Picture the scene.

You are 60 years old, suddenly you have started to have real trouble breathing - it's like running a marathon and then being forced to breath through a drinking straw.

You have never had anything like this before, deep in your chest you can feel the wheezing as you breathe in and out.

It's night.

You phone your GP and he comes out to see you. He gives you eight tiny pink pills, and tells you that you need to go to the hospital as an emergency case. He calls for an ambulance.

Then he leaves.

I honestly can't believe this - you have a patient who is not only 'properly' ill, but is also rightfully scared. So how can you leave them at home and not stay with them for the short time it takes for an ambulance to arrive?

I know what would happen if the patient died - the Ambulance service would be blamed for taking too long to get to the patient, rather than look at the motives of a GP who is quite happy to leave a seriously ill patient alone.

I don't know how some people can sleep at night.

However there are a few GPs who stay on scene with their patient until we arrive - I always make a comment of thanking them for doing this. In return they seem surprised that the majority of GPs are happy to leave patients alone

To whoever it main concern,

The feeling on the 'shopfloor' of the LAS is that morale is suffering.

I think that part of the reason that morale is so low is because of the lack of communication within the service. While we do get bulletins every so often, I would suggest that this isn't enough.

When there isn't effective internal communication there is opportunity for rumours to breed. So for the past two years the whole Agenda for Change process has been subject to some astoundingly inaccurate speculation.

As a consequence of of this rumour-mongering people are unsure of the future, and this does not keep a workforce happy.

So I would like to suggest how the internal communication within the LAS could be improved in a way that would cost next to nothing.

We are all aware of the banned unofficial forum, yet it has become one of the ways in which news is spread quickly throughout the service. While some of the reports on the forum are true, it has also become a breeding ground for false information through incorrect interpretation of official bulletins, and via 'friend of a friend' information.

A recent example of this is the rumour, or truth, as there has been no official word, of cameras being fitted in the back of new ambulances in a bid to stop violence against crews.

My suggestion is that there should be one place on the service intranet where selected people (station and sector reps, team leaders, DSO's and a person from each meeting group) can publish exactly what is happening.

Perhaps it could even allow comments from people on station.

In essence, internal blogging.

I understand that we have the internal website "The Pulse", but there are sections on that which haven't been updated since 2003, and while there is some good information on it, the focus is too broad, and it reads as if it has been written by a committee more used to making press releases.

A blog is extremely cheap and easy to set up, even easier to maintain, and can have multiple authors.

You can set up a way to post to it via email, so minutes of meetings could be published as quickly as they are typed up.

Imagine a situation where a crew can come on station, click on the link to the internal blog and instantly find out what is happening in their area, in the service as a whole and what was decided at the vehicle steering group.

If the blog allows comments (perhaps moderated), then when Team Leader 'X' mentions that they are having the stations on that complex repainted, then roadcrews could make suggestions about the colour of the paint.

This internal blog would not replace the traditional bulletin system but, for a miniscule outlay would actually enhance it.

I am, of course available for consultancy.

The usual disclaimers apply

This is a post that has been a long time coming, if only because I can't really think of a way to make it in the slightest bit interesting.

Agenda For Change.

The short (and therefore hopefully less boring) version is this.

The government want to standardise pay for the whole of the NHS, so they are splitting different wages into 'bands', from band 1 the lowest, to band 9, the highest. Within each pay band is a range of potential wages, so, for eaxample, pay band 4 starts at £16,004 and then increases in 6 increments to £19,284.

Band 5 starts at £18,698 and then increases in 8 increments to £24,198.

Are you with me so far?

To decide what banding each profession in the health service starts at a group is convened, and they "job match". So if for example you "Supervise fellow workers", or "At risk of potentially serious physical abuse", then you score some points and can be put into a higher band.

This is the problem that we in the ambulance service have - because of the things we are expected to do in our daily work, the government would have to pay us a lot of money.

So it has taken two years for them to try and work out how much to pay us.

They still haven't decided.

But today (actually I as was writing this) they published their findings.

Paramedics will be paid in band 5 (to be reviewed in 12 months).

They still haven't decided on EMTs (which is yours truly).

The bulletin that we have just recieved states that 'experienced' EMTs will be paid in Band 5, while less experienced ones will be paid less.

This is, frankly, a load of bollocks.

The reasoning behind the different increments within the band is that this is to represent increasing experience. The banding is supposed to represent what our job is.

EMTs all do the same work, so why I should I find myself working with someone who does all the same things that I do, has the same skills and has exactly the same job description, and yet gets paid a differing amount.

(But we won't know for sure for another two weeks...)

I can see a few things happening.

First, the Unions have all signed up for this, and so the general feeling from the crews on the road is that we have been sold down the river, this means that morale, which is poor at best, is going to plummet.

Secondly, I imagine that our ORCON percentage (our main benchmark of performance) is going to also take a nosedive.

