How can I best tell you about my night?

Shall I tell you about how I kept my cool when I found out that I had been waving my (ungloved) hand through my patient's vomit?

Instead should I write about the alcoholic couple who called for me because one of them had had piles (hemorrhoids) for the past couple of years - and then started arguing amongst themselves?

How about the despair I feel when I keep turning up to the same nursing home, for patients who are always given as 'not eating', yet when I turn up the patient is about as close to death as you can get? How the 'nursing' staff seem surprised that the patient has so 'suddenly' deteriorated? Or how the 'nurses' are so thick they can't tell I'm being angry/sarcastic at them?

How about being called to the family that are shouting at each other in some foreign language (I so hate being left out of an argument), while the son thinks he is having a heart attack, when he is actually just having a panic attack?

Should I divulge how I turned up to one of our (very) frequent callers, asked her if she wanted an ambulance to take her to hospital, and when she said yes - told her to stay in the phone box she was using to call us while I waited for the ambulance in the car?

What about my being sent to a job waaaay outside my area (1 year old with a belly ache), only to find an ambulance there first? Then needing to arrange for the mother to return from the party she is at to look after the other four children in the house? Perhaps I could mention that she didn't believe that it was the ambulance service that was phoning her at the party?

Or maybe, just maybe I should just write about being nearly in tears watching the poor people that Comic Relief is trying to help - people who would be blissfully happy to have half the chance of the idiots that I go to?

It's a bit embarrassing to start welling up when you are sitting in a messroom, surrounded by other ambulance crews

Stuart Moore found this little gem on the BBC website, essentially about GPs planning to dial 999 for non-emergency calls.

Ambulance bosses say a threat by GPs in Swansea to dial 999 for non-emergencies would bring the service to a standstill and risk peoples' lives.

Doctors say ambulances are over-stretched and non-emergency patients who need to be admitted to hospital are left to wait.

Ambulances have to respond quicker and within a guaranteed time to 999 calls.

GP’s are upset that ambulances spend their time stuck outside A&E with no beds at the hospital to offload their patients onto.

The Morgannwg Local Medical Committee, made up of doctors from the region, has put forward a motion to the Welsh LMC conference on Saturday calling for members to use the 999 system rather than pre-book vehicles.

Swansea based GP Dr Ian Millington, secretary of Morgannwg LMC, said: "It's really a way of using the system to guarantee that patients get appropriate care.

"What we are trying to arrive it is where we can guarantee a time for a patient to arrive at hospital. Increasingly that's becoming difficult if we use the normal control room number.

These non-emergency patients are the patients who can wait for an ambulance, as their condition isn’t immediately life threatening.  People who are believed to have a DVT, a chest infection, or a urine infection are the typical non-emergency calls we go on.

Stuart asked my thoughts on the subject, these are –

Short answer : “GAAAAHHHH!”

Longer, more sarcastic answer: “Don’t GP’s do that anyway?  Especially for the patients that they haven’t actually seen, just diagnosed over the phone”.

Sensible answer : “Why do GPs think that abusing a system will help patients?  If they carry out their threat then ORCON (Government target) will be hurt, the ambulance services involved will be slated for poor response times and will get less funding, this will result in a worse service.  This only leads to patients getting a worse deal than before.”

I’ll leave you with these comments, so you don’t just think it’s just us road crews who think it is a bad idea.

But Don Page, Chief Executive of the Welsh Ambulance Service NHS Trust, warned if the GPs carried out their threat it would have dire consequences.

"To undertake the threatened action will result in the emergency ambulance service coming to a complete standstill and unable to respond to real emergencies and life threatening calls," he said.

"It would be unprofessional and negligent of GPs to take such action which would clearly put the lives of people at risk.

"I understand the concerns of GPs but I would urge them to step back and consider the dangers that such action would cause."

So there I was, watching the local news and they have finally told people about the dodgy kebab shop that I blogged about here and here. The BBC have written about it on their website (and thanks to Emma for pointing it out to me).

I'd just like to have a bit of smugness about how a blogger broke the news before anyone else.

Shame no-one else really noticed.

(Nearly forgot about this, what with all the searching for people who mutilate their own genitals online)

Yesterday I felt that my role as a RRU was justified, and this, coupled with the better weather, means that I am in a much better mood.

The unfortunate thing is that it was a tragedy that made me feel better.

The first job of the day came two hours into my shift, the call was "Woman fell out of bed, not breathing". I got to the house in two minutes and climbed the narrow stairs to find a 55 year old woman laying in the lap of her daughter - also on the bed was two small children (perhaps one and two years old). The younger woman was crying - my patient wasn't breathing.

I had to pull her out from the side of the bed so I could get my resuscitation attempt started, not very dignified, and probably not that nice to watch either, as a stranger in green pulls your mother across the floor.

I connected her to my heart monitor/defibrillator, and saw that she was in PEA, so I started chest compressions, and ventilating her with my ambu bag.

While doing this I was trying to get some form of medical history, but none of her relatives could speak English that well, but I managed to gather that she had just rolled out of bed, and besides tablet controlled diabetes she was otherwise healthy.

I was just about to finish the first round of CPR when I heard the ambulance crew turn up - I shouted down the stairs that the call was indeed a 'suspended', and when they entered the room they started to intubate and try to gain venous access. Venous access means that we can give potentially life-saving drugs, but in this case the woman's veins were so small that after two attempts we realised that it wouldn't be possible in this case. Instead we were able to give her the drugs via the ET tube, which is the breathing tube we use to protect the patient's airway.

We then saw a change in her cardiac rhythm, from PEA she entered VF so we 'shocked' her with my defibrillator. She then went from PEA to VF and back again every time we shocked her.

