It was one of those days when the sun was shining, everything seemed right in the world and both my crewmate and I were happy to be working. Normally these feelings don't last long as you find yourself wrestling with an aggressive drunk or something - but we were enjoying it while it lasted.
Our call came in as 'pregnant female, fell over', not a huge problem - people fall over all the time and babies tend to be pretty well protected while still in the womb. Reaching the scene we found a woman who was doing a good show of not being distressed, she had tripped over and now couldn't feel the baby moving. There was no pain or bleeding, and everything else checked out fine.

The LAS policy is that we should take the patient to their 'booked department' - this patient's department was a fair way out of London, it was actually in Essex. As it was so far away (it would take us 40 minutes to get there), I called up Control to ask permission to go there, they agreed that it was in the patient's best interests and so we started the drive.

I'm glad we have satellite navigation, that's all I'll say...

As we pulled up to the hospital the patient's mother arrived and was very grateful that we had brought her to 'her' maternity unit, we then handed over to perhaps the nicest midwives ever and went to do our paperwork. While there we waved a 'hello' to a confused looking Essex ambulance crew. We don't often get out that far from London.
'Greening up' we returned to our patch and continued working.

It was only a few jobs later that we found ourselves going into the Royal London Hospital, this was a good thing as we were getting hungry and the London Hospital has a McDonalds opposite - great for the healthy ambulance diet that I, and my belt, have become accustomed to. I wander in there to get my 'Cheeseburger, fish burger and Big Mac' when who should I bump into other than the ambulance crew we waved at back in Essex.

They had done a transfer from their hospital into London and had decided to grab a similar meal for the long drive back to their area.

It can be a small world.

OK, I'm bored, so I should be going back to work on Saturday - depending on whether they want me to get an occupational therapy assessment first - it'll be good to get back on the road. If I've learned one thing, it's that I could never work from home - kicking around my place all day just leeches enthusiasm from me. It'll also mean I can write more as I'll have more new material.

We have a huge amount of equipment on the back of our ambulances, from the complicated hydraulic trolley, through various splints, oxygen delivery systems, a defibrillator and ventilator to the machine that can measure the carbon dioxide that a patient breathes out.

But it's often the simple bits of kit that are most useful.

We were called as a second crew in order to help them with a 'difficult removal'. It wasn't a good sign when we arrived on scene and had to make our way up four flights of narrow communal stairs to get to the front door of the house. Then we had to negotiate another narrow stairwell to get to the bedroom that the patient, and the other ambulance crew, were.

The patient was one of those 'generally unwell' people - nothing specific and he would need further tests in hospital. The problem was that he was too weak to move - that and his blood pressure was incredibly low. Dangerously so.

The original crew had given him a load of fluid into a vein in an attempt to raise his blood pressure enough to get him out of the house - for some reason this wasn't happening. The crew were concerned that if they sat him up to put him into the usual carrychair the blood would drain out of his brain. This would be a bad thing.

So we put our minds together and decided to use one of the simplest bits of kit on our ambulance. A carry sheet.

A carry sheet is, at it's simplest, a canvas sheet with handles attached. You put the patient on the sheet, all grab a handle and use it like a very soft stretcher. I believe that it is going 'out of favour' because health and safety gurus think that it is bad for our backs. The thing is, out in the real world, you sometimes need to use equipment in an 'unapproved' way in order to get the job done. The need to improvise is just one of the reasons why I love my job.

We dutifully explained to the patient and his wife what we were going to do, then rolled him onto the carry sheet and prepared to carry him out the bedroom, down the stairs, across the walkway, down four flights of stairs and out to the waiting ambulance.

Headfirst.

I would imagine that it didn't feel very safe, four sweating, puffing and groaning ambulance workers carrying you down all those stairs. Narrow stairwells are a complete nightmare when you are moving at three abreast. Then you have to bend the patient around corners. All headfirst in order to keep the blood flowing to his brain by keeping his head lower than his body.

