Last night I worked out of a different station to normal, although it was still in the same complex of stations, with a team leader assessing my clinical skills. It was an interesting night, and although I was going to nothing except the most serious 'Category A' calls - I still ended up getting called to a drunk.

I had two 'suspended' patients, one of which had been dead some time, and had been found by his relatives deceased in bed. There was nothing we could do for the patient, so the other crew on scene were left to arrange the police to deal with the death.

The second suspended was rather more interesting, in the 'Chinese Curse' fashion.

The call was given as a 90 year old female with difficulty in breathing, and on reaching the scene we were directed into a room with around 15-20 people who were wailing and praying over a very sick old lady.

At first, there was no way I could reach the patient, so I ordered the people out of the room. Some left, although they were quick to return, and I quickly looked at the woman - she was breathing, but her breathing was very poorly. I prepared our equipment to give her oxygen but as I did this, I looked up and saw that she had stopped breathing. A quick pulse check showed that her heart had stopped as well. At this point a lot more of the family came back into the very small room and started to, well, get in the way.

We started CPR, and a second crew turned up. The family were very unhappy that we were attempting to resuscitate their elderly relative, and while I could fully understand this, for resuscitation, is not a pleasant thing for anyone to go through, there was little we could do. If we hadn't attempted to resuscitate her, then we could lose our jobs and, perhaps more importantly, rob this woman of any chance of survival.

So we continued to resuscitate her, and prepared to remove her to hospital - at which point the family became really upset, and adamant that we should leave her alone. It got so bad at one point that my crewmate called for police backup.

There were a lot of angry looks directed to us, and various mumblings that we didn't understand their culture and religion. I can understand this, but still, our hands are tied. If someone suspends in front of you, and they don't have a 'Do Not Resuscitate' order, then we have to attempt a full resuscitation. To do anything else would be to allow someone to die, and therefore a dereliction of our duty of care.

We decided to meet the relatives halfway, in that we would follow our resuscitation protocol, which allows us to cease resuscitation if there is no response after 30 minutes of CPR and drug therapy. This way, the relatives wouldn't have us take the patient to hospital for a (most likely) meaningless attempt at treatment. They seemed somewhat happier that we were doing this, and calmed down a lot.

We treated the patient for 30 minutes and there was no recovery, she was recognised as deceased, and we left the police to deal with the paperwork that follows after someone dies. I think that we handled the situation as sensitively as possible. There is always a worry that what we consider best for a patient, might not be what the family consider in that patient's best interests - but in some circumstances our hands are tied by procedure and protocol.

While I think we did the best we could for everyone concerned, I wouldn't be surprised if a letter of complaint found it's way to the LAS.

But as we weren't nasty to the family, and followed our protocol - I should think we will be alright.

One of the perks of this job is the need to cover football games. Well...it's a perk if you enjoy seeing your local team play, personally I can't stand football - but overtime is overtime, and it does make a nice change to the usual jobs I go to. So this Sunday I got to see West Ham play against Derby.

The L.A.S. provide 'Major Incident' cover for these games, we don't look at sprained ankles or minor injuries (for that is the job of the St Johns ambulance). We also don't look after the players who get hacked down and are unable to walk, only to watch them turning somersaults a scant five minutes later when their team scores a goal (that is a job for the private medical firms).

So, unless a stand collapses, there is a major fire, a bomb goes off or someone drops dead in front of us, there is very little we have to do. At the West Ham ground (my local football club), there are four 'road crew' present, along with at least one major incident support vehicle, one radio operator and an officer. The road crew sit down near the pitch, while the officer and radio operator sit in a V.I.P. box overlooking the whole ground.

Today I was given the role of "safety officer", which doesn't mean I've been promoted - it just means that in the event of a major incident, I'm supposed to watch out for the safety of the ambulance crews present, liaise with the Police and Fire Service about any hazards that might be a problem, and to make sure that any crews that attend the incident aren't getting too stressed. I also have to talk to the person in overall control at the incident about any issues within this sphere that may occur.

We were warned that there was an increased chance of violence at this match because some hooligan 'supporters' are appearing before the magistrate tomorrow - and that some of their 'crew' might want to cause some trouble. Luckily for us, that wasn't to happen despite a 2-1 loss.

It was really cold down there in the stands, I had my undershirt, shirt, body armour, fleece and Hi-visibility all weather jacket on - but I was still freezing. Anyone listening carefully as I walked around trying to keep warm would have heard a clink-clink-clink-clink sound as my frozen balls knocked together.