Thirdly, it's going to cause friction between EMTs, paramedics and Team Leaders (who are on Band 6 despite hardly touching a patient). Especially when you consider that Paramedics are going to be paid their new, higher rate much earlier than any change in EMT wages. Add in the time that it will take for them to decide which EMTs are better than other EMTs and there will be a huge disparity in pay for quite some time.

My next post (assuming a Major Incident doesn't happen beforehand) will be about how the LAS could have lessened this problem.

Just to remind everyone (because at the moment I am incredibly angry, and this may explain any typos) is that the thoughts and views expressed here are mine alone - they do not reflect on my employer, or anyone else in the service.

Here is the thing.

I’ve got a friend who works with the blind and partially sighted.  Unaccessible websites drive her (rightfully) potty.

My web design skills are so poor that I’m not sure how accessible this website is for that sort of person, I’m not sure how screen readers and magnifiers cope with the design.

(I would change the design, but I haven’t a clue how to do so in order to make it more accessible).

So I had an idea, one that I don’t think anyone else is doing, and that is to podcast my reading of my posts.

Preferably at the same time I write them, but if I’m writing them at work, then as soon as I get home to where my (new) microphone is.

So if you have trouble reading my site, you can instead listen to me read it out.

So there will be two podcasts, a weekly one where I’ll talk about all different stuff, and this new one where you can get a vanilla audio version of my posts.

The feed for this is http://randomreality.libsyn.com/rss/Audiopost

Obviously I’ll have to fiddle around with it a bit, to get the right settings/file size/format, but hopefully it’ll be a step in the right direction towards making the internet and blogging a bit easier to use for the blind and partially sighted.

Let me know what you think.

It's funny how the niceweather we are having at the moment makes you look at everything in a different, happier light.

Take today for instance - I was sent to a 'Life status questionable' in the street. Now a 'life status qestionable' is supposed to mean that the person who called us doesn't know if the person is alive or not.

What it means in reality is that the caller has either driven past in a car without stopping, or the patient has such an offensive smell that the caller dare not get close to them.

So I rush to the scene, and find an alcoholic sitting in the street. Around him are his four alcoholic friends.

the person who made the call is nowhere to be seen.

"He's just tired", I'm told by one of his friends.

"Why's that?", I ask.

"Well, he's just walked from Whitechapel", Whitechapel is about 6 miles away.

"Oh", I say, "No wonder he is having a bit of a sit down".

"This'll help him out", says one of his friends giving him a can of Special Brew.

The ambulance crew turn up, and we all have a little chat on the corner of the street - everyone is as nice as pie, and no-one is really injured.

I know that I should be annoyed (waste of ambulance time and resources, waste of lives on behalf of our alcoholic friends), but it wasn't really their fault that an ambulance was called.

And the sunny weather just put everyone in a nice mood.

Long may it last...

Of course saying that nice weather means that young men drink long into the night, and then beat each other up

Very little scares me, violent drunks, dark alleys, terrorist bombs, careening around corners at silly speeds - none of these things bother me.

But I do have one completely irrational fear.

And today, I faced that fear.

Terror is often depicted as happening at night, in the middle of a thunderstorm - but for me terror happened on a sunny Monday morning...

The first job of the day was nice and simple, a little old lady with a leg infection who needs some antibiotics that can only be given at hospital.

Just don't ask me why this was a high priority call, and therefore needed a rapid response unit.

I spent some time chatting with the patient and her relative, nice enough folks just feeling let down by their GP. Little did I know the trauma that would soon be inflicted on me...

The ambulance crew turned up, and put the carry chair next to the patient. The patient was having severe pain on standing, so one of the crew and the patient's daughter grabbed an arm each and gave her some help standing.

During this I'm standing in the kitchen door, and the other crew is standing in the hallway door.

Then I see it.

I have big hands, and the spider that ran up the back of the patient was just a shade smaller. I was standing some way away and even with my poor eyesight, I could see it's huge fangs, it's hairy legs, and an evil glint in it's eyes.

I froze.

I'm not f**king wrestling with that monster, was the first thing that sprang to mind.

Sprinting onto the patient's head it sat there for a moment, no doubt deciding which of us would make the tastiest meal.

The daughter screamed, the (female) crew helping the patient screamed, the (male) crew standing in the doorway swore, screamed, and ran out into the hallway to hide.

"Get it off! Get it off", the daughter screamed.

The spider decided to sit on the face of the patient, it's legs gripping the patient's ears like a facehugger from the Alien films.

"Eeek!" screamed the patient.

The daughter then smacked her mother right in the face, and the spider went flying across the room. I had visions of it smashing into a vase, bringing it crashing to the floor.

(Did I mention that this spider was fairly large?)

I'm standing there like a lemon - my long dormant arachnophobia flaring into action, I was petrified.

I don't like killing things animals, I even fish out the silverfish from my bath before washing my hair - but if this thing came near me it would be a fight to the death.

The patient sat alone in the room in the carry chair, breathing heavily from her daughter's assault.

