Now, I accept that in terms of the human body and the weird and wonderful things that it does, I am an expert. I have training - intense training on all functions of the body. I have training on the effect that drugs and chemicals have on people. I am aware of the natural progression of the normal life cycle.

I'd like to think that some other people might have a basic idea of such things - I know we don't come with an operators manual for this sack of meat and bone that we drive around, but I'd like to think that at some point you get the general gist of certain things.

Perhaps you might even recognise in another person something that you may indulge in a little yourself.

So it annoys me somewhat when I'm forced to drive, at speed on blue lights, to something that I know is going to be nothing serious. Especially when there is an adult who can be deemed intelligent enough to be responsible for forty other people already on scene.

It annoys me that some companies write prescriptive policies that rely on 999 emergency services to do their work for them in the name of 'risk management'.

It annoys me when workers for said companies refuse to step outside their policies for cut and dried cases - when they are so fearful of being disciplined for doing the right thing that they need to call an emergency ambulance to do something that all two year olds can do.

It annoys me that our computer system (and management) in Control won't allow a calltaker to use their common sense in grading a call's response, resulting in me being a threat to other road users as they send me haring off on a call apparently only a smidgen less serious than someone who is dead, and about as serious as someone having a heart attack.

And much more 'important' than a gran with a broken hip.

What didn't annoy me was the patient - he'd had a little bit to drink but wasn't unconscious for it. In fact he'd done something that I've done myself in the early hours of the morning.

He'd fallen asleep on the bus.

I walked up to him, said hello and shone my torch in his face. He opened his eyes, looked around apologised profusely for falling asleep, then walked off the bus.

The bus driver looked sheepish.

It drives me bloody crazy - a person falls asleep on the bus and the bus driver isn't allowed to touch them. They call for an ambulance and because the patient is 'unconscious' it's a top priority call. Because of the eight minute target we are forced to respond at speed, ignoring other, almost more certainly deserving, calls. We get to the scene and wake the 'patient' up, often they are drunk, but sometimes they are just tired. We are then forced to do a full work-up on them and take them to hospital (unless the patient refuses).

I personally do at least one of these a week if I'm working late or night shifts. Often it's more.

Now, despite what our policy says, we'll normally persuade the person that they don't want to be checked out and go to hospital - this is because we have 'common sense', sure we could be bitten on the arse by thinking for ourselves - but I'd like to think that I can recognise the difference between someone who is about to die and someone who is merely asleep.

Unfortunately this common sense doesn't extend to bus drivers who are scared of accusations of assault.

We ambulance types often work outside our policies sometimes because it's in the best interest of our patients, sometimes because we would otherwise be without food and drink for twelve hours and sometimes because it's just the right thing to do.

(An example, we are supposed to wait for the police to turn up at violent incidents - if it's in a public place that we can safely reconnoitre I'll not bother waiting for the police, if it gets hairy we can always drive away).

Or maybe the drivers are scared of being assaulted themselves, in which case lets call for someone who's job it is to get assaulted, what with our intensive training of 'run away! run away!'

The LAS sometimes suggests that certain calls are unnecessary and would be better dealt with by a GP or Walk In Centre - perhaps we might try an education campaign directed to bus company executives and drivers, explaining that it is often possible to wake someone up without needing an ambulance for medical support.

Things that I have done this week.

• Resisted punching a patient after they became incredibly abusive towards me because the nurses at the hospital decided that they were perfectly suitable to sit out in the waiting room.

• Got a painful back and arm after trying to stop a drunk driver from breaking their neck after they had driven their car, at speed, into the back of a parked car.

• Breathed in aerosolised blood from a patient with a high risk of having a blood-borne disease.

• Dealt with a middle-aged woman who thought that her lifespan had been cut in half after being pushed over by a reversing car. Then wanted us to take her home before taking her to the hospital. She had no injury at all.

• Called the police to someone who was beating his Staffordshire terrier in the street, winding it up and letting it chase young girls.

• Picked up our regular, smelly, occasionally abusive drunk on three separate occasions.

• Had someone cough all over me when I had my face next to their mouth.

• Spent twelve hours sat in the seat of a Mercedes sprinter ambulance feeling my back slowly seize up. Every damn shift.

• Kicked a bucket.

• Had a grand total of three patients thank me when I settled them safely into hospital. That's out of approximately forty patients. Incidentally about the same ratio of patients who actually need an emergency ambulance.

• Inserted one cannulae, gave one dose of Salbutamol, one patient oxygen and argued with one 'carer'. Did not have to engage my brain with anyone or any situation.

And I get to see what happens tonight...

(I'm going to try and follow rule #1)

It would seem that you just can't trust those people who misuse illegal drugs...

We were called to someone who'd smoked some heroin, drunk some beer and also smoked some crack cocaine. He was... 'not alert', hardly surprising really.

The flat was full of drug users, our patient was the one being propped up by a woman.

