I only tend to see the bad nursing homes. I'm not talking about nursing homes where the patients are abused in the traditional sense, but rather where they seem to have simply been... left.

I went to one the other day, run by a large prestigious private healthcare company, it is clean and looks very pretty. But I'd rather die than spend my final days there.

The patient was 90+ years old and had been bleeding from her vagina since 9am that morning. I was called at 11am. They had left her bleeding for three hours.

I met her laying on a towel on a plastic bed, there was no sheet, and the only bedclothes she had was a single sheet across her body.

Her room was clean, but was empty of anything personal - there were no pictures, no letters, no ornaments. Nothing.

I looked at her drug chart. She was on two types of painkiller, but for the past five days, those, and her other medications were marked as having been 'spat out'. I'm guessing that this was because of her advanced dementia, rather than an informed refusal.

If she was spitting out her medicines, I wonder if she was also spitting out her food and drink. There was a bottle of drink next to her bed, but there was no way that she would be able to reach it. Looking at her skin, she did look dehydrated.

The 'nurses' all walked with the speed of arthritic turtles, and I had to struggle to find one that knew anything about the previous visit the patient had made to the hospital. Actually I struggled to find a nurse that knew much about anything.

'I don't know this drug', I said to one of the nurses testing her, 'what is it for?'

I knew what the drug was for, but the nurse didn't...

One of the care assistants sat on the end of the patient's bed. The patient seemed a bit distressed at this, but it was hard to tell as she was staring at the ceiling. The carer suddenly got off the bed, and this obviously caused the patient pain as she cried out.

The care assistant left the room, and I was left trying to comfort the patient, holding her hand and apologising.

I wondered what this woman had seen, what she had lived through. I could imagine her dancing in the 1930's, being married and having children (her daughter was on the way to the hospital already), raising her children while living through the war, maybe working as part of the Land Army. I thought about her husband, probably long dead, and the friends she had also probably outlived.

It always depresses me to think that some people end up in homes like this, where the care is slipshod, and her life is now just an accumulation of numerous small acts of omission.

So it seems that many of you are either very clever, or have been reading this blog for a long time.

Yesterday was incredibly busy, there were a lot of ambulances off the road because there was not enough staff to man them, and there were only two RRUs in the area. One of which was me, and so I was being run from one side of my patch to the other all day. I don't mind driving miles, as it's always entertaining to race through the streets on blue lights.

My last job was a maternataxi in one of the 'less exclusive' parts of town, my patch touches on both the highest and lowest income areas in London. This place was within sight of where multi-billion pound deals are made.

It was a small flat, and the family were about to prepare to break the Ramadan fast. The young patient was having contraction pains, and her waters had just broken. She was being looked after by her neighbour, and on immediate inspection there was nothing much to worry about.

'Hmmm', I thought, 'She's pretty close to giving birth though'.

Contractions were about two minutes apart, and were lasting one minute each. Still, at least she didn't have the urge to push.

Time passed...

No ambulance arrived.

More time passed...

Still no ambulance.

I phoned up my Control.

'Hi there, EC50 here on a labour. If there is a truck on the way, they might want to bring the carry chair with them', I was up in the clouds in a block of flats, so I didn't want to have them running down to get the chair when the mother was getting close to that 'I can't walk' moment.

The patient groaned and said something in her own language.

'She wants to push', translated the neighbour, but looking at the patient I didn't need that translation.

'I think we'd be better off in the bedroom...', I suggested.

But the patient didn't want to struggle up the stairs.

Now my job changed from reassuring the patient, to reassuring the patient that, should it come to it, having a baby at home wasn't going to be a problem, especially because the kitchen was fairly clean*. I mean, a kitchen is much easier than the back of a car, at night, with no streetlights.

I really wanted to examine the patient to see how near the birth was - but I'm always a bit respectful that Muslim women don't particularly want me poking around in their nether regions. If the ambulance didn't arrive soon though, I'd have no choice.

The ambulance arrived.

Luckily one of the crew was female, and so I told them what was happening, and that the female crewmember might want to have a little look at what was happening before we tried moving her out of the labyrinth of a tower block we were in.

