Dark street.

A man who has been beaten unconscious.

I kneel down, and use my hand to steady me.

Under my palm I find two of his teeth.

Saturday night in East London.

The first job you get after a week off tends to set the tone for the rest on the night - not tonight though.

My first job was for an eighty year old collapsed outside her front door. I turned up and sure enough, there was a clean. tidy little old lady laying under a quilt (provided by her neighbours). Completely unresponsive, I burst into action (*cough*), checked her blood sugar levels, and found that it was rather low.

(2.0 mmols, don't ask me what that is in 'American').

One injection later and by the time the ambulance crew were carrying her down the stairs, we were all having a laugh and a joke.

So a good job where I managed to "cure" someone.

But then the night has appeared to take bit of a downturn (so far...), with a 'maternataxi', a 'hot and sweaty' 20 year old (no jokes please), and a series of 'assaulted outside pub', which ended up with me calling the police because it started to 'kick off' again.

I did have another job, where I was going to a "blind 18 year old, possible broken bone, unable to walk, learning difficulties". Control asked me if I wanted to police present as the patient was apparently 'upset'.

I told them that I didn't really think I needed the police to manage the situation.

Here is hoping that the drunks of East London decide to stop beating each other up for a bit...

Some good news though - the pregnant woman I wrote about who was mugged has just given birth to a healthy baby.

Apparently an ambulance has crashed into a car in Enfield. The crew are alright, but we don't know how the people in the car are. If I find out more I'll let you know (or point to the story on a news site).

So, it seems that there isn't anything chemical/biological to worry about - so no doubt the Decontamination team are all disappointed...

The police commisioner has told all us Londoners to carry on as normal, but to avoid the affected areas.

The last I heard was that some of the team were looking at a "white powder" incident - but we get a couple of them a week, so it's unlikely to be anything serious.

Once more, most Londoners will look at what happened today, shrug their shoulders and make a cup of tea.

(Something I'm going to do now...)

One of our crews has been told to "Blue Light" down to Headquarters in order to provide cover for the area affected.

Decon officer is still on standby.

Everyone here is fairly relaxed about the whole thing, but we are quite a way away from everything.

Our Decon officer has just been told that he has to come off the road and be ready on standby. This means that our level of threat has been raised a bit.

Could it be because they are worried that there may be a chemical component to an unexploded bomb?

Apparently there are chemical suited people going down into Warren St station.

(Probably just making sure that everything is 'clean').

No-one on station has had a 'normal' call for the past 40 minutes.

Looks like it might be fairly minor - current theory is that a bomb has failed to go off on a tube. So far it's not being declared as a major incident.

At the moment we are all on station sitting watching the news.

Here is hoping that no-one is hurt.

I suspect I can direct you to your normal news-sites, as I'm not going to have any great insights from here on in.

There is a special diagnostic procedure that us seasoned medical professionals use.

"Handbag medicine".

To the lay bystander it may seem that we are standing over the unconscious (or merely uncooperative) patient, rooting through their belongings, looking for something expensive to steal. For women this is normally a handbag, for men you will find us going through their wallet.

But! It is not true that we are seeking to boost our wages (meagre though they are), instead, dear reader, we are trying to help the patient.

If the patient is unconscious then we need to get as much information as possible, and one way of doing this is to go down their possessions.

The best thing that we can find is a card that is big, bright, hard to overlook with "I have epilepsy" written on the front (with the patient's name, date of birth and next of kin contacts written on the back).

The next best thing is often an address book/diary, it's especially helpful if the patient has filled in the front "personal details" bit.

At a pinch we can use our detective skills with envelopes (opened and unopened), credit cards, GP slips, prescription forms (often very helpful), immigration or asylum documents (popular in this area) and (also popular in this area) court summons.

So, an East Anglian Paramedic Bob Brotchie has come up with a rather good idea, given that people today, (myself included) seem wedded to our mobile phones.

ICE

Basically you put the details of the person you would like contacted In Case of Emergency into your phone under the name 'ICE'.

It's a good idea, and the drawbacks (the phone might be broken or separated from the patient) are the same drawbacks as anything that you would write on a piece of paper.

So, do it today!

True, if you are seriously injured enough, then we won't be rooting around your mobile phone (we'd be actually treating you), but it'd help the staff in the hospital when they get a quiet moment.

There have been hoax emails going around saying that if you put ICE into your phone then you get your phone credits drained away. This is absolutely a hoax.

This has been a public service announcement.

Or..."The reason why Barking road will be closed for an hour or two".

* If you have broken your arm and leg, please don't wave them around, as the sight of your bones trying to protrude through the skin isn't a pretty one.

* If the nice ambulance man puts your neck in a hard c-spine collar and tells you to stop waving your head around - listen to him. Broken bones heal, broken necks can be a bit more final

* Do try to get hit down a side road - if you get hit in a main road, then the disruption to traffic will be a lot worse.

* If your 'friends' say that they saw everything and will be at the hospital, try to have the sort of friends who will actually turn up there, and not just think better of it and bugger off to whatever hole they crawled out from.

* Yes, I know your arm and leg is broken, but seriously - keep your neck still.

* If you don't want me to know your name that's OK. Just make sure you carry some identification in your wallet.

* Having a shaven head makes it really easy to spot a head injury, thanks for that.

* Loose clothing is really easy to cut off. Please dress appropriately.

* Keep...Your...Bloody...Head...Still!

