I'm reliably informed that this job came out as 'Man knocked down'. It's a big fear that we all have that we get attacked while going about our work and it is for this reason that we will hold back and wait for the police if a job seems 'dodgy'. The problem is that sometimes you have no idea that there is a danger in the area.

My thoughts are with those affected by this, both the man who was killed, and the others who have been hurt. I hope the crew involved aren't badly hurt and I wish everyone a speedy recovery.

There are a lot of people in my area who don't speak English as their first language, actually, there are a lot of people who don't speak English at all.

The reasons why I don't like it when people can't speak English are because it disadvantages them both personally and in society.

Personally I like to be able to talk to the patient themselves, while we often use other members of the family as translators it is a poor substitute for talking to the patient, being able to interpret their tone of voice and body language.

Certain topics can be tricky to deal with via a translator, the recent spate of domestic violence cases I have been going to are much harder to deal with through a translator, I always have the fear that the patient is being misinterpreted either accidentally or on purpose.

Then there are conditions for which some translators are perhaps ill-suited. We often use small children as translators as they often have the best understanding of English. Using a small child to translate for their auntie who is having a miscarriage is always tricky.

A huge part of my job is to reassure people, it's a lot tougher to reassure someone if you can't speak their language.

Then there are the societal problems with people who don't speak English. I go to a lot of places that are quite insular. The people I meet buy all their goods from people who speak the same language as them, their friends all speak the same language and they only watch the television that comes in their language.

This leads to people not becoming a part of English culture. Now, you may call me imperialistic, but I think that English culture is pretty good - we have sex/race/cultural/diasability equality (with varying success), we frown on people beating their children/wives and I'd say that we are fairly open with respect to other people. When people come to live in this country I like to think that they would take on some of these properties, but this is much harder if they don't speak English as it means that they can remain insulated from 'English' culture.

To help with the translating we have 'language line' which is a telephone translation service. It enables us to use our mobile phone as a 'universal translator', which is very cool, but also very expensive. To be honest I'm yet to need to use it - I'm pretty good at understanding people based around body language, the few words of English that they can speak and the waving around of hands.

To be fair, for a lot of people it's not that they can't speak English, but it's more that they are not confident to speak it, I try to encourage them and to provide a space, in the back of my ambulance, where they can try talking English without fear of being ridiculed.

It keeps my working day interesting at least.

There are times when it is simpler, and better for the patient, to stand back and let the relatives decide the best case of action.

I went to an older woman who had suffered from a stroke some time earlier, she had made as good a recovery as expected and was being looked after in her home by her family and some paid for carers. There was a lot of equipment in the house. Lifts and hoists had been installed, the patient had a modified wheelchair and a specialist bed. The reason why we had been called was because she had developed a chest infection - this can be very serious in someone who is essentially bed-bound and so she needed to go to hospital.

As I walked into the house I sensed a vague negative attitude towards us - it may have been that they were waiting some time for the ambulance (as it was one of our low priority calls), it may have just been that they were rightfully unhappy that their mother needed to go to hospital again. So the atmosphere in the house meant that I would have to handle the family carefully. The family had a lot of experience with their mother, so, where we would normally 'barge in' and take control of the situation I decided that I would discuss the best way to move the patient with them.

At every one of my suggestions I explained the reasoning behind my thinking, and I let the family use their equipment to carefully, and in their own time, move the patient to the hospital.

And the end of the journey the relatives were a lot happier, all because I let them do most of the 'work'.

If there are any spelling/grammar mistakes in the above post - tough. Today is the only time in three weeks I get to see Laura. I hope you understand.

"Our eyes met across a crowded room"

One of the things that Peter Bradley, the boss of all the London Ambulance Service, does is to occasionally come out on the road and do a shift working on an ambulance. Last night he was in our area teamed up with a team leader, running an extra FRU car. Whenever he has been around I've not been working, however last night I was working at the same time...

We were called to a 37 year old man who was 'suspended', not breathing and with no pulse. Control told us that there was a hysterical woman on scene and that it was a child who had called us. We rushed around there and saw that we had been called by a passing teenager. Hopping out of the ambulance and I saw a FRU pull up behind us. In it a team leader...and the Boss.

My crewmate and I ran into the room and found the man dead - there was nothing that we were going to be able to do for him. Sticking out of one leg was a needle and on a nearby workbench there was some citric acid, a spoon, a lighter and other drug paraphernalia. It looked like he had overdosed.

There was nothing that we could do except for wait for the police, the team leader and the Boss looked after the distraught wife and the man's young daughter, while my crewmate and I made sure that no-one altered what could be a crime scene. It's very sad to see someone so young dead, and to leave behind such a young child is terrible. We try to rationalise this by saying to each other that perhaps she is better off without a drug user in the house, but... I just don't know.

The Boss and Team Leader came back in with the police to show them the body and I bid farewell to the Boss with a cheerful, "Welcome to Newham sir".

The team leader seemed very eager to get him away from me, I have no idea why. This is a shame as I would have liked to have asked him how crap it felt to be screwed over by the government so much.

Actually, I think that may have been why the Team Leader was so eager to get him away.

The health secretary admitted there would be difficult decisions to be taken on staffing, because "some parts of the NHS in England have taken on too many doctors and nurses".

