It turns out that Newham General Hospital had at least 70 people through their doors concerning the food poisoning epidemic. Some patients also had gone to King George's hospital or to Whipps Cross hospital, which, if you add in the number of people who are suffering in silence at home makes a lot of rather sick people

The kebab place has duly been closed and the various public/environmental health bodies are looking closely at the situation. I have heard an unconfirmed rumour that the cause of the sickness was due to Salmonella

At least one person is very ill, and at least eight people were admitted to Newham hospital. This has stretched the resources in the area to near breaking point, Newham hospital and King George's hospital were both closed on Sunday night because the A&Es were full, and there were no beds left in the hospital. It got so bad that Newham hospital declared an internal "major incident" a wise choice I think, as it means that the resources needed to deal with the situation are pointed in the right direction.

Unfortunately, with our local hospitals closed, patients have needed to go further to get to a hospital. Some are quite happy, such as those who get taken to the Royal London (remember, in most people's eyes the Royal London is the hospital to go to. Meanwhile others have been less happy (such as those who have been taken to Whipps Cross

It is my belief that a terrorist network doesn't need bombs to bring London to it's knees, it just needs to spread a little Salmonella around, and then watch the NHS collapse

My first shift 'on the car' went fairly well - there are lots of things that are different between the car and working on a truck that I think you may be interested reading about, which means I'll have a series of postings about RU work to write about when I next get some days off.

While others were dealing with stabbings and shootings (at least two in the area last night) I, who is supposed to go to the most serious calls, had two patients who actually needed hospital treatment, a crying baby, and 5 cases of 'D&V' (Diarrhea and vomiting). I was not alone in dealing with this sudden increase of D&V, Newham hospital was very busy with an epidemic of similar illness, and it seemed that crews were persuading a lot of them to stay at home and nurse themselves..

If you live in the area I work then I'd stay away from the Kebab shops in Romford road (Manor park end) if I were you, as at least twelve cases were tied to one kebab shop, with perhaps as many as twenty seven people eventually falling ill with the same symptoms after eating from the same shop.

Now...can I name the shop involved? Legally and ethically, am I on firm ground?

Maybe I should study journalism at night school...

The other cases were all fairly simple, although at one job I had to wait over an hour for an ambulance to turn up - I was stuck in a house where the only person who spoke any English was a 4 year old child. Not normally a problem, but there was some uncomfortable silences. Still, the family understood that we were really busy and were all very nice - offering cups of tea and little snacks, which is something no-one has ever done for me while working on an ambulance.

I may have something more interesting tomorrow, but for the first night it was really pleasant to be eased into this entirely new way of working.

Now to sleep...

So after some time (arranging things with work, battering my computer into submission and have a day of doing nothing except "chilling out") I think I an finally reveal the 'big secret' that I have been using to keep you coming back to read this blog...

I'm still in the London Ambulance Service, and I've not been promoted - however the vehicle that I drive, and the role that I play will change.

I'm no longer going to be driving one of these... Or even one of these...








But one of these...

For the foreseeable future I am going to be on the Rapid Response Unit.

The role of the RRU is to get to emergency calls within eight minutes, thereby pleasing the government, and by extension, pleasing management.

I am to get to calls as quickly as possible, get a history off a patient and start treatment until an ambulance can arrive - I then leave the patient in the care of the ambulance crew and drive off looking for another emergency call. When I don't have a call to go on, I am to spend at least some time driving around the area in the hopes that I will be closer than an ambulance when a call does come in.

This means I have even more autonomy than working on an ambulance, because I am working on my own - there is no crewmate to bounce ideas off. There is also a better chance of things going horribly wrong - imagine having to deal with a cardiac arrest on your own, with distraught relatives knowing that there isn't going to be an ambulance for 30 minutes...

Still - it should be fun, especially considering that I'm starting this new rota with a Friday, Saturday, Sunday night.

Today was typical, in that the jobs we did veered from interesting to dull, and from heartwarming to heartbreaking.

As an example of how one job can be different from another, we found ourselves attending an elderly man who was looked after by his daughter and son-in-law. They lived in Portugal, but when he had became ill they had moved back to England to look after him. The house was spotlessly clean, as was our patient, there was real love in the house, and they obviously cared deeply for him. He was generally a bit poorly after a fall earlier in the day, so we took him to hospital for a check-up. Straight after that job, we ended up going to a pair of alcoholics living in squalor, where one of the pair had fallen over while drunk and had cut their ear. The patient later said that his partner had punched him, and that is why he had a cut ear, that and she had also kicked him in the stomach.

