I reckon I'm going to have two complaints put in against me this week. Not from patients, nor from relatives, but from random members of the public.

You see, I've been 'rude' to two of them.

Take the first one. We were called to a teenager who'd been run over by a car, he had quite a nasty injury that threatened the health of one of his limbs (I'm being deliberately vague for various reasons). So I parked in the road as there was nowhere else to park that wasn't on top of his head. We did a few bits at the side of the road, then scooped him up into the ambulance. We then had to do a lot more 'stuff' to him before heading off to hospital, partly to stabilise his injury and partly to make sure that his big obvious injury was indeed the only thing wrong with him.

I then hear a knock at the back door of the ambulance and, thinking it's the police, go to have a look.

It's the driver of one of those big stretch limos - the sort of things that are hired out by hen parties. He wants me to move the ambulance so he can drive down the street.

I try to explain that I've got a seriously ill patient in the back of the ambulance, and that it needs both of us crew to look after him. I say I *try* to explain but the man won't let me get a word in edgeways - he just wants me to move because he has 'kids and their parents' in the back of his limo. I tried to explain, but he just wouldn't stop talking at me. I'm conscious that my crewmate may need me in the back of the ambulance. Trust me, I'm not being purposefully obstructive.

Well, the red mist starts to rise at the corner of my vision, so I tell him to (and my exact words are), "Shut up!"

"That's a bit rude", he says, and then draws breath to moan some more, but I interrupt him.

"Yes! I know!", and I then storm back into the ambulance to deal with my patient. (I may have flounced back into the ambulance, my arms do get a bit flappy when I'm angry).

The limo driver then miraculously manages to squeeze his huge vehicle past the ambulance despite my not moving.

The second one was last night - the ambulance bay at the Royal London was packed with ambulances. It also had a bloke in a private car parking in one of the bays. I'm trying to park so that the 18 month old who has just had a fit can get in to the hospital to see a doctor. This car is blocking my way, and blocking the ambulances who may want to get out for another job.

"Excuse me sir", I call after the driver, "You can't park there, it's for ambulances only".

"Where am I supposed to park", he shouts back at me.

"Well sir, if you go around the back of the hospital you can park there".

"But then I'll have to walk", he shouts back.

I note the 200 yards he'd have to walk.

"So", I shout back at him, "You ignore the big 'No entry' sign, the big writing on the floor that says 'Ambulances Only' and stop me from being able to park my ambulance THAT ALSO HAS A SICK PERSON IN IT!". My arms may have got a bit flappy as well.

He turns around and heads into the hospital. I'm not sure that he heard the shouted "Pillock!" after him. I thought long and hard about putting a brick through his car window. I decided not to.

Needless to say this was highly amusing to the other ambulance crews in the area.

I wouldn't mind but I'm normally very placid. And again this person could put in a complaint against me and I'd have to defend myself to people much higher than me in the ambulance management food chain. Remember, my only complaint against me so far was from someone who assaulted me and was horrified when I told him that he 'slapped like a bitch'.

But I'm only human.

I wonder if it's anything to do with the negative pay 'deal' we'll be getting or the proposed new 'unsocial hours' payments which will probably end up screwing us over for the next couple of years.

Expletive Deleted.

Isn't it nice to be valued by the government? Pay rises below the rate of inflation which are also staggered which effectively means that my standard of living is set to go down.

Crap conditions, increasing demands, moronic running of the NHS and increased expectations with no increase of resources. Lies from the government who took money away from the ambulance service that made it's (worthless) targets. A screwing over of our new members of staff giving them barely liveable wages for years. An expectation to work harder, an expectation to increase our scope of practice and all this leading to increased danger to staff.

It's enough to make me want to strike, and I'm hardly militant. Makes me feel so happy to go to work this weekend and pick up drunks all night while the MPs sleep safely in their beds. Makes me want to punch someone... preferably someone in Westminster.

All I want is the same value money I had last year - now it's worth less.

Which is how I feel.

(And breaking news is that London Underground workers are getting a 4% pay rise. Maybe striking does work)

*This is all assuming that ambulance pay is in the same general area as other public service workers, something that I see no reason to be otherwise*

As is normal these days the nursing home that we went to was 'well known' to us. The patient had the normal 'difficulty in breathing' which I have learnt means anything from a cold to the patient not breathing at all.

As we arrived I spotted two Healthcare Assistants standing outside smoking. "Another ambulance", one of them commented, "This place is a right dump".

I couldn't really disagree with them.

So we made our way up to the patient - no-one was there to show us where to go, again not unusual. Our FRU was already there, he's a good bloke and I trust his clinical skills completely. He'd already done a full assessment and was talking to the nurse in charge. From the sound of the patient's breathing and his high temperature it was obvious that he had pneumonia.

So I asked the nurse how long he had been coughing and having trouble with his breathing.

"Ten minutes", she replied.

Now, you don't need to be a medical genius to realise that his breathing must have been horrible for quite some time. But given the amount of times I've heard that "the patient was fine until five minutes ago" from a nursing home nurse I suspect that there is a whole load of medical books that need rewriting.