By the time we huffed and puffed him into the ambulance his blood pressure had raised a little.

Fear of being dropped will do that to you.

I'm busy creating a presentation on 'citizen journalism' at the moment for Birmingham on Friday - the problem is that I don't know what my target audience will be, so I'm maybe aiming it a little too low. Stressed. Not good. But at least my knee is much better.

It had been a busy day - running from A to B and back again dealing with some rather unwell patients, so a call to an elderly lady with a cut leg was going to be a nice change of pace.

We'd been told that she had fallen on the bus, but was now at her home. As we pulled up we could see one of the council's buses parked outside, they are used to take the vulnerably elderly to day centres and the like. The pavement was soaked in soapy water.

The driver of the bus met me, he looked a little worried as he showed me to our patient. She was sitting in a chair, her leg was raised and although the bus driver and his mate had used a towel to try and stop the bleeding her leg was still leaking a fair amount. Still it was a fairly simple job - bandage up her leg and run her drive her into hospital where they could properly clean and close the wound.

All throughout my treatment of her, the patient was more concerned with making sure that the bus workers didn't get into any trouble. She was a little bit... 'dotty', which her neighbour assured us was normal for her. She wasn't worried about her leg, nor really about the amount of blood that she had lost (not a huge amount, but it looked like a lot), all she was worried about was the bus crew.

For their part the bus crew had done a lot of good, especially given the fear that a lot of council workers have of being sued when acting outside their 'protocols'. They had made her comfortable, had given her some effective first aid and had cleaned up the pavement and her garden path. They had even brought her shopping in and put the frozen things in the freezer. Given what a lot of other workers would have done, they had acted above and beyond their duties.

And all they were concerned about was that the patient got better.

It's so refreshing to come across some care-workers who actually care, unfortunately it is rarer than I would like.

It is funny how you find yourself going to the same people, I'm sure that some form of 'Power Law' applies to patients as much as everything else. while sometimes you can get seeming 'clumps', other times the reasons for the repeat calls are easy to understand.

Take, for instance, a twelve year old boy. He had a history of collapsing at home and at school and previous medical tests had been performed to see if there was some cause for this. When I first met him he was waiting for an MRI scan.

He had collapsed at home - my immediate sense was that this is a family that cares for him very much, nothing tripped my 'spider sense' that there was anything wrong. My own examination of him didn't show anything unusual, his behaviour didn't lead me to think that he had had a seizure. His blood sugar was normal which ruled out him being an undiagnosed diabetic and everything else I did drew a blank.

He'd been to hospital a day earlier and, after a battery of tests, they had discharged him. The tests had shown nothing. I was more than happy to take the boy to hospital, his family were nice and I've developed a 'risk adverse' attitude to leaving children at home.

I later talked to the unit and they told me that, although they could find nothing wrong, the paediatric team were going to admit him overnight for observation.

It was only a day or two later when I got called to him, he had collapsed on a public green on his way to school. One of his teachers was next to him. This time he wasn't moving or talking but a quick assessment told me that he wasn't really unconscious. So I got him up and took him to the ambulance. One teacher went to phone his parents, the other stayed to talk to my crewmate.

Once more all his vital signs were normal and once his father turned up we took him to hospital.

It was only after we put him to the paediatric waiting room that my crewmate turned to me and told me what I had suspected from the first time I saw him. The teachers suspected that he was being bullied although the child would not say anything to them about it. We passed this information on to the hospital and, after checking with the notes of his last visit, the hospital let us know that the paediatric consultant was thinking along the same lines. Various meetings were going to be planned with the school and the social services to fix this problem.

I'm glad that the hospital were taking things seriously, we've all heard of schoolchildren who commit suicide over bullying, so it is important to have support services like this. This isn't the first time that I've seen a child become physically ill due to bullying, I suspect that unfortunately it also won't be the last.