This is the fun bit of this job, we go from loving families to quarrelling drunken couples.

We had a bit of a 'trauma' with a victim of a hit and run. The patient was crossing the road, when he got hit by a car, bounced up onto the bonnet and ended up in the middle of the road. Luckily he wasn't hurt in a life threatening way, but he did have a broken arm (for the medics in the audience, or those who can use Google, the patient had a simple transverse fracture of the mid-shaft humerus). He didn't have any other injuries - which in my book makes him rather lucky, especially considering the speed that cars can get up to down that particular road.

What was particularly interesting was that, although the man was laying in the middle of the very busy road, only a bus, and one bystander had stopped, the bystander was making sure that he didn't get hit by any other cars. People were so unbothered that at one point I had buses rushing past my head as I treated him. You'd think people might slow their driving a little when swerving around an ambulance parked in the middle of the road with all it's lights flashing...

But not around here they don't.

We also went to a 'Fire job', where a mother had left a 7 year old, a 5 year old and a 2 year old locked alone in a house while she popped out for some fruit. A small fire had started, and the children had only been saved when a neighbour walked past and saw the kids crying at the window, and the orange flicker of flames in the background. He broke the window and saved the children. The mother was, perhaps unsurprisingly, distraught. A moment of carelessness nearly cost her children their lives. The quick thinking of the neighbour had meant that the children were completely unharmed, so I hope he gets a nice write up in the local papers.

The final job of the day was to a 'nursing' home - the patient had apparently developed a bony lump under her hip. The staff thought that she may have broken her hip - but as the patient is bed-bound, and no-one admitted dropping her it would be a very suspicious fracture. I had a look at the supposed 'fracture' and couldn't see anything unusual, the patient was just extremely frail. The patient was suffering from dementia, and when I examined her properly, was also rather dehydrated. So we took her into hospital - along with a 'carer' from the home. All throughout the transport the patient was scared, so I did my best to look after her, hold her hand, talk to her - that sort of thing. During this the 'carer' stared out the window of the ambulance and didn't say a word apart from worrying that she would have trouble being relieved when her shift was finished.

When we left the patient at the hospital I told the 'carer' (can you see why I put 'carer' in quotes?) that her job now was to "hold her hand, talk to her and reassure her because she would be scared in this unusual place. In fact it gives you a chance to do that caring thing that you don't have time to do normally".

I think she knew I was a bit angry at her - but she did as I said, so maybe she got the point.

Another 12 hour shift tomorrow - then (hopefully) I'll have a day or two off, when I can sleep and perhaps manage to fix my laptop.

If the above post doesn't make any sense then tough, I'm knackered and all the Red Bull in the world can't make me into a Hemingway.

Todays functioning is brought to you by...



CAFFEINE.

Actually, the majority of the NHS is fueled by caffeine and chocolate. This is why there are no old ambulance crews.

Lack of sleep is not a good thing, especially when you are trying to (*cough*) save lives. Therefore insomnia caused by worrying about a potentially corrupt 'SVCHOST.EXE' file may impact how I deal with people.

So it's a good job I was driving today. It's also a good job that no idiot decided to pick today to leap out in front of the big yellow truck with blue flashy lights that was making loud warbling sounds.

However, things that will cheer me up include finally getting a CTU (from TV's '24') ringtone working on my phone.

I also found out that the world is indeed a small place because I read about a R&B star on Warren Ellis' site, who decided to pluck out an eye, only to then turn around in my chair and chat with the crew who took him to hospital.

I could give you the inside gossip, but it'd be breaching patient confidentiality, a big No-no. But I can tell you that no-one around here knew who he was. All the other information/pictures are in the public domain.

However my day was made so much better because my 'secret plan' has unfolded, and I will start my new role on Monday.

But for now, the ability to form coherent sentences is leaving me. I must sleep - I have another 12 hour shift tomorrow.

For the first time today, the people of East London have decided that they don't need an ambulance, so I can quickly write an entry while supping a cup of tea.

