Blah...blah, ORCON...blah...lack of patient care...blah...blah...stupid government target...blah...blah...no rhyme or reason...blah...blah...

You have heard me ranting about ORCON many times in the past, about how it causes a reduction in patient care, how it isn't a good reflection on an ambulance service and how there seems to be no evidence as to why eight minutes is so important. Whenever I've asked about the magical eight minute figure no-one has been able to give me a straight answer.

The (excellent) Magwitch has taken on this mystery that no ambulance person has been able to answer and has detailed his findings here. It's a superb read and I suggest you all take a look at it, and the comments, and decide for yourself why the reasons for this target seem to be hidden.

I think some further investigation is needed. Anyone an expert on the British Library?

There is a road on our patch that I'd never been to before, there are only thirty or so houses in it. However, in the past two weeks I've been there on four occasions.

Last night I was there because someone had slipped and fallen on the floor. Last week I was there for an ill child, but it was the first two times I went there that will stick in my mind. They were both on the same day.

It was the first call of the evening, a 'difficulty in breathing' for an elderly woman. We entered the house to be surrounded by a large number of relatives, this isn't unusual it was an Indian family and they tend to be large. The patient herself was a very frail and bedbound elderly woman, she had had many strokes in the past and was dependant on her family for her care.. It didn't need the FRU paramedic to tell us that she was extremely unwell. The patient was unresponsive and had laboured breathing. She had a sheen of sweat on her, a sign that her body was struggling and she was completely unresponsive.

It soon became obvious that the patient had pneumonia and wasn't shifting enough air to keep alive. We loaded her and one of her relatives onto our ambulance and 'blued' her into hospital. The relative seemed resigned to our patient dying, we couldn't disagree with them.

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By the time we took our next patient into the same hospital, all the relatives had arrived. They had spoken with the doctors and it was decided that it was in the best interests of the patient to not pursue any active treatment, and instead to let her die. The relatives had asked if they could take her home, and the hospital was in the process of arranging transport for her.

It must have been a hard decision to make - having seen many, many futile attempts to save someone's life, it always seems to involve pain and suffering as needles are pushed through skin, drugs with nasty side effects are given and breathing tubes are inserted. It was brave of the patient's relatives to make that choice that this moment was the end of their loved one's life and that it should be as undistressing for the patient as possible.

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It was less than an hour later that we were called back to the same address, the job was given as 'patient deceased'.

What had happened was that the hospital transport had taken the patient home and, before they left, the patient died. They then advised the relatives to call for an ambulance.

So we arrived and everyone decided that it was for the best not to resuscitate her. We offered our sympathies and arranged for a GP to come out to certify the death.

The family were lovely, they offered us tea and thanked both us and the hospital for what we had done. We hadn't saved her life, but we had allowed her to die with some dignity at home, rather than being treated futilely on a hospital trolley.

When I went back to the same address a couple of days later (for the sick child), I saw the funeral notice on their front door. Last night when I went back to the same street for the woman who'd fallen over, one of the family came out and thanked us again.

Four times to one small street, and with a family and a 'job' that I'll remember for a very long time.