Neither of the crew wanted to go near the patient in case the spider was merely lurking...biding its time until it could attack. My bags were taken off me and I was told in no uncertain terms that it would be me who would approach the corner in order to actually collect the patient.

A deep breath, a muttered Litany against fear, and I scooted across the room and, keeping my eyes on the many dark corners, swiftly bundled the patient up and got her out of the house.

"Don't worry", said the daughter as we left the house, "Mum's dog will soon eat it".

Depends how big the dog is, I thought...

I was going to moan.

I was going to tell you about the driver who tried to play 'chicken' with me. I would have told you about the brain-dead idiot who ran out, without looking, from behind a bus, causing me to leave 20ft long skidmarks (on the road thankyouverymuch). Maybe I would have mentioned the kid who thought it would be a fun thing to pretend to jump out in front of my car. All while on blue lights and sirens.

I might even have complained about the maternity department who told their patient to "phone for an ambulance" (which she plainly didn't need).

I definitely would have told you about the two drivers who couldn't wait for five seconds before swearing at the ambulance crew and myself for 'blocking the road'. Didn't matter that we wanted to see if the guy lying on the pavement was dead or not. They only stopped shouting when two policemen sauntered over to them in their "I can't believe you are that stupid" way, cultivated by long hours in Newham.

I would have moaned, but I've had two Chinese takeaways, so I am now feeling content and will therefore tell you about how the internet saved the day.

I got called to a 14 year old female in a block of flats who had collapsed.

Nothing particularly interesting about the actual collapse, but what was interesting was how the ambulance was called.

The patient was talking to a friend via a web cam.

Her friend saw her collapse (well slid down under the view of the web cam).

Her friend then phoned the patients house, where the phone was picked up by the patients gran.

Gran then rushed into the patient's room where she saw the patient collapsed on the floor.

Gran then phoned for an ambulance.

We turn up.

We save the day.

Yay for us.

So all hail the internet, saviour of teenage girls!

WARNING: This posting may be just a tiny bit uncharitable. Blame it on me working a busy nightshift.

Poxy bloody heroin addicts.

This post may also be just a shade judgemental...

I got sent to a call, "Male collapsed". I'm first on scene and as I enter the flat there is a partially dressed man on the floor with a woman kneeling over him.

At least she is honest.

"He's clucking, because he used to inject, and now smokes heroin. We had a fight now he's acting strange".

'Clucking' means that he is withdrawing from heroin.

"Is he on methadone?", I ask.

"Yes, but they don't give him enough", she replies.

Heroin addicts never think they get enough methadone, which is a drug that is used as part of heroin addiction treatment.

She continues, "so he went a bit strange, so I gave him a few runs to see if it made him any better".

'Runs' are a description used in smoking heroin.

So his addict girlfriend (she admits to sharing a drug of choice) has seen him go a bit strange and thought that giving him some heroin would help.

Normally this wouldn't be too much of a problem, we'd take him to hospital and let them sort it out...

But this one doesn't want to go to hospital. He is refusing despite using our range of persuasion tricks.

Apparently the local A&E doesn't give him enough methadone either. Apparently he has to take heroin with him when he goes to A&E so he can have a smoke of it outside the department.

We are stuck. We can't drag him out, his girlfriend and mum can't persuade him to go, and the police won't be able to do much.

This is also the sort of job that can (in the local slang) 'go bent'. In other words, this is the sort of patient who will take great pleasure in dying five minutes after we leave.

The ambulance crew decide to get an officer on duty to come down - this covers our backs, and means none of us should get the sack should the patient decide to stop breathing.

I'm sorry to be judgemental, but as soon as you start thinking it's a good idea to start injecting heroin into your veins, you stop being a human being, and instead step outside normal society.

I've never met a heroin addict I've liked.

On the flip side, there probably aren't that many heroin addicts who have found ambulance crews that they like.

It's on jobs like this that I rely on the training, and on my belief that, no matter how little I like the patient I'm treating, if I'm nice and polite to them it makes my life so much easier. I'll also treat them to the best of my ability, because anything else would just be wrong.

But it certainly doesn't help to think that while I am treating this patient there may be some little old lady, lying on the floor with a broken hip, awaiting an ambulance which is slow in coming because we are tied up dealing a heroin addict.

It also makes me both angry and sad that this person has completely wasted their life instead of doing something useful and productive. And don't forget the relatives, friends (and quite possibly) victims of crime) that are affected by his addiction.

And then after this job I get three maternataxis one after another.

Still, as my mother says "It must be nice to be busy - it must make the shift pass quickly".

I'd still like a cup of tea every so often...

And with a bit of luck I'll be in a better mood tomorrow. In the meantime - Does anyone know a good nightclub in London for a Saturday night? Does the LA2 still play 80's music? Every time I work nights I look with envy at people enjoying themselves - so this weekend I intend to enjoy myself and maybe go 'clubbing'.