I'm sitting in the back of the ambulance watching as a sixteen year old girl cries while explaining to the policeman why her father beat her.

Her tears are falling onto her clothes leaving small salty circles.

While she is in pain, this isn't the reason why she is crying.

She uses up the last of our tissues.

Her jaw and chest are hurt where he used his fists and feet to beat her. I'd say that she has at least one broken rib.

I sit there listening to a long list of abuses her father has visited upon the whole family, from the seven year old up to his wife.

She didn't deserve this.

Her tears only stop once we reach the hospital.

NeeNaw gives a description of a job very similar to one I went to today.  I may have been a trifle rude to the drunk I found laying on the couch…

Loads of stuff, including twelve hour shifts has meant a slight slacking of the blog.  Time for some catch-up.

• Mac Expo – Fun, and I met Magwitch, who’s blog you should definitely read.  I do dearly love my Mac (and my Windows box, and Xbox360 and…)  The problem with the Mac Expo was that there was a lot of nice software, just priced way out of my range.  £576 for a software backup solution?  No thanks!  I did buy one bit of software, and I’m training it now.  There were some good demonstrations and the general ‘vibe’ made it worth goig.
• Laura is, as always, lovely and somehow is managing to put up with me and my personality.  She is obviously a saint.
• I was in the Metro last week – I’m not sure if I should be happy though…  Allow me to explain.  I was approached by a PR company handling the new ‘Saved’ series.  They asked if I would do an interview with an online site and I agreed.  Then, without my permission, they reprinted some of my blog in the Metro as pretty much a full page advert for ‘Saved’.  While the blog is Creative Commons licensed, it is licensed under a non-commercial license, meaning that you cannot use it for commerical use without my permission.  So I’m not really happy that it got used without them even asking.  I may give them a little phone on Monday – or they could phone me…
• What would you say if you had a chance to have a chat with the writers and producers of ‘Casualty’? On Tuesday I get a chance to have a chat with them and *ahem* put them right.  I understand that they must make the programme interesting, but it just seems a bit like the writing is lazy.  I think it would be for the best if I stick to the medical side of things.  Still, I’ll be enjoying their hospitality and will blog about what happens later.
• I have a shiny new Bluetooth GPS receiver which, when coupled with my phone, means I’ll never get lost again.  Superb!
• (Too busy to answer loads of emails #1) Loads of people offered me hosting for a Wordpress blog, they are all very kind and I’ll be making my mind up about such things next week.
• (Too busy to answer loads of emails #2) If you have sent me a ‘Thanks, I like your blog/book’ email, I will answer them, but it takes time for me to do so.  Sorry.
• (Too busy to answer loads of emails #3) If you have emailed me about something important, it’s probably dropped off the face of my world, if you want to be sure I got it, please send it again.
• Couple of medical stories are in the ‘vault’ ready to be written, normal service will be resumed soon, etc, etc…

Here is a question. Describe an ambulance.

For most people it would be a big white (or yellow) box with blue flashing lights, when you dial 999 it turns up and two ambulance people put you in the back of it and it trundles (or rushes if you are sick) off to hospital.

Not for much longer.

In the near future the LAS will send a lone person in a car to anything that doesn't obviously need an ambulance (I'm not sure about the exact policy for who gets a big ambulance as well, I think it's being worked out). That person on the car will then decide if a 'big' ambulance is needed or if the patient can be treated by a GP/ECP/Walk-in centre.

The numbers I have been given by one of our managers is that the number of 'cars' will increase from 70 to 210 across London while the number of 'big' ambulances will be reduced from 350 to around 250.

I can understand what our management are thinking, as anyone who has read this blog for any time will be able to see, a lot of our calls don't require ambulance treatment. In an LAS report half of our patients don't need hospital treatment and in fact only 10% of our calls are life threatening.

As I've mentioned in Monday's post we are getting our budget cut so we need to 'think smart'.