For my part I'm glad that I could provide a safe and reassuring environment for the time he was with us - He might not be physically hurt, but that didn't mean that we would ignore his mental health. It's not all about bandages in this work, and sometimes it's the stuff like this that makes you feel that you are doing the right job.

I'd never been to the patient before although the person I was working with told me that the household was a regular place to visit. Two people lived there, an elderly man and his wife. He has diabetes and leg ulcers and finds it hard to get around the house due to Parkinson's disease. His wife has quite far reaching dementia although she is physically fitter than her husband.

Social carers come around a couple of times a day.

Apparently the normal calls to this house are for him feeling unwell with his diabetes or for her hurting herself moving around the house.

We arrived on blue lights as the morning carer had called us and told us that the husband had collapsed.

He was beyond 'collapsed', he was lying on his back in the living room, his trousers around his ankles and his entire body was shaking. When I tried talking to him all I could get out of him was incomprehensible grunts and groans. When I tried to touch him he would become combative and try to push me away.

I looked around, the carer had vanished. Unfortunately this isn't unusual and to be honest they often aren't missed.

My first thought was that he had a low blood sugar - a nice easy job, give him some sugar and wait for his gratitude as we 'cure' him.

His blood sugar was within normal limits. This wasn't going to be as simple a job as I'd hoped for.

I did a full examination and there was nothing that would suggest the reason for his collapse or for his confusion. Every time I tried to do something to him whether trying to examine or dress him he would try to strike me, so my examination wasn't perhaps the best.

His wife was alternating between pacing and sitting talking about shoes - thankfully she wasn't distressed. Actually she was quite cheery, I guess that she is used to us folk, dressed all in green, coming into her house and making things better. There was no way that we could leave her at home while we took her husband to hospital, she would have to come as well.

We made the decision that we wouldn't be able to look after both of them, I would have my hands full with my patient and there was no way that I could also keep her out of trouble. My crewmate called up Control and asked for another ambulance to take our patient's wife into hospital.

The second crew soon arrived and took control of the wife while I and my crewmate got our patient onto the trolley. Once we got him onto the back of the ambulance he immediately settled down, it was as if someone had flipped a switch in his brain. We went from wanting to 'blue light' him into hospital with me holding him down to being able to drive normally into hospital while I had a friendly chat with him.

So once more we left the patient at the hospital - the nurses there would also have to look after his wife while they investigated why he had become confused and collapsed. At the end of my shift the hospital's theory was that he had suffered a 'Transient Ischaemic Attack' or 'mini-stroke' which had resolved on it's own.

And they did take good care of his wife.

My knee still aches but I'm not as reliant on the cane, hopefully it'll soon be good enough to return to work.

(...Or At Least Means He'll Never Get A Promotion).

Let me start with a few assumptions.

(1) Ambulance workers are human beings, human beings require food.
(2) The government wants the NHS to spend less money.
(3) People who use the NHS have high expectations.

The problem.

There have been a lot of stories in the news about people dying because of 'Crews on rest breaks' and even one where the proliferation of solo response FRUs are questioned as well.

To answer the first story - it was unfortunate that the people running Control put two crews on a break at once, I'll suggest why this may have happened later in this post. To quote the LAS response to the death,

An LAS spokesman said: “We dispatched a rapid-response car, which arrived at the shopping centre within eight minutes at 1.30pm, the member of staff being able to start treatment immediately. An ambulance was sent at 1.32pm after it became available from attending another incident and, according to our records, arrived at the shopping centre at 1.41pm and at the patient a few minutes later.

So, within eight minutes a solo paramedic arrived and nine minutes later there was an ambulance, so the maximum time the patient waited was seventeen minutes. Without knowing the circumstances I would imagine that even if a crew had been sent from Edmonton station they would have shaved only three or four minutes off that time.

The crews on the meal break wouldn't have even known that there was a call, Control are under orders not to disturb crews except in the last 10 minutes of the break.