As I've mentioned before, I'm not a huge fan of football (overpaid idiots, getting paid more in a week than I get paid in a year, booting around a plastic ball) - so I spent most of the match listening to The Magnetic Fields on my smart-phone, while stamping around trying to get some sensation back in my toes

As a quick aside, who needs an iPod Shuffle? My smart-phone can do the same thing and more - it can even make phone calls...

Half time came and went so we joined the St Johns ambulance for a cup of tea and a sandwich, rather than watch a bunch of scantily clad young women prance about. Then we were back in the cold - where I tried to stay awake while West Ham, perhaps predictably lost...

With the exception of someone having a crafty cigarette and setting off a fire alarm, it all went rather smoothly. I did find it funny that the people in the stadium knew what the "Inspector Sands" announcement meant, and did nothing but laugh quietly at it.

At the end of the match we have to stay around until we are 'stood down', essentially when the last few supporters are leaving - so we sat in the ambulance, with the heater going, wrapped in our own blankets (and remember - we know what those blankets have been wrapped around, yet we still used them - that is how cold it was).

We then started making our way back to station...

...only to come across a policeman who had tried to stop a car - only to have them speed up (possibly accidentally) and hit him. He wasn't especially badly hurt, but we took all precautions as we transported him to hospital. He'll need a few x-rays, but I suspect that he will be fine.

Now I'm sitting in my flat, waiting for tomorrow's night shift, at the end of which, I shall know how my secret plan is to unfold...

By Neville Dean, PA Crime Correspondent

A 27-year-old man was critically ill in hospital tonight after several youths climbed into the back of an ambulance to attack him.

The victim had initially been injured during a fight involving around 20 youths armed with baseball bats and a knife in Bounds Green Road, north London.

He had suffered a head injury but managed to get to the ambulance, which was close by on an unrelated call to help an elderly collapsed woman.

As the victim sat in the back, several of the youths who had been chasing him then climbed in and assaulted him.

A member of the ambulance crew was also assaulted, though not seriously. He continued to treat the victim and managed to request urgent police assistance.

The suspects then made off. All those involved are believed to be of eastern European origin

The victim was rushed to hospital, where his condition was tonight said to be critical

The original caller, an elderly woman who had fallen, was treated at home and did not need to go to hospital.

Three men were arrested shortly after the fight, which happened at around 9.10pm yesterday. They are in custody at separate north London police stations.

Police are keeping an open mind about the motive for the attack and are taking statements from those involved.

An incident room has been opened at Lewisham, under Detective Chief Inspector Phil Adams. Anyone with information is asked to call 020 8284 4868 or Crimestoppers on 0800 555 111.

Have a look here for the BBC story

From what I hear on the rumour-mill, the Paramedic wasn't seriously hurt.

The victim later died in hospital. It's a sad state of affairs when you have armed gangs jumping into an ambulance in order to kill someone.

Fighting between gangs is something that we are seeing more and more of. Random muggings are fairly rare, but violence between gangs, or people who otherwise know each other is the main type of violence that we see.

Normally fuelled by alcohol...

The police have impounded the ambulance for forensic examination, which is going to be a hell of a job considering the state of our motors.

Yesterday was almost unbelievably quiet, I did a grand total of five jobs in a twelve hour shift, something pretty much unheard of in our neck of the woods. What made it more remarkable was that half of the crews from Poplar station were off the road with broken ambulances, and yet we weren't needed to cover their area.

The first job was an 'assist only', which most often means that some little old lady has fallen over, or gotten stuck on the toilet. They haven't injured themselves, but just need a bit of a hand to get back on their feet. I've never heard anyone complain about being used for assist only jobs, I suppose it's because they are easy to deal with, and the patient is always grateful.

We used to have to go to nursing homes to help them lift patients, but management, along with our Health and Safety group realised that we were hurting our backs, when all nursing homes should have the proper equipment to lift people (hoists and the like).

I also had to give a statement to the police about a job that I went to in June, it appears that they are charging the fiancée with murder. The policeman told me a few interesting things about the case that I don't think I can go into details about, just in case someone who reads this ends up sitting on the jury.

However I did learn an interesting factoid from the policeman - that Newham has the highest number of paedophiles in the UK. Maybe I should forward this to "Heardsaid".

I also found out that I am one step closer towards my secret master plan...

The title for this post concerns the superstition in all healthcare, that to utter the phrase "It's quiet" is to invite disaster, the correct usage should be "It's a bit Q-word here today".

