I've just spent the last five hours trying to polish 800 words; it's not easy this writing lark when you aren't writing for a blog, but instead for a format you've never tried before.

I think I've got the 'blog post' format down pretty well, but to write for something else when you have never really studied writing is harder than you would imagine.

I'm looking forward to my 'day job' tomorrow, as I can do that job pretty easily.

Over the radio today I heard what sounded like a nasty job. It started as our Control asking for any free ambulances to deal with a 24 year old female who was having a seizure; I couldn't take it as I was dealing with my second 'maternataxi' of the day (waters intact, contractions every few hours).

After dropping off this walking, healthy and not about to give birth any time soon patient at the hospital we heard a crew 'blueing in' a 24 year old female who wasn't breathing.

I don't need to explain how this would be reported in the media as I've written enough about it in the past.

It's still a damn tragedy though.

We have a number of policies concerning the care for patients, what we should do to them and what should happen if we don't take them to hospital. Sometimes we come across situations that fall outside our policies - it's for that we have to rely on our experience and our common sense.

We were called to a sixteen year old with 'learning difficulties' who was refusing to eat. The address seemed familiar and, sure enough, as we pulled up outside the door I recognised that I had been here a few days ago.

On that first visit the girl was complaining of leg pain, she was lying on the floor and very upset. I'm no expert but it seemed that the mental age of this girl was somewhere around that of a four year old. She was looked after by her mother, the father hadn't been seen since the birth of the child. She was screaming in pain and seemed, at first, to be inconsolable.

That all changed as we looked after her, she brightened up and was laughing and joking with us by the time we reached the hospital. The pains in her legs seemed to have vanished. She doesn't have good mobility at the best of time, so it's always hard to assess any change.

So we were returning to the same girl. This time her mother was telling us that she wasn't eating, the girl was lying on the same spot on the floor covered with a blanket and crying. As soon as we walked into the room a large grin broke out across her face and she started laughing. It seemed pretty obvious that the girl wasn't sick.

Her mother told me how the girl had cried when she had to leave the hospital. She had returned to hospital twice more in the last two days, so it seemed that this was a repeating pattern.

It seemed pretty obvious to me that the girl was manipulating her mother so that she would go to hospital where she was the centre of attention. Of course this was all assumption and I wondered if there was any way I could get proof of this.

I get on really well with the receptionists at our local hospital, they are all *extremely* lovely people. So I phoned them up and asked me what the girls previous medical notes said. This is probably going against a whole load of guidelines and protocols, but I needed to know if, by taking the patient in, we would be reinforcing her behaviour.

The medical notes basically agreed with my assessment of the situation - she had told the doctors that she liked being in hospital because, 'home is boring'.

The hospital was arranging for a follow-up appointment with the paediatricians and were also liaising with the social services to get the mother and her daughter the help that they needed.

So after some discussion with the mother we came to an agreement that we would leave her daughter at home, her mother would keep watching her and we would see if it could break the pattern. We agreed to help the mother wash her daughter for bed, even though her daughter was now throwing a 'bit of a strop' as she now knew that she wouldn't be going to hospital.

So she was left at home, a risk for us because if she were to drop dead it'd be us to blame - even if it were for a completely unrelated cause. But I'm of the mind that sometimes you have to be cruel to be kind.

(And kudos to my crewmate - as the female in our party got the job of helping the mother clean her daughter while all I had to do was talk on the phone).

We had another 'returnee' that same night. A twenty year old man who called us with abdominal pain. He didn't tell me that he had been to the hospital earlier that day but had left after ten minutes. I think he'd have a bit more waiting to do after that particular abuse of the service...

Laura is worth £7.52 an hour, I’m worth £10.09 an hour.  This is the sort of thing we have to deal with.

On the plus side we do get to drive down the wrong side of the road.

It's actually a bit of a question the reason why I write this. I know that there are doctors and similar who read this blog and I'm kind of hoping that they can answer the question that I have.

First a little background. Our patient is a 93 year old female who lives in a nursing home; she'd been discharged from hospital earlier this week following a chest infection. Over the past day she had gone off her food and was refusing to drink. The nursing home's GP was called and he prescribed something that scared the hell out of us ambulance folk.

