fitting. We quickly made our way to the location, to be met by a block of low-rise flats that often sneak up on you in our area. These are three or four floors high, and have no lifts. Also there was one of our first responders. We entered the block, and immediately made our way to the stairs (it is a little known law of physics that in flats with no lifts, people on the ground floor are never ill - only those on the top floor).

Entering the flat, the general state of disrepair, mess and the 3 litre bottle of strong cider I tripped over tended to give the impression that it was owned by an alcoholic. We got into the living room to find a large man laying senseless on the floor, while his daughter was sat over him stroking his hand, trying to reassure him. A quick check over, some oxygen and a chat with his daughter revealed a history of alcoholism (surprise!) and the occasional alcoholic fit. He was a big man, so we packaged him up in our carry chair and carried him down three flights of stairs. All the time his daughter was saying how strong the nice ambulance men were - which only goes to show that she wasn't paying attention to my reddening face and struggles for breath...

We got the patient into the back of the ambulance where, he started to fit again - this time lasting about 2 minutes, he also decided to bite his tongue and vomit - which meant that the back of the ambulance (and myself in some part) was covered in bloody, cider-smelling vomit. I think I've mentioned before how I can't smell alcohol, yet I can smell cider...and it turns my stomach. We packaged him up and 'blued' him into Newham, where he had another two fits (despite some rather strong sedation) and by the end of our shift he was still in resus having infusions of Phenytoin and Pabrinex.

So a busy night without the chance to see our station, with at least one mopping out of the ambulance... pretty standard really.

I've often mentioned that the ambulance service and the police tend to get on rather well together, this is at least in part due to us both being called to the same jobs, and probably because we share the same view of the "Great British Public".

An example, we got called to a drunk who was being verbally abusive to a bus driver - we were called because the drunk had fallen over, while the police were called because of the abuse. The drunk man was obnoxious, and well known to both of our services, and because of the lack of an injury was left in the care of the police. If he had been injured then the police would have left the matter in our hands.

So, when we co-respond, the ambulance crew pray that the patient is uninjured, so the police have to deal with them, while I suspect that the police hope that the patient is injured so they don't have to arrest them.

However, there are a lot of specialist teams in the police service that we tend not to come into contact with that often, we mainly get to meet the normal 'beat' coppers. Thankfully we rarely see the murder, child abuse, drugs, or dog teams. This isn't to say we never see then (and our station did get a Christmas card from the local murder squad telling us to 'keep up the good work'), it's just that it is fairly rare.

So it was rather surprising that I met with the dog handling team twice last week. On the first occasion, we were called to a known schizophrenic who had threatened to kill herself. The patient herself (a regular attender at the local A&E) was a bit of a pain to deal with, she wanted to stay at home and kill herself and couldn't see why we couldn't let her do that. Her dog, on the other hand, was a real pleasure - happy to see us, interested in smelling all our equipment and extremely friendly. As the police were already there, they got the dog squad to look after the animal until the patient was discharged from hospital.

In case you think I am being harsh on the mentally ill, the patient attends A&E every day with the same complaint of wanting to kill themselves...she hasn't managed it yet

The second time I saw the dog handling team, was when we had to gain access to a house where the patient was unable to come to the front door and let us in. The interesting part in this story is that there were five dogs of unknown temperament in the house. For half an hour the police unsuccessfully tried to gain access, mainly by climbing up a ladder and trying to open a bathroom window. We were able to talk to the patient, and so we knew that they weren't badly hurt, otherwise we would have had to kick the door down. Then the dog team turned up, and using a top secret criminal technique, managed to get the front door open in about 10 seconds, thus putting to shame the half-hour everyone else had spent trying to gain entry.

All five dogs were really lovely, although energetic - and at the end of the job I had to spend 20 minutes brushing the dog hair off my uniform.

There is a joke we have about dogs. When we ask a patient if the dog is friendly, the patient always answers that they won't bite, the reply to this from the ambulance crew is to add the unspoken, "They only bite people dressed all in green".


Finally, to reply to some of the comments and emails about my posts about 24 hour drinking. I suspect that part of the problem is the term used. We should stop using the phrase "Binge Drinking", and instead use the term "People who drink to get drunk". I think that might clear up a lot of confusion...

A little while ago I was interviewed by the BBC, if you are interested you can read the article here (it also makes mention of The Policeman's Blog, a constantly enjoyable read). But surprisingly not the exceptional Real E Fun.

If you are new to this blog, then a good place to start would be the sidebar section on the right 'The Story So Far'.

Also on the BBC website is a little piece about fears from the Royal College of Physicians concerning the changes in the current licensing laws, something that I wrote about two posts back. The government would like you to be able to buy alcohol all day, rather than have you 'binge drink' to get yourself drunk before closing time.

When the change was first proposed I thought that it would be a good idea, but bitter experience has made me change my mind...

The government seems to think that without a time limit on drinking, people won't drink as much. Sorry to say it, but the reason a lot of people go out to drink (at least the ones I meet) is to get incapably drunk, then to continue arguments (or make up new ones) so that they can beat seven shades of Hell out of each other.

Current UK youth culture doesn't seem to allow for sensible drinking - not when it is seen as socially desirable to get 'legless' and when asked how a night out went people are proud to talk up how drunk they got. Without a sea-change in the attitude towards drinking, 24 hour licensing will be a disaster.

The ambulance service got as many calls in the first seven hours of the New Year as we would normally get between midnight and four pm. Was this purely New Year 'celebrations', or because of the vastly extended drinking hours? Why were a lot of these calls for people being assaulted, when New Year is supposed to be a time for celebration?

I haven't come across the obvious comparison that if the government think that increasing access to alcohol will reduce the health/crime costs of it's behaviour, then why don't they increase access to all drugs, for example heroin? Won't that lower the health/crime costs of all other forms of drug abuse?

The other argument is that by staggering 'closing times', then there won't be as many fights over kebabs and taxis. While true that this might reduce fighting between strangers, most of the people I see assaulted know their assailant - and have probably been sharing drinks all night.

Add in the people who think that the police won't be looking for drink drivers at 11am, and you have a huge potential for injury.

Most of our regular attenders are alcoholics, and we are finding younger and younger alcoholics every year. I'm starting seven shifts of 6pm - 2am, and experience tells me that most of these calls, and night-shift calls are for drinking.

With constrained drinking times, we know when there is a likelihood of trouble and our management plans resources accordingly, which is why there are (if manning permits) more ambulances on at weekend nights. I'd imagine it is the same in the police force as well. With the introduction of 24 hour drinking all that planning goes out of the window.

So what all this above post means is this...

...I've already broken my resolution to be kind to drunks.

Yesterday there were around 5,000 ambulance jobs across London (estimated by there being 4,925 jobs at 23:22) That is compared to the more normal 3,200-3,500 that occurs during the rest of the year.

And we only have to wait another 363 days for it to happen again.

...Or maybe not. The number of calls we are going on has steadily increased over the years - perhaps by the end of 2005 it will be normal to have 4,000+ jobs a day.