I'm 'third manning' at the moment, which is a way of easing me back into work. I'm a third person on an ambulance, which means I get to see how other people work.

We were called to a man who had been pushed over following an arguement over payment at a shop. The man (the customer) was sitting on the floor wailing and shouting as our patients who feel aggrieved often do.

My mate attempted to get a history from the patient, but he refused to talk to us. He would talk to his friend, but not to the ambulance crew who were trying to help him. He was being generally obstructive.

We gathered, from other people, that he had a painful leg - he didn't tell us this himself, he just ranted about how he wanted the person who had pushed him over arrested.

So, without being able to get a verbal history my mate decided that he would physically examine him - so he got out his scissors and cut the trousers off of the patient so that he could examine the injured leg. The patient still refused to talk to us, he was too busy trying to get the other man 'nicked'.

I mean - he'd been pushed over, he was hardly going to hurt himself in anything but a most minor way...

Except that his femur - the strongest bone in the body had snapped.

We have no idea how this could happen in a middleaged man with no other illnesses and (after the x-ray) no sign of pathological bone disease. It's the sort of job that you pick the person up off the floor, dust them off and they refuse to go to hospital.

So we got him into the back of the ambulance to discover that the traction splint that we would normally use was missing a small, but vitally important, bit.

So I got the job of hanging on his leg providing traction while my mate gave him some excellent painkillers and *his* crewmate drove us into hospital.

The hospital was impressed as well.

It's a good job my mate decided to be 'evil' and cut his trouser legs off. The patient didn't have an accident history to suggest a broken bone, the patient themself didn't suggest a broken bone and we could have quite happily taken to lifting him off the floor.

There is a reason why we don't cut the clothes off everyone who falls over, it costs them money, it's very cold at the moment and it's frankly undignified. But now I'm wondering if I need to start stripping everyone I come across...

I’m back to work later this afternoon – three shifts as a ‘third man’, it’s part of LAS policy that those of us daft enough to injure ourselves for long periods of time should be eased back into work.  I’m just looking forward to a lovely Newham Friday Saturday night…

I can finally stop moping around being bored and get some new material.

Laura had a nasty job earlier and she’s written it up on her blog as an incredibly moving post.

Update: Date changed because I had no idea what day I was writing this - the perils of shiftwork.

Have a look at this,

Two ambulance paramedics in North Yorkshire have been sacked because they did not respond to a 999 call while on a meal break, the BBC has learned.
The two men had been on duty for about six hours during a shift last month when the emergency call came in and they said they were unable to respond.
The Yorkshire Ambulance Service sacked them and they are appealing against that decision, the GMB union said.
Managers said they would not comment on the case during the appeal process.
Details of the emergency call or how it was eventually dealt with are not yet known.

The story then goes on to give another example of someone dying due to 'being on a break' (which I believe that I have debunked previously). I don't know anyone in the trust involved so I can't make the story any clearer than what has been released to the media.

The way in which this story would result in a justified sacking would be if the crew consciously refusing to go on a job by lying about their break status. But the story doesn't say this, it has no further details. For the record we can get the sack for 'preventing the public access to an ambulance' as is right.

What annoys me is that this story has been published in the media in the first place. The headline says as much as the body of the story, '999 Crew sacked in meal break row'. The crew have been sacked and the story doesn't give us any more information than that. Everything is 'no comment' or 'details are not known', the story is a headline and nothing more beyond that. The simple fact is that we don't know what has happened and won't until the appeal has been completed. I'm interested in how they got hold of the news in the first place.

Once the reasons are known - That is when the story should be published. When there is enough information to tell us the story, not just a 'Man bites dog' headline.

Unfortunately it seems that the BBC website and the media in general has a problem with ambulance crews having breaks, apparently it has become news that meal break=death. It isn't good news that there aren't enough ambulances, or that we are being sent to people who don't need an ambulance (apart from the annual New Year stories). It's a 'nice' headline and that is what counts.

But what do I know - I'm not a journalist.

If I find out more I'll set the record straight here.

UPDATE: I've had someone closer explain some more about the story - but I'm not going to write about it because it's still under appeal. More perhaps as stuff enters the public domain.

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.