Here is the thing - The press love this story because it points blame at the crews, our management or even EU legislation. Here is the story that you don't hear every day, but would be much more common.

'Man dies waiting for ambulance because they were all out dealing with idiots who call up for a stubbed toe that happened two days ago'

But it is harder for the press to prove that the reason why there wasn't an ambulance there in minutes was because they were run ragged chasing after mis-users of the service.

On the breaks themselves - in a 12 hour shift we are paid for 11 1/2 hours, we have half an hour unpaid break and 10 minutes that are interruptible. If our break is interrupted in those last 10 minutes then we receive a payment of £10. This replaces the old system of having our breaks 'bought' off us for £7.10 and while we would often be able to 'sneak' a meal, it was actually a disciplinary offence to do so. With increasing work pressures this was getting harder to do. These breaks must be completed within certain hours.

Why mealbreaks are impossible.

So - what is the problem with providing workers with mealbreaks?

Year after year the ambulance service has been put under increasing pressure. We have increasing numbers of calls. We are expected to provide services that were once the domain of GPs. More people are calling us for non-ambulance work, the recent stories about some of the rubbish we go to on a daily basis are just skimming the surface of what we do every day. If we look to reduce the numbers of inappropriate callers then, as Magwitch notes, the press is up in arms.

We do not sit on station playing pool or sitting with out feet up - we tend to go out in the morning and not stop until the end of our shift.

Then we have the pressure from the government, first they tell us that we have to get to Cat A calls in eight minutes, then they change the goalposts (Now we'll have eight minutes to get to the patient from our Control picking up the phone, rather than from knowing where we are sending the ambulance). Then the government tell us that the NHS needs to 'make a profit', whatever *that* means. Despite the increasing number of calls and our increasing roles we have less money than last year to cope.

Patient care is going to suffer as we seek to please the government.

The government therefore want us to do more calls, with wider roles but with a lot less money.

They sit in their ivory tower dictating what they want and the ambulance service bosses say, "Yes we can do that". If we don't do it then the money is cut even more. You never hear the government suggest that maybe we need more ambulances to cope with the increased roles.

Due to the budget pressures we have been put under recently there was essentially no overtime available. While we are supposedly fully manned it still meant that there were plenty of ambulances unstaffed. This situation was brought about by the government cutting our money, all at the risk of patient care.

When we have to provide the government with our response time figures we'll flood the area with ambulances so that we can make it in a 'big push'. Budget be damned. It used to be if we didn't make the target then our budget would be cut - now they cut it regardless of us making our targets.

And so we flip-flop, from saving money to providing more ambulances and back again. Our management are on the government leash and are being pulled in two directions.

This may explain why two crews were put on break at once - because management are under pressure from the government to save money wherever possible they are trying to get us our full breaks (in limited time windows) because we can't afford the £10 for an interrupted break.

So the short version - We don't have enough ambulances to to provide the care that the public and the government want and the introduction of meal breaks has just shown up how stretched we are.

And for some reason our bosses won't admit it.

A solution?

So what can we do? People are not happy with the service so there are three ways to deal with this. One way is to lower the expectations of the public toward ambulance care (and perhaps the NHS in general). If the public considered themselves lucky to get an ambulance, then they wouldn't complain so much, this is the attitude I often get from people who weren't born and raised in the UK. But there is no way to do this, and we shouldn't - we should expect, and get, top service from the NHS.

The second way is to reduce the number of calls we get by streaming out the 'crap' or by educating people about the misuse of ambulances. This isn't simple and would take twenty years or more to implement. Fines or paying the cost of the ambulance would sit in this camp and, as I've mentioned before, I don't like the idea of paying for ambulances because it would frighten off the poor.

The final way is for the government to give us more money and to stop pulling us in two directions at once. This isn't going to happen, the motive behind Patricia Hewitt's desire to 'make a profit' is that they want to invest less in the NHS. I'm not suggesting that we need to throw money at bad services, but there does need to be an increase in funds. If you were running a business you wouldn't expect to be able to expand your company without some form of investment.

