I like to think that I'm good at my job - I concentrate on what I'm doing, I try to help people and I try not to make any mistakes.

Yesterday I made a big mistake - but it made me feel like I'd just received a big birthday present.

I turned up at work ready for my 14:30 start in time to go across the road and get my 'dinner' (a half-pound of dripping fat burger... yummy).

I returned to the station and started to eat it. Then one of our relief workers arrived and asked what I was doing there. I told him I was waiting for my crewmate to turn up, he then told me that he would be working with her that shift.

So I phoned up our resource centre and they told me that I had booked annual leave. Rather a lot of annual leave.

I'd completely forgotten that I'd booked it - so it was a nice surprise to be able to turn around and head home.

So between now and August the 27th I have one day of work. On the 2nd of August I head off for three glorious weeks of touring warm parts of America ending up with five days spent sitting on my arse in Hawaii. This makes me happy although it may been that blogging on this site may be a little light.

You may have to put up with me writing about my holiday rather than reading about sick people. Sorry about that, but if my mind is so frazzled that I can't remember when I booked leave I think I need a holiday.

First off a private message - Thanks Darren, the gift is very much appreciated, you shouldn't have.

I've written a bit about not wanting to leave people who I am called to at home, but there are times when for one reason or another patients do get left behind.

Take for example the fifty year old woman who had supposedly suffered from a stroke. We had turned up and she was lying on the floor not talking to anyone. Her husband and son were standing over her, obviously worried.

It was tricky to assess her - English isn't her first language and she wasn't speaking much anyway. So I checked all the usual things including some basic neurological tests. Everything was normal.

There is a thing that some people do, some cultures more than others, when they find themselves losing an argument they 'collapse'. Normally you can tell these straight away by the telltale symptoms of faking a collapse such as keeping your eyes screwed shut when I try to lift an eyelid.

This was the feeling that I had from this woman. She didn't want to go to hospital and the son was very sensible - I explained everything to him and he agreed to keep an eye on his mother. You never know when something simple might turn out to be some bizarre illness.

So she was left at home.

The other person that day who I left at home was a young woman who has a terminal disease. We arrived and the FRU responder had already treated her. Luckily the FRU pilot knew her, apparently she never wants to go to hospital (and to be honest I can't blame her) and will normally recover somewhat after our treatment.

The slight problem with this is that she had been drinking a bit, did this reduce her ability to give or refuse consent? I'm sure that this was one of those jobs that if something bad happened to her I could be hauled over the coals by my management or the coroner.

but...there was someone with her, she seemed competent enough to me and there was a documented history of her not wanting to go to hospital, so I made the decision not to try and have her dragged off against her will.

Once more, I do things so that I can live with myself. Even though I'd rather take people to hospital so they can see someone brighter than I.

One litre of Red Bull and two litres of Coke Cola and I still don't feel up to facing the day.

I think I have caffeine tolerance.

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Once more my job gave me two calls that are in contrast to one another, both involving children.

The first was an eight year old boy who'd fallen over and taken a small chunk out of himself. Nothing too serious and something that would be fixed by three sutures. The only thing (and yes, I may be a bit harsh here), was that he was constantly crying. His mother was also weeping as if he was about to die.

I asked him if it was the pain that was making him cry, but he told me that it just 'stung' a bit. He was crying because he was scared. I explained that it wasn't serious, that he'd be home in an hour and that it wasn't a problem.

But still he cried.

His mother also wouldn't stop crying, even though I explained the same thing to her.

No matter what I did or said, it made no difference, the crying continued. As did the wailing, the sobbing and the shrieking.

So I put a plaster on the wound and took him to hospital. By the time we got there I had a splitting headache. I'm reminded of what my mother would have said. She would have taken one look at the wound and told me to, "stop crying or I'll give you something worth crying about - it's hardly a scratch and your own fault for climbing trees".

Didn't do me any harm.

...And across the globe eight year old boys are given machetes and AK47s and are fighting in armies.

Later that same day I went to an adult who had been beaten up. He didn't speak English, his son and his daughter in law didn't speak English.

His eleven year old granddaughter did.

She was bright, she was sensible and she was pretty much the only contact with the non-Punjabi speaking part of England that the family had.

She had been born in England, which makes me suspect that her parents had been here for eleven years without learning any English. Which is a poor effort by any standard.

So they relied on her to deal with any place that didn't have translators. I spoke to her about it - she had helped them navigate the maze of benefit offices and social services. She had been there while her mother had another two children, translating what the midwives said, she was the translator between her family and her school.