There are problems with this approach though. I (and many others) are of the belief that everything goes to hospital, it only needs one person to die at home (even of an unrelated cause) and if you are the last healthcare person to see them then it is 'your fault'. We will no longer be able to do that, the expectation will be that the people on the cars will be refusing ambulances to people. Refusing an ambulance, especially if you are on your own may well increase the number of assaults on crews, not to mention the (governments) 'Patient's Charter' says that if you demand an ambulance, then you get an ambulance...

I would assume that those going on the cars will get extra training, which costs time and money and will be a slow process.

I also wonder if going on the car will be a volunteer position, because if so I doubt that the cars will be fully manned resourced. A lot of people (myself included) would go insane working on our own for any length of time.

It could work - I hope it does because we don't have the government support to provide more ambulances. I have a sneaking feeling that it won't.

I just wish I had a better (quick fix*) idea.

Magwitch has already touched on this subject.

*My long-term fix would be to hugely increase health education in schools, but the results of that would take a generation to come into effect, no good for a government looking for re-election.

The Healthcare commission assesses and rates all NHS trusts.

The LAS got a 'Quality of Service' of 'weak'.

The reason?

We failed "All ambulance trusts to respond to 95% of category B calls within 14 minutes (urban)" - Possibly because we are chasing after Category A calls with not enough ambulances.

We also 'underachieved' at "Deliver a ten percentage point increase per year in the proportion of people suffering from a heart attack who receive thrombolysis within 60 minutes of calling for professional help." - Is this because we don't do thrombolysis in London, instead we take the patient to an angioplasty centre, which is much better for the patient.

So, once more we are punished for not having adequate resources and punished again for providing a service superior to that normally expected.

We are getting used to be valued by the government.

Our boss gives his response here.

Right, a bit of a moan.

When us ambulance people signed up for Agenda for Change, we realised that while we would be taking a cut in our basic pay, the deficit would be made up by our 'unsocial hours' payments.

It works like this - I am paid a basic wage. If I work 'unsocial hours' then I get paid more for those hours. 'Unsocial hours' are currently between 7pm and 7am in the morning.

The government is changing the boundaries of the unsocial hours to 8pm to 6am. That's two hours less a day.

I'm hoping that our pay will remain protected (i.e. not drop below the amount I was getting paid before Agenda for change started).

Secondly, more crap from the government. We, and other healthcare workers are going to get a pay rise pegged at 1.5% as opposed to the rate of inflation which is 3.6%. I'm looking forward to that extra 2p per hour given that our role keeps expanding.

Is it any wonder that workers keep leaving the NHS?

Finally, the London Ambulance Service ended up financially 'in the black'. So our budget is being cut by £3 million and is being given to a failing department. This has meant a reduction in overtime, which again has reduced some people's take-home pay. Given that our trainees are paid 75% of the basic wage and many of them rely on the overtime, now there isn't enough to go around. While manning is at an all time high, there are plenty of rumours that large numbers of ambulances are going un-resourced*.

So we are being 'punished' for saving money, we are going to get paid less and our pay-rise is lower than inflation.

If it wasn't for the government it'd be a nice job.

I'm glad I'm not the boss of the LAS.

Maybe Dr. Rant has the right idea.

*I was told off for not being politically correct when calling the staffing of motors 'manning', hence 'resourced'.

There is a secret(ish) forum for as ambulance staff, one of the people there posted this, while slightly tongue in cheek I thought that it would be shamefully wasted if it stayed on the forum. I reproduce it here for your reading pleasure. Send happy thoughts and wishes of quiet nightshifts to 'The Saint' who originally wrote this.

Would all helpful passers by please note:

If you really must ring for an ambulance for someone you see collapsed/dead/fitting/sat in a shop doorway, please ring then, and not three hours later, by which time – not surprisingly – the deceased has got up and left.

Two adult males sitting outside South Kensington tube station, sharing a bottle of Diamond White cider are NOT collapsed – they are having breakfast/dinner/lunch/a party. Singing, talking, vomiting and belching are all indications that the said males are alive.

Someone who is sitting in a shop doorway when it’s pissing with rain is SHELTERING, not collapsed.