At one point during transport to the hospital we got a pulse back, but this soon degenerated into VF.

The hospital worked on her for an hour, and at one point she had both a pulse and a blood pressure, but unfortunately she later died.

And the memory of the job that I have is of cleaning her hair from where it had gotten stuck to the ambu bag, just after she had died in the hospital, hoping that the son-in-law wouldn't then choose that moment to look in the back of the ambulance.

At least I felt justified in my role - all too often you get used to being called to jobs that are, frankly, crap. This was a 'proper' job, and although we didn't save her, we gave her the best chance we could - if we hadn't been there, then she wouldn't have had even that chance.

This is a strange job - people who aren't sick annoy you, and yet the really sick people are 'good jobs'. We are only happy when someone is suffering.

As the London ambulance Service doesn't have an ambulance station on every street, and given the state of London's roads and traffic, we find ourselves going out on 'Standby'.

Essentially ambulances crews, and RRU cars are told to drive away from the station (with its heating, toilets and tea making facilities) and sit in public roads to help cover a wider area. The idea is that because the 'resources' are spread out over a wider area you will be able to get to calls quicker, thus improving our all important response time.

Crews don't like going out on standby - but I doubt anyone would like sitting in an ambulance cab waiting for someone to be ill/injured/drunk. Management like crews being put out on standby because it apparently improves response times, which pleases the government.

The standby points are chosen to be reasonably far away from station, around three miles in my case, and in an area where there is a reasonable expectation for there to be a high number of calls.

They also try to place you where a number of major road routes meet, so you can rapidly make your way out of your area to cover the shortfall in other sectors...

There are limits to how standby can be used - you can only be put on standby for twenty minutes at a time, and you can only be put on standby between the hours of 8am and 8pm, so while it is unpleasant to be put on standby, it isn't the complete torture that it could be.

On the RRU there is another ruling - that they can't spend longer than 30 minutes on station, so although I had five jobs over the space of twelve hours yesterday, I spent very little time actually on station. Most of my time was spent sitting behind Stratford shopping centre with the engine running so that I didn't freeze to death. When I got bored with that, I would roam the area, essentially looking for some trouble.

It is a fair assumption that it takes half an hour to do one job, from activation to being ready for the next job - so I was only actually working for two and a half hours, for and hour and a half I was on station, leaving me sitting in the car for eight hours.

Well...today was not what you would call a barrel of laughs. I don't know if it was the weather, the lack of jobs (five jobs in a twelve hour shift does not make the shift pass quickly), or that I'm nearing the end of 5 sets of 12 hour days shifts - but I'm rather fed up.

It's not helped by being on your own in a car with no-one to talk to, and if you go back to the station for a bit of human contact you get shooed out by Control who want you either roaming the streets, or sitting at your standby point. Then I come home to an empty flat...

insert sound of mournful violins

There was one bright spark during the shift - that of a supposed heroin overdose. I turned up and the patient (female) was laying in bed asleep, also in the bed was a male. The patient turned out to be a heroin addict, on methadone and was also a prostitute. The flat was pretty much as you'd expect a junkie's flat to look.

The 'patient' was just sleeping, so I woke her up and she told me to go away, which I did - but only after checking her pulse, oxygen levels, blood sugar and so on and so forth.

Sitting in the car afterwards doing my paperwork, I found myself in a slightly better mood, it wasn't because the job was actually funny, nor was I bothered that if her 'male friend' had given her a shake she would have woken up without an RRU and ambulance being sent to her. But for some reason, unknown to be my mood was lifted, if only for a short while.

My final twelve hour shift of this run is tomorrow, when I shall try to post about standby points from my Smartphone. Then I have a week off - at least some of which will be spent running around nuclear bunkers and woods trying to shoot people with plastic pellets

This is just a quick test posting to see if I can get picture posting working from my mobile phone

If you can see the picture I've just taken - it's the view from the front of the car as I sit here on standby, in order to better cover our area

Of course, if this hasn't worked, then you will see nothing, and this post will just be confusing.

Extra karma points if you know where I am...

Yesterday I did five jobs, of which I only got to see three patients, as Control sent me to jobs where an ambulance was either already there, or just a lot closer. Of these jobs the only one of any interest was a four year old girl who had vomited, and then was behaving strangely. The child had a number of medical problems, related to her being born at 23 weeks premature. To me it looked like she was 'post ictal' following a fit, but there was no history of a seizure. I was glad that the ambulance crew turned up quickly, as there is little I can do in that situation apart from try to get a provisional diagnosis, and give her some oxygen.

I believe that she was later transferred from our local hospital to a specialised paediatric unit.

Today, at the moment, I'm 'off the road'. According to the night staff, the engine management light has been showing throughout their shift. Also the rear windscreen wiper has stopped working (could these two things be related? I have no idea).

When a vehicle is broken it finds its way to the mechanics who have their garages on our station, a little pink form is filled in letting them know of the vehicle defect and they do their best to fix it. I hate going over to the mechanics, as there is one of their number who has a real attitude problem, and I can't always be bothered to deal with him. I also feel like I'm encroaching on their 'territory' - which is strange seeing as I wander around people's homes all day.

But today, the crew working are all nice people - and I didn't feel too bad about giving them a bit more work to deal with (I've mentioned before how certain vehicles on our fleet are essentially held together with tape and chewing gum).

Once the fault (whatever it is) has been fixed, and the mechanics are quite good at their job so it shouldn't take long, I then need to take the car to get the computer system in it fixed - the GPS system is getting confused and thinks I'm driving around the South of London, which is something I avoid as much as I can...

Then, hopefully, I can start doing some work.