She was now translating for me while I tried to determine why three men had broken into their house and beaten up her grandfather.

She had been forced to grow up incredibly quickly while her family came to rely on her. I wondered if she has got used to the quizzical looks all the adults in the house was giving me when I tried talking to them.

Very, very sad that this eleven year old girl had to deal with all these adult problems.

From TheyWorkForYou.

Sandra Gidley (Romsey, Liberal Democrat)

"To ask the Secretary of State for Health how many (a) male and (b) female teenagers were admitted to accident and emergency departments on grounds related to drunkenness in each month of (i) 2007 and (ii) the last five years, broken down by NHS trust; and what treatments they required, broken down by category."

Dawn Primarolo (Minister of State (Public Health), Department of Health)

"We do not collect data relating to alcohol-related attendances at accident and emergency departments." [Emphasis mine]

Tables have been placed in the Library which supply data for teenagers admitted to hospital [Emphasis mine] via accident and emergency with a primary diagnosis of T51 toxic effect of alcohol (i.e. more severe than general drunkenness and loss of inhibitions) for the last five years, broken down by gender and health care provider. The information provided in the tables does not include instances of the toxic effects of alcohol as secondary diagnosis."

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From the BBC

"The introduction of 24-hour drinking laws may have trebled alcohol-related admissions to A&E departments in inner city areas at night, a study claims.
Researchers at London's St Thomas' Hospital compared overnight visits before and after the 2005 law change.
There were 80 alcohol-related visits in March 2005. This hit 250 in 2006, the Emergency Medicine Journal said. "

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We 'code out' all our calls. There are two or three numbers to write down that represent what has happened to our patient. The first number is the 'type of injury' code. So (from memory) - Code 01 is 'Illness known', 02 is 'illness unknown', 03 is 'fall', 14 is 'assault' and so on.

Then comes the injury code. 01 is 'abdominal pain', 75 is 'minor head injury', 69 is 'vomiting', 23 is 'epileptic seizure'.

'62' is alcohol related.

The small problem is that where someone has two types of injury, for example they had a seizure due to alcoholism and cracked their head open, there are only two boxes to write numbers. For the fitting head injury mentioned that would be as 57/75 ('fitting - other cause', 'head injury - minor'). There would be no place to write down the '62' - alcohol related.

Couple that with the problem that the boxes are very small and easily forgotten and are therefore are occasionally not filled in and you have an obvious lack of data on how alcohol affects A&E attendance.

There are some vague figures mentioned in parliament. But these are only for people admitted to hospital - not for that much more common breed of people who are treated and discharged or are allowed to sober up and make their own way home. Or for those that attend, are violent and are thrown out.

So the St Thomas' Hospital study is incredibly important, and should be going on nationwide. During nightshifts alcohol probably accounts for 40-60% of my work, half that during dayshifts. Yet it would seem that no-one is recording or studying the numbers and types of people using the NHS for this reason.

Again from the BBC

"Both the Department of Health and the Department of Culture, Media and Sport, which was behind the legislation [to increase licensing hours], were dismissive of the findings, noting that the study only related to one hospital in one particular month."

So why isn't there a more widespread counting of the number of alcohol related attendance? Something done all year in all hospitals, something involving ambulance service trusts. Just a simple tickbox asking if we considered alcohol the cause of the injury or illness.

If it were recorded and studied, might it not make a difference in how we provision care, fund hospitals, amend licensing laws and tax alcohol?

Or is that why it's not done?

Two jobs, both of which revolve partly around the inability for my patients to keep their blood on the inside. I can go weeks without seeing a drop of blood, on this day there were two patients. One after the other.

Two patients - one who had just had her wisdom tooth removed, the other had his arm sliced open to the bone when caught between two lumps of machinery.

Both patients stressed out by their injuries, both trying to be brave and both being nice to me in their own particular way.

One patient bleeding at least half a litre of their blood over my ambulance, needing me to blue them into A&E

One patient, a few drops of blood at the scene, the dressing that was applied caught a small amount of blood.

She was sped into hospital after trying not to cough blood over me.

He took a more leisurely ride in where his arm would almost certainly require surgery.

Her problem would be solved by her bleeding stopping, the work of a few people.

His problem would be solved over months of work by a complete team of people.

Two patients - different but alike.

More from the Mail.

"I always carry a large pair of scissors. Issued so I can cut a patient's clothes if necessary, they're my one form of self-defence if I'm in real danger."