The patient was seriously ill, and you don't get like that in ten minutes. My guess would have been that he was unwell for at least a day, yet no-one thought to call a doctor or us until it looked like the patient might die.

Yet again the nurse in charge of his care didn't seem to know anything about the patient, when I asked about the patient the nurse seemed to think that giving me a list of their medicines counts for this. Sadly this is also not unusual. I did my usual trick of pretending not to know what a certain drug does, then ask the nurse to see if they know. It is essential that a nurse knows about the medication that they are giving someone so that they understand the effects and side effects that can occur. Unfortunately in many of the nursing homes we go to this is a rarity.

In this case she was unsure as to why he had been recently prescribed some antibiotics.

I used my 'ex-nurse' knowledge to write a quick entry in the patient's nursing notes - that way nothing can be added after we have left. It's a little trick of mine that satisfies my bloody-mindedness.

So we moved the rather ill patient to the ambulance and while treating him waited for the accompanying member of staff. We waited and we waited, I was considering just driving off. Eventually one of the usual foot-shuffler 'nurses' made an appearance and we left for the hospital.

It's depressing, and I've written about this before, but it's all too common to find this sort of neglect going on in nursing homes. The companies who run these places make huge amounts of profits, yet the care is what I, in fact what most people, would call sub-standard. If the number of people with dementia continue to increase, then more people will need nursing care, and if the care isn't there at the moment I dread to think what it will be like in the future.

Two links to finish off - one is to Inspector Gadget who tells us of a terrible story where two scum who left a police officer brain-damaged have just had their sentences reduced. The other link is to a great work of fiction by Rocky Mountain Medic.

Oh, and hello if you came here from the Daily Mirror.

For those in the UK Panorama tonight has a programme on violent patients in the NHS (BBC One 20:30).

Us ambulance crews are verbally and physically abused on an almost daily basis – it has gotten that we tend to ignore the verbal abuse that we get.  It’s only with the increasingly common physical assaults that we fill in the required forms.

Let me give you an example from my last night shift, a not unusual job.

We were called to ‘woman collapsed in the street’ at gone midnight.  We arrived to discover our ‘patient’ lying under a bus stop with what appeared to be her worldly possessions in a plastic bag.  There was no-one else around except for the minicab driver who had called us from hi office that she had ‘collapsed’ in front of.  While my nose can no longer detect alcohol my crewmate for the shift was able to tell me that the patient smelt as if she had been dunked in a brewery sewer.

A quick check in her bag revealed nothing obviously medically wrong with her (medicalert bracelets or ‘I am an epileptic’ cards).  It did however reveal that the woman had been released from custody earlier in the day.

I tried to wake her, but she screwed her eyes tight and refused to talk to us.  The problem is that we can’t leave her on the street; someone else would call us and we would be back and forth all night.  Likewise if she froze to death we would be to blame and, if she were stabbed later in the night we’d also probably be to blame.  The police also wouldn’t be interested, they have stopped taking people who are drunk, one too many deaths in custody is to blame for this.  So, as she refused to go home or to her hostel, the only place that we could take her was to hospital. 

I was in a good mood, so I explained all this to her, that we couldn’t leave her here, and that if she didn’t come with us the police would probably be called and that they might take a dim view of her drunkenness (a bit of a bluff, but it sometimes works).

So she started to swear at us, she threatened to hit me and she was generally rather rude…

Again, this is all water off a ducks back to me.  At one point she tried to kick me, but I’m an old hand at drunks in the street and by the cunning tactic of stepping out the way managed to avoid a scuffed shin.

Eventually we managed to hoik her up and into the back of the ambulance where, after a bit more swearing, she settled down.

She did give me a dirty look at the end of the journey though.

I would say that I get a patient who is verbally abusive at least once or twice in a shift.  I don’t mind violence from people who are medically unwell (e.g. diabetics with low blood sugars, post seizure epileptics).  But can I really count ‘drunk’ as a medical problem?

I also count myself lucky that I work where I do – unlike the hospitals where people become frustrated by long waiting times and percieved injustice I’m often seen as a friendly stranger who makes everything better.

For further stories of assaults you can look here, here, here and here. Unfortunately these won’t be the last.

The first job of our nightshift was to an overdose. Sometimes these are nasty, sometimes they are easy. Sometimes you know what the job is going to be like from the information sent down to our ambulance.

"55 year old man, overdose on diazepam and alcohol ?how long ?amount".

My psychic powers kicked in and I predicted an alcoholic who had taken many tablets of a small dose of diazepam (a muscle relaxant and sedative) with rather a lot of alcohol. Probably nothing too serious in a physical sense, but it never hurts to get there as quickly as is safely possible.

The FRU was already there, along with the patient's sister. Our patient had drunk a *huge* bottle of whiskey along with around forty tablets of very low dose diazepam. He'd taken about double the daily dose which meant that he was going to be sleepy but it wasn't likely to be life-threatening. He'd still need to go to hospital to be sure and so he could have a psychiatric referral.