Us men left the room. Then we heard her say that the baby was 'crowning'. Birth was going to be a few minutes away.

I opened the maternity pack that I always bring with me on calls like this, and we laid the patient down on the kitchen floor. I phoned for a midwife, while the ambulance crew delivered the baby.

They made much less of a mess than I normally do.

A perfectly happy, healthy baby girl, a happy mother, a happy neighbour and an even happier aunt.

From waters breaking to delivery in under 45 minutes. Not too shabby.

The midwife was delivered by another ambulance (traveling on a flat tyre for the last part of the journey) and I left them to check out both the baby and mother, and to deal with the delivery of the placenta. I was no longer needed.


* Cleaner than my kitchen anyway.

The back of a car down an unlit street at night.

In student digs.

In a ‘troubled teenagers’ hostel.

On the sofa in a block of flats.

In the back of an ambulance.

And now today – on a kitchen floor…

Can you guess what all these things have in common?

Answer in around 24 hours.

I often talk about ambulance Control, but although I’ve spent a shift up there, I don’t really know what it is like to work there full time.

But now I do.

Nee Naw is the blog of one of our Control staff.  If you like my blog (and you must if you are reading it), then you will also love this blog, as it shows exactly what it is like on the other side of the phone.

Go and read it now, then bookmark it/add it to your feed, and then you will truly know the idiots that we have to deal with…

Dr Charles writes a hounting account of a potential future that we are all dreading.

UPDATE:And this is why we are worrying.

From Warren Ellis – ‘ So how dead does this place get on a Sunday night?’

Well today (looks at his watch) yesterday was pretty much dead person day.

Two corpses, two nearly dead, and one about to die.

All in one shift.

I think my favourite was an elderly gentleman in a nursing home, who had real trouble with his breathing.  I asked the nurses there to sit him forward, so I could listen to his chest with my stethescope, and they replied, “How?”, and, “I don’t understand”.

I think I got a bit ‘shouty’ with them after that.

I’ll gloss over the way they opened the door for me, but then let me find the patient all on my own…

Posting will possibly be a bit light over the next few days, as Jeannie is coming over to stay from Seattle, so most of my time will be spent showing her around London.  I’m looking forward to it.

Then there will be drinks, feel free to turn up and say hello to a genuine American.

I walk into work at 6:15am, I've been awake since half past five - Well, I say awake - what I actually mean is that I am somehow moving around, and have managed to drive to work, my mind is still comfortably asleep in bed back home.

I start to check the equipment in my FRU, most of it is there, but I'm missing a few pieces of kit. Expensive pieces of kit, probably sitting on a vehicle elsewhere in our complex.

Then my phone goes off. "Hello", says Control, "We've got a cardiac arrest for you".

I jump in the car, check the address, then I see the age of the patient.

42.

Control has also sent a message that the patient's wife is doing CPR. This means that he might just have a chance of surviving this...

I race towards the address, it doesn't take long, although because of recent rainfall, I'm sliding all over the road.

It's only when I turn onto the road that I realise that I've been to this address before. I've spoken to this man previously, he seemed like a decent person. I know him.

I run in through the door, the hallway is clean but I can't see anyone, so I shout out.

"Up here", comes the cry of an obviously distressed woman.

"Sounds genuine", I thought.

So I bound up two flights of stairs and into the bedroom, where I see the wife performing pretty effective CPR on her dead husband.

She is crying.

I take over, connecting the patient to my monitor/defibrillator I see the patient's cardiac rhythm is Asystole - There is no activity in his heart at all.

Now comes the tricky part. I'm on my own, and there are a lot of things that I have to do very quickly.

I do fifteen chest compressions, this will hopefully get some oxygen to his essential internal organs. But to continue doing this I need to get his lungs full of air. So the next thing I do is connect up the 'ambu-bag' to my oxygen cylinder.

I tilt his head back and use the ambu-bag to inflate his lungs twice.

I start another fifteen chest compressions.

Downstairs I hear the crew entering the house.

"Top floor mate", I shout, "Job is as given".