Good grief, Hewitt is bonkers.

I'm beginning to think that 'Care in the Community' for our mentally ill has gone a bit too far when one of them has become Secretary for Health.

NHSBlogDoc is as incredulous as I am.

I'm watching the TV and a politician has just referred to people who 'binge drink' as 'people who drink to get drunk', a phrase I first used on this blog a year ago. Maybe someone in government is reading this site?

I've written before about how I am a different person when I'm wearing a uniform, how I am more confident, more proactive and sometimes a bit more 'shouty'. The reverse is also true and I think that this is, in some way, due to the way that people treat me when I'm wearing the uniform.

People see me in uniform and permit me to direct them, advise them and do things physically to them. Without the uniform I can't do this.

It all became obvious on the way home from the centre of London one night. I was using the tube and, on coming up an escalator while changing between lines, came across a man who had collapsed.

There were two members of the public with him, a station officer and a station cleaner. As I approached I saw that he was pale and sweaty, he triggered that bit of my brain that says 'this person is properly ill'.

I tried to walk past, I really did. I think I got two steps beyond him before turning around and returning.

"Hi there, I work for London Ambulance, can I help?"

He'd apparently became dizzy and then had collapsed, a little chat with him revealed a significant history of internal bleeding in the past. Feeling for his pulse I couldn't find a pulse in his wrist, this meant that he had a very low blood pressure, this would explain his paleness and sweatiness.

I asked the Station officer if he'd called an ambulance, and he mumbled something in the affirmative. I tried to take control of the situation, but it all came out a bit vague and quiet. I put the cleaning bucket under his feet to try and raise his blood pressure a little and awaited the ambulance.

All the time this was going on I was feeling rather vulnerable, unlike when I am 'on the job', I could also tell that the people I was with weren't taking me as seriously as I would had I been wearing a uniform.

The ambulance crew arrived and I handed the patient over to them. They didn't seem impressed, again probably because I wasn't wearing my uniform.

As I walked away I felt rather bad, If I had turned up in a FRU car, then the job would have felt very different, but without my uniform I wasn't as confident.

It's funny what a green shirt can do for your confidence.

I had a job that required me to undertake an extended role.

The call came down as 'Patient's own hospital bed broken, patient stuck', rather predictably I had visions of some little old lady folded in two by an electric bed.

The 'patient', as it were was sitting in their chair, he husband was running around flapping and the domestic carer was looking confused.

The bed was a type that I had never seen before, it had a hydraulic ram underneath it which tipped the mattress on end by 90 degrees, I suppose so the patient sort of 'slides' into an upright position.

The bed was stuck in this upright position - if the sheets had been black it would have looked like the Monolith from 2001.

After some fiddling around (a technical term) I managed to get it into the horizontal position and checked that it would raise and lower as designed. I'm grateful for my various experiences fixing broken things.

So ten minutes later, after pointing out the rather large print on his bed's instruction folder (Which said 'Emergency out of hours technician ring 0800 xxxx'), and we left another satisfied customer.

I decided to have a joke with Control.

"Control, The patient's bed is fixed, I'll do my paperwork for this job then I'll be ready for any blocked gutters or windows that need fixing".

Funny how people panic and call us...

I have a problem with knees, partly it's because I'm slightly squeamish about them, partly because when they break or dislocate it is incredibly painful for the patient.

Our woman had slipped on a wet floor, she had landed on her knees and, after we drove across most of our patch to get to her, we found her laying on the floor.

Upstairs.

In a narrow corridor.

She wasn't a 'small' person either.

My physical examination led me to believe that she had broken or dislocated her knee - it was a bit tricky to examine her in the enclosed space she found herself, her weight didn't help either.

The patient was lovely, she understood why she had waited so long for an ambulance. She'd also taken some painkillers before we arrived, something that is an absolute rarity. She was nice to talk to and when I explained that we would take things slowly for her benefit she understood.

First thing that I did was to give her some of our painkiller gas entonox. Then I slipped a splint around her injured knee, this combination seemed to help the pain a lot. She proved to be a good patient by immediately understanding my instructions on how to take the entonox - another rarity in our area.

The staircase that we needed to get her down was steep and narrow, there was no way we could use our carry chair. She would have to be strapped to our scoop and carried down the stairs that way. But we would need help.

I'm 6'1", my crewmate is 5' 1 1/2", not the best combination of sizes for getting a large woman downstairs on a scoop (although my crewmate would like you to all note that she (believes) is the strongest one out of the both of us). So we called Control for assistance, namely another crew or an FRU person. We were assured that one would be on their way.

While we were waiting we placed her on the scoop and started the long process of strapping her to it so that, when we tilted it by 80 degrees to get her out of the house, she wouldn't slid out of the scoop like someone being buried at sea.

After some time one of our Emergency Care Practitioners arrived and he gave us some much needed help in man-handling the patient down the stairs and into the ambulance. We took the patient to hospital where x-rays showed a dislocated knee.

This is what I like about my job - This job wasn't about saving someone's life, it was about causing them as little pain as possible while solving the puzzle of how to get the patient out of the house all while keeping them as calm and happy as possible. It's not a 'buzz', but it is the satisfaction of a tricky job well done.