One TSP of table salt, stirred into lemon juice to be taken three times a day.

I'm hoping that 'TSP' is teaspoon and not tablespoon.

Is it any wonder that she is refusing to drink when the next thing past her lips could be incredibly salty. I would also imagine that this would upset her stomach.

I know that if someone has a low amount of salt in their blood it is a problem - but I've never seen it treated in this fashion before. I would actually consider this 'treatment' abuse.

We contacted the LAS HEMS doctor (note their new website, they are even having a go at a blog, although they should get rid of the helicopter sound). He was also shocked by this 'treatment'.

So - before I put in a formal complaint about what I consider an inappropriate and possibly dangerous treatment, I just want to be sure that I haven't missed some brilliant new research that shows giving salty drinks to little old ladies is preferable to the way we normally treat a low salt content in the blood.

It has been in the news recently that the BBC has hold of documents showing a large increase in the number of 999 ambulance calls. This is the reason why my phone hardly stopped ringing yesterday as various BBC radio stations wanted interviews. (I had to turn two of them down because I was going to be spending a rare evening with Laura).

One of the reasons given for the increase in calls was the recent British Heart Foundation urging people to call for ambulances if they get chest pain. In my own experience there hasn't been a huge increase in calls due to this, I suspect that the LAS has the official figures, but in my area people don't need any encouragement to call us out.

When I started working for the ambulance service we would get around 2,500 calls across London each day - now it isn't unusual to get 4000+. While a government spokesperson says that there are more ambulance staff than in the past (which is true), it doesn't follow that there are more ambulances. Ambulances which were covered by staff on overtime now staffed by reliefs.

I don't think that there has been an increase in the actual number of ambulances in the last fifteen years; yet we have increasing call numbers and our ever expanding role.

I would say that there are a number of reason why there is an increase in calls.

• The lack of GP services 'Out of hours', since GPs were allowed to stop covering out of hour services the quality of primary care during the hours of darkness have plummeted. Due to decreased GP cover we are going to more and more 'primary care' situations, jobs that would normally be under a GP remit.
• The increasing 'I have the right' brigade - people who know that they have a 'right' to an ambulance as a free taxi to hospital. All thanks to the 'Patient's Charter'
• People want healthcare when they want, rather than when it is available. Waiting for an appointment to have your foot wart removed is such a chore, you want it off now? Call an ambulance to take you to hospital.
• A general lack of education - a simple chest infection in an otherwise healthy person isn't going to kill you; but some people do believe that a cough is something life-threatening.
• A lack of magic cures - I've lost count of the number of people I've been to recently who have seen their GP for a chest infection, have taken two of the prescribed antibiotics and yet they aren't feeling better. Then they call an ambulance. Here is a hint - there is a reason why there are 28 tablets in the pack...
• Increased population, more and more people are living in smaller places, buildings are being thrown up all over London, yet there isn't a corresponding increase in healthcare provision. And the government is closing two A&E departments in our area, because, you know, they are full all the time.
• 24 hour licensing, I know it's an unpopular view in some circles, but we are going to more drunks, and alcohol related calls than ever before.

One of the problems is that we are trying to solve all these problems by throwing ambulances at them. We are covering for reduced GPs by implementing ECPs (Emergency Care Practitioners, GPs on the cheap). Who is going to want to get an appointment for a GP when you can dial 999 and have someone turn up at your door when you want. We aren't refusing ambulances to people who don't need them, partly for fear of being sued or making a mistake. As a whole, health education in this country is dreadful - barely going beyond 'safe sex' and 'stop smoking' messages. Drunks in the street are going to a nice friendly A&E department rather than a less comfortable police cell where they are charged with an offence.

Part of it is that we are mollycoddling people for fear of being sued, and having bad press. If the ambulance service continue this way then I can't see things getting any better. Because of the lack of funding from the government we are having to change the way we work in order to meet those useless targets; this will lead to problems with patient and crew safety - but that is a post for another day.

Without a sea change in society as a whole and in the funding and measurement of targets in the ambulance service, despite the LAS' best intentions, things aren't going to get any better.

The BBC news forum has some hilarious comments (and it does point out some of the weird ideas that people have about the ambulance service).

As I type this there is an *awful* segment on blogging on the BBC breakfast news.

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*