Yes. Apart from them not being sharp (because you don't want to cut a patient's flesh by accident). And not heavy (because they are cheap NHS plastic). But you can use them to rub against the back of someone's hands to get them to drop you.

My one form of self defense is running away really quickly, or not being there in the first place.

I hate being made to look like I'm aiming to stab people.

...And while I sit on station waiting to the floor of the ambulance to dry due to my last patient having some difficulty keeping their blood on the inside I have a chance to moan at the Daily Mail.

I'm in today's edition and they make it sound like the words are coming right from my mouth rahter than an accurate reporting.

The first paragraph is the worst, making it sound like I'm some sort or hero being surrounded by knife-wielding maniacs. Trust me, if that were the case I'd be driving away quicker than you can say, "Look at that sensible man driving away from the armed nutters".

After the hyperbole it settles down a little, but if you are a regular reader then you know that the words aren't my own - it is quite interesting to see how it's been written for the style of the paper, words like 'horrific', 'shocking' and 'pressure cooker'.

It's not a huge misrepresentation - but it does make it sound like East London is a war-zone rather than a place that can get a bit rowdy.

Still it *is* the Daily Mail, so what else did I expect when I chatted to the reporter earlier in the year.

You can read the full article here.

We have an internal monthly 'magazine' called LAS News, and to be honest it's fairly awful (sorry communications department). But in this month's issue there are two interesting tit-bits of connected news.

'Savings to be made to ease the financial pressure'

Savings of nearly £11.5 million will need to be found to balance the Service’s books this year. Increased costs – including £14 million for staff pay as a result of the introduction of Agenda for Change – means that the Service’s £219 million budget will not cover outgoings over the next 12 months.

As approximately 80 per cent of costs relate to staff, it is possible that some posts will no longer be funded. Although no decisions have been made on how many jobs and which areas of the organisation will be affected, some reductions on posts will be achieved through not recruiting to vacant posts.

It is also hoped that some savings will be able to be made through more cost-effective purchasing of resources such as uniforms, vehicles and fuel.

Which I read as we are in danger of going bankrupt due to changes forced on us by the government. It's also the first time I've known how large our budget is - £219 million pounds to run a 4,000 jobs a day 24 hour service and civil emergency planning service.

Which, if my 'back of the envelope calculations' are right (£219,000,000 / 365 days in the year / 4,000 calls a day) equals £150 per job. That is to pay everyone, get new vehicles, new stock, petrol, uniforms and so on and so forth. Around £30 of that £150 goes to my crewmate and I, of which our bank balances see around £10 each.

And then it looks like we are going to lose some posts - probably starting with the training department as we can't afford to hire new staff. Then some people will leave the job due to retirement and the total number of staff will decrease as they won't be replaced.

But I'm not budget minded, so it's a bit hard for me to comment on such things.

However...

'Boost for alternative patient treatments'

A payment of £38 is to be made to the Service for every patient who receives appropriate care that sees them not needing to be taken to an A&E department for treatment. In a bid to reduce inappropriate A&E admissions, London’s primary care trusts have set aside £800,000 this year as an incentive for the Service to provide alternative treatment for patients who do not need to go to hospital.

So - every person who we go to, and don't take to hospital means we 'earn' £38. Which is a fair chunk of the £150 that I mention above. To be able to claim the full £800,000 we just need to leave 21,000 patients at home (sorry - refer to alternative care pathways), which is 57 patients a day. Out of 4,000 calls this means we only have to refer a shade over 1% of patients.

This is easy - I refer far more than this number and I'm a 'nervous nelly' when it comes to leaving people at home. So it's not really an incentive if we are doing it already is it?

Now for the complicated part - We supposedly refer 32% of patients via our telephone advice service, or they are attended to by an ambulance crew but not transported (data from the same story), yet we are looking to double the amount of telephone advice staff. I have no problem with this if it means that more people are given appropriate advice and an ambulance isn't sent. But, given our budget pressures mentioned in the first story, where are these staff going to come from?

Off the road? If we are going to less calls then we need less ambulances don't we?

Yet I still hear Controllers on the radio asking for any free ambulances to attend to emergency calls because we are all busy.

I don't know - I'm just a bloke with a big yellow van; I'll leave it up to people brighter than me to work out if I'm missing something obvious. As always if someone from management wants to email me corrections I'm more than happy to print it.

(Apart from the magazine being poo - I'm sticking by that. Also the internal website makes my eyes bleed and is completely unfit for purpose).