Why the flippancy? Lets just say that he and his friends are "well known" to the local police, and to the odd ambulance crew. Also, you want to know how we deal with nasty trauma? Dark humour...

My last call for yesterday was to a "65 year old female, fall in street, possible head injury", I was only two minutes away, and I was happy to do a nice simple job.

Falls in the street are often minor injuries, where I have to do little other than minor treatments, and give a bit of the old Reynolds chat

I pulled up on scene and saw a crowd of people standing around, looking fairly relaxed, and in the middle of them a woman lying on the floor. Someone was stroking her hand.

I walked up, looked down at my patient and said, "Hello, what seems to be the problem".

There was no answer, and her eyes kept staring ahead.

I checked her pulse, she didn't have one, nor was she breathing.

"Oh... Bollocks", I thought.

I quickly started our treatment for this condition. Connecting my defibrillator to her (A box that monitors heart rhythmn and can 'shock' the heart), I saw that she was in 'VF'. 'VF' is what is called a 'shockable rhythmn', which means that I can give her heart an electric shock in an effort to restart her pulse.

When you see Doctors on the telly shouting 'clear!' and then the patient's body jumping, this is what is happening.

So I 'shocked' her three times, when I wasn't shocking her, I was doing CPR (pushing on her chest to keep the blood flowing to her vital organs) and breathing for her with my ambu-bag. I'd had to cut her clothes off (so I could attach the pads through which to deliver these shocks to her chest).

All the time I was fully aware of the crowd around me, and I was hoping that none of them had a cameraphone. None of the bystanders had seen anything, and none of them knew the woman (it looked to me as if she was just popping down the local shops).

The crowd were thankfully no trouble, actually they tried to be helpful - one person offered to help me with her breathing (I refused, because in reality it's tricker than it looks). There was another person who helped me, by running into their house and getting me some paper towels.

Why paper towels?

Well, I tend not to wear gloves, and while trying to resuscitate her, the patient had vomited up her last meal. So my hands were covered in her vomit. The paper towels were so I could wipe my hands before belatedly putting some gloves on.

So the crowd were, as we say in this part of London, "As good as gold". They didn't get in the way, they didn't annoy me by asking awkward questions while I was busy, and even the little kids who were watching were well behaved.

It took a long nine minutes for the ambulance to arrive, not their fault, they were a long way away, and the traffic at that time of the day is pretty heavy.

We continued to attempt a resuscitation, and at two points we managed to restore the patient's pulse. Unfortunately she later died in hospital.

Once more I was left thinking about the relatives, who would be sitting indoors wondering why mum/gran was taking so long to get back from the shops.

Also, a resuscitation attempt is not the most dignified thing to have happen to you. That this woman had to have me cutting her clothes off, me jumping up and down on her chest and vomiting over herself, all in full view of the crowd, is not the best way in which to leave this world.

I'm hoping I have nothing but minor calls today...

8:30 this morning.

I'm trying to explain something to an (understandably) hysterical woman, and her two children (4 and 7 years old).

I'm trying to explain that her 37 year old husband, and their father, is dead, and that there is nothing I can do for him.

There is nothing I can do to stop her crying. The children are in disbelief, and I don't know what to say to them either.

Sometimes this job is really shitty.

On an uncharacteristically quiet Sunday, the crews at West Ham station have taken some time to relax on the grass outside their station.

We have also just had the four planes for the commemoration ceremony fly past - we then rushed into the station to watch them on the television, just seconds later.

We have recently updated the AMPDS dispatch system in Control. This piece of software is supposed to categorise all the calls into the three different priorities...

Cat A (Red)- High priority, life threatening injuries and illnesses.

Cat B (Amber)- Medium priority, chance for disability.

Cat C (Green)- Low priority, cut fingers, coughs, colds.

We had been hoping that the new update would cut the number of 'Cat A' calls we would be going to by better triage.

Unfortunately, the opposite seems to be true (for me at least).

For example, Maternataxis, which mainly used to be 'Cat B' and 'C' calls are coming out as 'Cat A' calls because it is often classed as "Bleeding from dangerous location".

"Dangerous area" seems to be a new criteria with this 'upgrade', as it's the discriminating factor on a lot of the calls I go on.

I've just come back from a 'Cat A' call to a 16 year old boy who heard a crack in his neck as he got out of bed. No history of trauma, no neurological deficit, just the normal sound us old people make after waking up.

This was a 'Cat A' because it was a "Dangerous area". I hate to say it, but pretty much every point on the body could be considered a "Dangerous area" depending on what had happened.

I understand that we have to over-triage in order to be safe, but our Call-takers aren't allowed to use any common sense or clinical judgement in deciding the category of a call. It's all very " Computer says 'No'", I'm afraid.

The flipside is that strokes (CVA) tend to be categorised as 'Cat B' calls, which is something that really needs to change if the National Service Framework is to be implemented. Road traffic accidents also tend towards being 'Cat B' calls.

Crazy.

Why am I mentioning this? Well I've just come back from the boy with the neck cracking, and after cracking my knuckles in front of him, the crew took him to hospital and the thing is, after being either cleaning my new flat, decorating it or at work for the past month, I'm starting to have a sense of humour failure.

So I may be a little 'terse' with some of my patients.

Which is good, because if you mollycoddle idiots they'll only think that what they have is serious.

Reynolds is moving on Tuesday, and has a lot of packing to do by then, he is tired, fed up and looking forward to the end of the week when it should all be finished and he can get back to the pursuit of joy...