I asked the sister about the patient, was he a heavy drinker? She replied that he wasn't just a heavy drinker but that he was an alcoholic, it's not that I really needed to ask - one look at the patient's house told me that.

The patient had taken the overdose in the morning, then rung his girlfriend to tell her what he had done. She was out at work and so the message was left on the answerphone. In the evening his girlfriend had returned home from work, heard the message and phoned the sister who lived closer. The sister had called us and went around to open the door.

What I wanted to know was, did the patient really want to kill himself and left phoning his girlfriend until he knew she would be out in order to make sure he was dead before she got the message? Or, more likely, was he so drunk while taking the tablets that he didn't know what the time was when he made the phone call?

It never ceases to surprise me how people who take an overdose act. They take a handful of tablets, then phone a friend. They then act surprised when the ambulance arrives.

Thankfully this patient was drowsy and compliant (he was a big man and I didn't fancy wrestling him into the ambulance). He'd slept the day away, spent some time sleeping in the A&E department and the last I saw of him was him walking into the patient toilet.

So an easy job, a sensible sister and a puzzle on the nature of a phone call.

There might not be a post tomorrow - you'll find out why on Friday.

Once more a shortage of ambulances makes the news...

A man stabbed outside a pub was taken to hospital in a fire engine because the area's three ambulances were busy...

...An ambulance service spokesman said: "The three vehicles on duty in the Maesteg area were already committed.
"The nearest available ambulance was at the Royal Glamorgan Hospital and this was dispatched but was stood down when police responders informed control that they would convey the patient in a fire brigade vehicle

Full article here.

What strikes me as amusing is that I heard of a fire engine bringing a traffic accident in my local hospital only a few days ago - once more because of a lack of ambulances, and this is in London, not Maesteg. Once more the demand for ambulances far outstrips the actual number of ambulances we have available.

At the moment the London Ambulance Service is at 'level 3' in our 5 point scale of how busy we are. So, despite not having the money for it (thanks to the government taking a large chunk of our budget away from us to pay another hospital trusts bills), we are having to pay people for overtime in order to keep the service running to the standard that the government and the public expect.

It's long been known that the ambulance service runs on it's overtime, and our ORCON times have been dropping through the floor because until now we haven't had the funds to pay for overtime (due to the aforementioned government taking money away from us). Now it is reaching a crisis it seems that we have found the money for overtime somewhere - I suspect by 'robbing Peter to pay Paul'.

It's a simple formula, 'Too many calls (often for rubbish) + not enough ambulances + high expectations from the public of the service we provide + demoralised staff = long waiting times for ambulances, delays getting to genuine life-threatening calls and an unhappy public/government'.

Large swathes of the population expect an ambulance for every cough, cold and sniffle - the government is unwilling to pay for this expectation and so the ambulance service gets squeezed from both sides.

In April we tell the government if we have made our targets. I hope that we don't make them this year. If we make the targets after the government has cut our budget, then what incentive do they have for giving us our pre-cut budget back?

If we make our targets, then we will have made a rod for our own backs.

UPDATE: Edited to correct my mistake - we are actually at level 3, not level 4 as originally written.

Warning - written after 26 hours of not sleeping.

I heard a great story last night, it had my crewmate, my patient and myself in fits of laughter.

We were called to a patient I've been to previously, they are a nice family and the patient is lovely, unfortunately the patient has a long list of medical problems and needs an electric wheelchair to get around. He had been taken ill and, after a four hour wait, had finally got me to pick him up.

He was in his bed and we would use our carry chair to get him out of the house. First though we needed to move the patient's own electric wheelchair. Now I'm experienced enough to know that I really shouldn't touch these things because I'll only end up breaking them, so we called for the patient's son to come and move it.

He tried moving it by standing next to it, but the patient said something to him in his own language and the son climbed into the wheelchair and steered it away.

As he did this he told us the story of having to take the wheelchair to the hospital on his fathers previous visit.

You see it's hard to stand next to a wheelchair to steer it via the joystick, so he climbed in it a rode it to the bus stop.

The problem was that there was a load of people standing waiting for the bus watching him.

So he felt too embarrassed to climb out - it would look a bit...well...'funny'.

So the bus came and the bystanders helped him get on it, then they helped him get off at the other end of his journey. He even gave them a wave of thanks as the bus pulled away.

The son told this story so well we were nearly wetting ourselves with laughter, his animated demonstration of the wave at the end was a sheer brilliant flourish.

Even the father had a (slightly gaptoothed) smile.

The thing that was so funny was that we could all put ourselves in his place and we couldn't really say that we wouldn't do exactly the same thing. It's like a Basil Faulty sketch, a weird playing up of not wanting to offend people and so getting yourself into a silly situation.

As I say, the patient and his family are really nice people and his son was interested in talking to me while waiting for a nurse to take our handover of the patient at the hospital. He was one of the very few people who said 'thank you' at the end of the job.

For those that are interested, blogging of BarCampLondon2 is starting over at Mental Kipple.