Well, no sooner than I post about how there is no-one who is ill, I end up 'blueing' into hospital a 44 year old with a severe asthma attack coupled with an Addisonian crisis. As an almost exact opposite to the rest of the people today, the patient is well known to the local ambulance crews as someone who won't call an ambulance until she is exceptionally ill.

We then went to a nursing home to transfer a patient with Alzheimers disease to hospital so that she could receive intravenous fluids to rehydrate her. She had been treated with antibiotics for a leg infection, and it had upset her stomach, so the patient had stopped eating and drinking. Why this job sticks in my mind is that the patient has been suffering from Alzheimers disease for the last 12 years, and that for every day that she was in the nursing home, her husband had visited her. She was very confused, and could hardly recognise her husband, she was doubly incontinent and unable to have a conversation, yet her husband doted on her. He came with us in the ambulance and spent the trip holding his wife's hand, and talking to her to keep her calm. He seemed very happy to talk to my crewmate, I doubt that the nurses in the nursing time have enough time (or perhaps the inclination) to spend some time talking to him, and it meant that he could talk to someone and have a decent conversation.

It was both touching and sad, the utterly confused state his wife was in, and yet the tenderness which he still showed towards her.

Another 12 hours tomorrow.

I'm on station at the moment, as it seems that the people of Newham are taking a break from being seriously ill. Of the three jobs we have done so far, none have really warranted an ambulance. The first job of the shift was a 50 year old male with a painful elbow - we took him into hospital, and he was a nice enough bloke, so we were quite happy at this.

Our next job was to a 70 year old who had tripped over in the street, the police were on scene (for a pub fight - stopping one that is, not arranging it) and so called us. There were no serious injuries, and the woman wanted to go home, so we dropped her off into the care of her son.

The award for the most 'misunderstood' use of an ambulance went to our last call, a 32 year old female who had painful eyes. Essentially she had swollen eyes due to an infection, and had called us to take her to hospital. She had been to the hospital three times in the past two days, and wanted to go to a different hospital. Unfortunately for her, she lives 300yards from the local hospital.

She then let slip the real reason why she dialled 999 for an emergency ambulance, "I want to go to Whipps Cross hospital, but I don't have any money". As she said this I took a long hard look at the cigarette she was smoking, and the way she held that cigarette between her painted nails. I felt like giving her the "An ambulance costs over £800 per call out" talk, but to be honest I couldn't really be bothered. So we walked her the 50 yards to her GP surgery and left her waiting to see her family doctor.

While some people might be annoyed by this sort of job, I'm not too upset - if the patient walks on and then off the ambulance, and doesn't try to hit me, or spit on me, then I'm happy with the patient.

I'm yet to start working with my new crewmate, as she is on a training course that will last about 8 weeks. And I might not be working with her then, if things go according to plan...

For those that are interested, I'll be at the 'Bell, Book and Candle' for the first London Blogger Meetup of the year on Wednesday. Feel free to turn up.

There are three types of road staff in the LAS (well, there is actually four, but they don't count in todays post). There are Core staff, Relief staff and Ghosting staff.

Core staff are the crews who have a fixed shift system and work with a regular crewmate.

Relief staff are moved around the complex (and occasionally off complex) to cover absences and leave. They often work with a different crewmate every shift.

Ghosting staff are temporarily allocated to a crewmate in order to cover a long term absence, for example if one person on a Core staff line is seconded to the Rapid Response Unit someone might 'ghost' that line for six months until they return. This 'Ghosting' can be ended at any time.

For the past couple of months I've been Ghosting a line with my crewmate, but just before Christmas, management decided to fill some of the Core lines that had become empty. One of these lines was the one that I was Ghosting. Because I like the station that I'm working at, I applied to fill any of the lines that were going free at the station. I'm 14th in line to fill a Core line, but because the shift rota at our station is poor, very few people want to work there.

So I was lucky, and got another Core line. This means I am now working permanently at this station. Unfortunately this Core line isn't with my old crewmate...

My old crewmate and I get on really well, at least in part due to us having similar outlooks on the job, and life in general. My new crewmate has a very different personality.

So it will be interesting to see how well we work together.

Yesterday then was the last time I would be working with my old crewmate. At the end of the shift, we were both extremely upset, there were tears, hugs, and declarations of undying loyalty...

...who am I kidding, I just told him to make sure he was in on time on Monday as he is relieving me on my new shift.

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.