I turned up to work today, only to find a poster in our station telling us that if we manage to reach 90% of priority calls within 8 minutes, then two Team leaders will come and wash the cars of those on duty on that day.

This leads to two questions - first, just how desperate are management to get our response rates up, and secondly, shouldn't Team Leaders have better things to do with their time than washing our cars?

Although I do admire their attempt to 'think outside the box'

The eight minute respone time is the main gauge of our success dictated to us via the government, this is called the ORCON time. As far as anyone knows, the eight minutes has no obvious basis in clinical practice - the best guess anyone can come up with is that the government considered it a good time because that is how long they have to vote when the Division Bell rings.

At the moment the complex is reaching around 68% of all these calls within 8 minutes - the only problem is that it is supposed to be 75%. This is considered Not Good, and so there is a rush to try and get that percentage up. As part of that plan we have these incentives, and a number of Rapid Response Cars have been funded across the area. The RRU's are supposed to get to a job in under 8 minutes - then if the patient is seriously ill provide immediate treatment, if the patient isn't ill, then there is little for the RRU to do.

If we get 75% or more, then we get more funding, if we get less... Well we get less funding.

Today I can tell you that the ORCON percentage is probably below the required 75%, because throughout the day our Dispatchers have been putting out general broadcasts for ambulances - so there have been more jobs than there are free ambulances.

This is the problem - we, as ambulance crews, don't hang about and dawdle to our emergency calls, we genuinely try to get to these calls as quickly as possible. But given traffic conditions, the size of our area, the actual lack of ambulances (and the staff to crew them), there is little we can do to improve the times.

I mean, if we drove any faster, we'd probably have half the fleet off the road being repaired after crashing into other road users.

Part of our job involves using a radio to talk to Control, so part of our training is in the use of the radio. The training is about three hours long, and you spend it pretending to talk on a radio passing jobs back and forth (this is before the computer terminals were introduced).

One of the things we are taught is the Phonetic alphabet, which I am sure you have all seen in film and TV. Normally it sounds something like "Foxtrot Alpha Sierra Tango Charlie Alpha Romeo", and is designed to make the spelling out of words over an unreliable radio transmission clearer, and less likely to have errors.

One other thing that you should be aware of, is that our radio has an open broadcast - this means that everyone in the sector can hear you talking on it. You can recognise your friend's voices, and this radio chatter gives you a general idea at what they are doing. Of course, this means that should you make a mistake - everyone knows about it.

Why was it, when spelling out a name I suddenly forgot the phonetic for 'M' (Mike), and instead, in a moment of panic, decided that the new phonetic for 'M' would be...

...Mango?

It's not as if I have mangoes on the mind - I can't remember the last time I ate one, but for some reason it was the first thing that came into my mind.

I bless the radio operator for not bursting into laughter and calling me a twit.

Work was fairly light today, I had one blue call, which was an eight year old who was having an asthma attack. When we got on scene, the child was having real trouble breathing, his lips had a worryingly purple tinge and he was using the whole of his chest to suck air into his lungs. I don't think the mother realised quite how serious her child's condition was.

We gave him a dose of a Salbutamol nebulizer (a medicine for opening the airways of the lungs, making it easier for the child to breath), and 'blued' him into hospital. I carried him into the resuscitation room to be met by a couple of doctors and nurses. By now the child was looking a lot better, and the consultant didn't look too impressed with my bluing the child in. The consultant didn't say anything, but I sensed a definite 'vibe', that he thought we were overreacting. However, once I explained how the child looked when we first saw him, the consultant was more understanding of my decision. The child stayed in the resuscitation room for some time, so they can't have been that unconcerned.

I have a rule at work - if I'm considering bluing in a patient, then I should just blue them in and have done with it. It's more embarrassing to turn up with a dead patient after driving slowly, than to have a live patient turn up quickly. No-one ever lost their job for bluing in a patient.

Sometimes you just know that a patient is seriously ill, even if everything else says otherwise. It's good to listen to your intuition.

I suppose that it can be hard to understand why the ambulance crew has blued a patient in if they look quite healthy when we roll them in through the door. Sometimes it's because the patient has improved, sometimes it's because the patient has a medical history that explains symptoms that would be otherwise frightening and that the patient hasn't told us about them.

And of course, sometimes, just sometimes, patients fake serious illness.

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.