But what can we do to force the government to listen to us?

Here is my solution. When the government asks for response figures we refuse. We stop recording and collating them. We spend the money that we have on improving patient care, not on fanciful imaginary 'performance indicators'. We make a stand against the utter idiocy that is the Department of Health. What could they do? Sack us all? It needs to be countrywide and across every level of the ambulance service. We need to be bloody-minded about making the government concentrate on Patient Care and not fulfilling their seeming desire to run the NHS into the ground.

We need to take a rolled up newspaper, strike across the dog's nose and in a firm and clear voice say , "No!".

It may be simplistic, but it's the only language they understand.

I had a writer from Casualty out with me a couple of weeks ago - he lives local to the area and the BBC likes them to do at least one 'ride-out' so that they can get the gist of what the ambulance service is like. I know, I know, it doesn't show up on the screen, but the thought is in the right place and as the BBC have been really nice to me in the past I'm more than happy to help them out.

He was a nice chap and before the shift started we had a little chat, he was shown around the back of the ambulance and I explained that I don't do 'heartbreak and trauma', more 'drunks and drunkards'. I explained that we would have the 'Curse of the Observer' with us today - whenever there is an observer with a crew, they get nothing but 'crap' jobs all shift. We then settled down for our first call of the day.

So it was only a few minutes into the shift we found ourselves rushing out to the ambulance for a 'Two month old child, not breathing'.

I turned around to the writer and explained that it was probably a child with a runny nose, it normally is. Then I realised what time of the day it was - 7am. It wasn't outside the realms of possibility that this could be a 'genuine' job. Maybe the parents had slept through the night and woke, happy that their child hadn't woken them, only to find them dead in their cot.

I told the writer that as soon as we arrived at the house he should jump into the passenger seat and to try and keep a low profile.

We arrived at the house at the same time as the FRU, I jumped out of the ambulance and struggled getting the equipment out the side storage, my crewmate ran into the house.

I heard the mother from the ambulance - she was making a noise, the mixture of crying and screaming that will turn anyone's blood cold. I didn't need to go into the house to know that the baby truly was a dead.

Entering the house I passed the mother to get to the rear bedroom. The father was pacing up and down, nonsense words were spilling from his lips. My crewmate and the FRU were kneeling around a tiny baby. She was laying flat on the floor, motionless. A drop of blood had formed under her nose.

It was a 'scoop and run' job - there is plenty that we can do for people whose heart has stopped even for children and babies, we are trained in the resuscitation techniques that the hospitals use. In these cases though, we'd rather let the paediatric consultants deal with it, they are much better trained than us and, with lots of staff in a well equipped resus room, young patients stand a better chance.

So we did some interventions on the scene while the mother got some shoes on, then rushed out to the ambulance. I drove us to the hospital, the writer next to me. Each time a car did something stupid the writer muttered that they should 'get out the f**king way'. We made it to hospital in a few minutes and left the child with the resus team.

Unfortunately there was nothing that the hospital could do.

Once more, sitting outside the A&E department doing my paperwork, I heard the mother's scream from the relatives room as the doctors broke the news to her that her baby was dead.

---

The writer was surprised at the speed and co-ordination that we showed in dealing with this job - even though I wasn't working with my regular crewmate, we worked as if we were one person. He was also surprised at the idiot drivers that refused to get out of our way. In my eyes the drive to the hospital wasn't a bad one, but then I have developed a high tolerance for driver incompetence.

We spoke to the police, there was nothing unusual about the circumstances of the death, the drop of blood on the child's face could have been caused by the parents attempting to breath for the child and the police seemed satisfied that everything was 'above board'.

Our Control asked if we were alright, they do try and look after us. We were all fine, but a Team Leader appeared to check up on us anyway.

Thankfully the rest of the day was fairly peaceful.