When I say the 'job is as given', I mean that it was given to us as a cardiac arrest, and that it is indeed a cardiac arrest and not a faint/panic attack/cough or belly ache

It seemed like ages, but when I later check the times, the crew were less than two minutes behind me.

Three people come bounding up the stairs - the FRU from another station jumped into the back of the ambulance, he was waiting on station for the previous shift to return when the crew got the call.

I continue the chest compressions, one medic puts a breathing tube down the patient's windpipe. The other is getting access to a vein, so we can give essential medications. The last crewmember is doing the very important (but often underrated) job of looking after the wife.

After about nine minutes of this treatment, the rhythm on the heart monitor changes. It looks suspiciously like a decent heart beat.

I check for a pulse.

I find one!

The patient then spends the next couple of minutes (while we are preparing to move him) slipping in an out of either having a pulse, or having a 'shockable rhythm' which needs an electric shock to revert this back into a heart rhythm 'compatible with life'.

He ends up getting defibrillated twice before we can load him onto the carry chair, lug him down two flights of stairs and into the back of the ambulance.

We then find a member of the public upset that we are blocking his parking space. He is currently blocking the only exit that the ambulance has.

One of the crew has a word with him. She is much politer than I would have been.

He moves out of the way rather quickly.

As there are three crew in the ambulance, they don't need my help - so I follow behind them so that I can get my equipment back. By the time I reach the hospital the patient is being prepared for transport to the intensive care unit.

The wife gives the crew a hug, and sobs how grateful she is. Even the doctor at the hospital compliments us on a job well done.

But, failing a miracle, the patient will die, he was without oxygen for too long.

Once more it seems that we are just making time for the relatives to say goodbye. But for us it still seems like a success.

October the 1st, 2004.

We are now one year on from the implementation of Agenda for Change (AfC), and us EMTs still don't know what our new pay and conditions are going to be. The planning for AfC was started a year before this. So AfC has been with us for two years.

I think one of my commenters put it best when someone asked about AfC.

The pay rise announcement for paramedics, whilst being a significant rise, is not the great deal that it's been made out to be, with very little option for improving your pay based on skills and knowledge.

The rise for Technicians which is what you would be to start with if you joined the ambulance service, is still to be decided. The offer from management has been thrown out by the unions as it was utter rubbish, and it's now been referred to a national committee. If the rumours are true, and it seems that's the way it will be, techs will be placed in Band 4 of Agenda for Change, so while our gross annual salary will rise to just over £25k, our basic salary will effectively drop from £21,900 to around £19k, with the rest being made up from enhancements - unsocial hours payments, London allowance etc. We'll get time and a half for overtime, but that'll be based on the £19k basic. Plus band 4 doesn't recognise us doing ECGs, giving drugs and supervising trainees.

To put it into perspective - there are hospital cleaners that are going to be placed in band 4. Enough said?

Sorry to rant on but this A4C stuff, but it really annoys the Hell out of me!


For me, it's not about the money - it's about recognising us for the jobs we do and the skills that we have. We essentially work on our own, have to solve time-critical problems and give drugs that are normally only prescribed by doctors. We are at risk of being beaten up, we have to calm situations down, and maybe even be the first on scene at terrorist bombings.

Yet it seems that we are not recognised for this, instead our basic pay will drop, and the only way that we will make up the shortfall will be the new idea (for the ambulance service at least) that working rotating shifts should earn you a bit more money. The drop in basic pay will imply that our day to day work is not worthy of financial recognition.

Of course, this is all supposition, as no-one seems to know anything.

Morale at the moment is, to put it bluntly, crap, and it wouldn't surprise me if there were some form of 'action' in the near future. (Nothing that would affect patient care though).

It isn't helped by the misinformation in the media that is claiming that we will be earning a 30% pay rise, as this is purely for our (top trained) Emergency Care Paramedics, who are taking on the role of out-of-hours GPs. ECPs are in band 7, EMTs are likely to be put in band 4. So I won't be seeing a 30% increase...

At least we haven't got a job description that tells us to expect to be beaten up by patients and their relatives.