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.

Quite simply superb writing from Inspector Gadget.

This is the worst kind of drama for us. It’s the kind where we have arrived before the other emergency services, specifically, before the paramedics. The officers from the response team are trying to save lives and calm the shattered pleas from relatives who were in the car behind and saw it all.

It's one of the ways I can tell if someone has been seriously hurt at a police incident, the coppers look worried.

---

Normal blogging schedule resumes tomorrow. For those that are interested I have graduated from crutch to cane.

I'm trying to stretch out my blogposts, I have a couple of jobs to write about but with my knee I'm not too sure how long I'll be off work - I'm writing this in the 'trauma clinic' waiting room, wondering what the doctor will say about my knee.

We were at the Royal London hospital, I was working with someone who is fairly new to the job. I like working with new people, they tend to not have any 'bad habits' and I can sound like the voice of experience. My crewmate was one of those steady guys, he'd been out of training school for some time and I could rely on him not to do anything daft on scene, or on the back of the ambulance.

As I mentioned, we were at the Royal London hospital having taken in the latest 'difficulty in breathing' that was, in reality, a runny nose. The whole shift had been like this, 'nothing' jobs that were simple walk-on, walk-off affairs.

"Attention all cars, attention all cars - ambulance required for a Bus vs Lorry RTA in Barking".

I was driving, my crewmate was the one looking after patients, he looked a bit excited.

"Might be a good job", he said.

"No mate", I replied, "We'll turn up and it'll be a fender bender".

So we offered up for the job, although it was miles away, and sped off.

During the drive there I could hear another crew getting sent to the same location, then the location of the accident changed - luckily I had planned this into my route to the scene, so we came across the accident first.

The bus has driven, at slow speed, into a JCB digger. The bus window was broken but there wasn't any other damage and as my crewmate jumped out he was just as quickly waved off - there were no injuries. We called Control and told them to cancel the other ambulance.

"Told you it would be nothing", I said to my crewmate, "It's against the laws of the Universe for me to get an interesting job...".

I got called to see the doctor halfway through writing this, essentially he is playing 'wait and see' and I have a repeat appointment in four weeks, which is fine by me as I don't want people cutting into my knee unless it's really necessary. I've been signed off work for two weeks which means one of two things - (a) I get loads of writing-type work done, or more likely (b) I get bored out of my skull. I have however learned why people who have canes on TV are always grumpy - it just flows naturally.

I’m thankful that Christmas is over, and as I sit here nursing a sore knee, I think back on some of the jobs that I went to over the holiday period…

Our patient was in his mid forties, he had called us from his mobile phone to tell us that he had suffered a fit.  While I’m used to people calling us if someone has a fit in front of them, the patient themselves phoning us is unusual (and normally means that they haven’t had a fit at all).

We found him sitting on the floor, beside a bus stop.  It was one of the really cold days and so it came as no surprise to me that he felt like a block of ice.  Our ambulance is warmer than an A&E department so I decided to sit and chat with him a bit so that he could warm up.

He told me that he was an alcoholic and that he hadn’t eaten or slept for the past three days.  A look into his eyes and I could see that it wasn’t just alcohol that was his problem.  I questioned him further and he admitted to taking ‘speed’.  If he was taking speed then I wasn’t surprised that he hadn’t slept for the past three days.

I checked him over to see if the cause of his seizure was anything we could treat.  All his vital signs were normal although we couldn’t check his temperature as our electronic thermometers stop working if it gets too cold.

His home address was on the other side of London, so I asked him why he was on ‘my patch’.

“It’s my daughter you see”, he told me, “She’s in foster care around here, but I want to see her for Christmas.  I even bought her a present.”.

I looked around in vain for something that may be a Christmas present for a little girl.

“I sold it, so I could get some cider”.

He’d been sleeping rough and in hostels after losing his daughter to social services, he’d been drinking so much that he had started to have alcoholic seizures.  Instead of eating properly he had been drinking cheap strong cider and taking amphetamines.  Then he had bought his daughter a Christmas present and sold it for a few cans of cider.  If I left him where he was there was a good chance that, without a decent meal inside him, he’d freeze to death.

So I did the only thing that I could do – I took him to hospital.

Then I had to put it out of my mind and do my next job.

For those that are interested I should be in today's Guardian 'society' supplement, more on that later.

Paramedics in Kent dealt with more than 350 calls in six hours from midnight on New Year's Eve - the equivalent of an average day for the emergency teams.
Kent's ambulance service said the calls were mainly drink-related incidents and road accidents.
On an average day, Kent crews deal with about 400 calls.

BBC News

I'm guessing that they have a lot less staff in Kent, as London deals with around ten times that call rate every day (3,500-4,000 calls a day), it just goes to show how different various ambulance services are. Anyone in the LAS care to tell me what the CAD numbers got up to last night and tonight?

(Spotted in the new section in the sidebar of this blog - the results of searching for 'ambulance' on BBC News)