Just because someone with crutches is sitting down, they are not necessarily in need of medical intervention. Having hospital crutches is a clue. They have already been to hospital, and have been discharged.

If you really feel you just have to interfere in the life of a person happily sitting there drinking himself into alcoholic oblivion, when you ask him if he needs an ambulance, please take it as a massive clue when he says “Faaaaaaaaarrrrrrkkkkkk Ovvvvvvvvvvv!!!!!” This is his little way of saying “Thank you for your concern, but I’m fine.”

When someone tells you they are fine, and they do not want an ambulance, please, please, please believe them. They are NOT lying – they know what they are doing.

Someone who is staggering between point A and point B CAN walk. The helpful clue is the movement of the legs and feet. If someone tells you that they cannot walk, but their legs are moving, THEY ARE LYING. Don’t believe them.

Green stuff coming from a drunks’ nose is NOT a reason for an emergency ambulance – it is actually a reason for an emergency hankie. Green stuff emanating from the patient’s nose is very rarely Cerebro-Spinal Fluid, despite what you might have learnt from Casualty, ER and Holby City. It is SNOT.

If you see a pair of legs under a car, and the legs are surrounded by mechanic’s tools, the person under the car has NOT been run over – he is more than likely to be FIXING it. Other clues are the radio playing nearby, and the deceased singing along to the music.

Talking of cars, if you happen to see several cars colliding with each other, and you can’t get through to the ambulance service, have a look around you. Yes, the other twenty people with phones stuck to their ears are ALL calling the ambulance service. That’s why you can’t get through. And please tell us the right location – saying you are on Greenford Broadway when you are on Southall Broadway is less than helpful. And please don’t insist you are right and the other twenty callers are wrong – it is highly unlikely.

Oh – and – please do not call the ambulance service if you see 200 people fighting on Fulham Broadway on Friday night. We are not remotely interested, and will not become interested until the police arrive. The police have guns, batons and CS gas, and can deal with a large fight a lot better than two female LAS personnel who are five feet nothing and jointly weigh 12 stone, and are only armed with rubber gloves and a frothy cappuccino from the Wild Bean Cafe. Please ring the police first – we’ll pop along a bit later. Honestly. We will.

Finally – the dictionary meaning of the phrase “passer by” is “A person who happens to be walking past someone or something.” It does not say “A person who stops and interferes. Don't do it Mate - it's not worth it!!

(I'm horribly ill at the moment, so this is also a cheating way of posting without much work on my part).

9010 is our code for 'Assist only, not transported'.

It's a grey, horrible day. There is a constant drizzle of rain and when I got in my car to come to work it was so humid everything I touched was sticky.

Our first call of the day was to an elderly female who was believed to have had a CVA, a CVA is another word for a stoke. It's never a nice job, so my heart sank*

We arrived to find the patient sitting in her living room chair, also present were her friends (who have a front door key) and a carer who was preparing breakfast. The patient was *lovely*, she was sorry to have called us out and was, as is common with our older patients, worried that she was wasting our time.

She hadn't had a stroke, instead she had been unable to get out of bed, and so had crawled onto her landing on hands and knees in order to get some help. Her bed had recently been changed after being discharged from hospital a week ago and the rails that she used to get out of bed had been left leaning against the wall.

So my crewmate and I fitted her bedrails. Then we made sure that she could get into and out of bed. I then checked her physically to make sure that she wasn't hurt in any way. We then had a nice little chat, flirted with each other a bit and then, because the patient didn't want to go back to hospital, left her with her carer.

Throughout this call the patient was really worried that she was wasting our time. Personally I think it has the chance of being our most worthwhile call all day - we turned up, fixed her bed (even though that isn't our job) therefore providing her with some more independence. We left her at home feeling happy and more confident about moving around the house. This wasn't a job where we save someone's life - but it was still hugely satisfying to help her out, even if it meant using common sense rather than following any protocol.

*This is also the day that 36% of the world think that torture is acceptable, that America decide that they will annex space and Blair demands more power for control orders and right minded people watch the funeral of 'habeus corpus'...