“He'll be alright”, she said, “I've been taking heroin for over twelve years”, she proudly announced.

Our patient was semi-conscious, sweaty profusely and was breathing rather slower than is normally considered healthy.

A quick shot of Naloxone, a drug that reverses the effects of Heroin, and our patient was a bt more responsive. With the aid of some police we managed to spend the next hour getting the patient out to the ambulance.

Once outside his 'friends' disappeared back into the flat and locked their front door. The police were no longer needed and so we sent them off to deal with a fight in a pub (probably) and started checking out the patient.

“I'm not going to hospital without my jacket and bag”, he told me.

But what would you know? It would appear that some people who take illegal drugs are perhaps a little bit untrustworthy. His 'friends' wouldn't open the door to us or to the patient.

So he refused the ambulance and our offer to call the police back. Instead we left him standing outside the flat, swaying slightly from the effects of the alcohol, no doubt until he got bored and stumbled back to his hostel down the road.

Strange thing about this 'client group', they are all very “I love you bruv”, until you give them the chance to steal something from you.

Incidentally, the reason why our patient had such a strong effect from the drugs? He'd been released from prison that very day, and so his tolerance for drugs had dropped during his time inside. Being released from prison has led to the death of more than one Heroin addict from this mechanism.

In some fluffy way it seems that victims are sometimes victims to other victims.

Or something.

I had my first letter of thanks yesterday, the first one I have ever had.

It was a simple little job, one of those jobs that you tend to do a lot of. The call was to an elderly woman who had maybe collapsed behind her locked doors. The problem that faces us was that front doors are often locked and it's hard to gain entry. We never really know what to expect from this sort of job, sometimes the person is fine and they've just fallen over. Sometimes the person is seriously ill and this is the reason behind the collapse.

Occasionally the person will have died in the night.

The patient's sister, who was also elderly, had gone to the house and was unable to raise her sister. She'd then gone to the police station and they had contacted us.

We arrived to find the police already there, as the door was sturdy they were waiting for the officers who had the battering ram. The sister had also returned with one of the police officers.

The battering ram arrived and the door splintered inwards. The police officers entered the flat and we followed them in to listen and see who found her first.

Thankfully the patient was alive and well and lying on the bedroom floor.

She's a stick of a thing and well into her late eighties. We quickly check her over to make sure that she doesn't have any injuries, then pick her up and lay her in bed. What then follows is little more than a more extensive examination of her and a bit of the old 'chat'. We talk to her and her sister while checking her blood pressure and the like about such diverse subjects as dead husbands and playing 'knock down ginger', about how out patient hates doctor yet how kind her GP is.

It's nothing unusual, it's nothing that we don't do for all our patients in order to put them at ease. They will often refuse to go to hospital so, assuming nothing too obviously wrong with the patient, we arrange a GP to come and visit then leave and make ready for our next job.

But somehow a card of thanks makes it's way to us. The younger sister had walked up to the hospital and asked the ambulance crews parked outside to make sure that we got it.

So I return to work, look in my letter tray and find the card. It's a simple little thing, it just says 'thank you', but it means a lot to my crewmate and me.

It's rather strange how things work out.

Take the job that we had recently - it was given as a woman who'd fainted but was breathing fine and had nothing else wrong with her.

We were pretty much round the corner, so it wouldn't take us long to get there.

We arrived at a junction smack bang in the middle of the road that we wanted. Do we turn right or left? We turned right and found the address.

The address was a bunch of flats, the name that we had been given was spelt wrong but as we are clever ambulance workers we went straight to the correct address.

I walked into the house, for some reason I was carrying pretty much all our equipment with me, I can't say why I was doing this, some sort of intuition I would guess.

And our patient was on the floor and wasn't breathing. Her heart was beating a quarter of the speed it should have been and she was not so much knocking on Death's door, but halfway down Death's hallway hanging up her coat*.

So we set about doing a few things for her, breathing for her and monitoring her heart. After we'd pushed some oxygen into her she started to breathe for herself and her heartbeat sped up to more normal speeds.

We left her at hospital with a pretty good prognosis.

But that only came about because of good luck - if we had been further away she would have died. If we'd turned left instead of right she could have died. If I hadn't carried some of our weirder bits of equipment into the house she could have died. If she lived on the top floor of the flats instead of the ground floor she could have died.

With the exception of her stopping breathing in the first place, it would seem that luck was with her.

*Stolen from the rather excellent Alan Moore.

JULY

Another call, oh well. Never mind, it's a nice day and it's better than being cooped up in an office. Let's get there while waving at the small children who wave at blue lighting ambulances. Hmmm, one of our regulars drunk in the street - still it gives me faith in humanity to know that someone on a bus driving past was concerned enough about their fellow man to call an a ambulance. Let's get him up. Hello Fred, another trip to the hospital? I wonder what drove him to drink, I wonder why he keeps losing hostel places. Its a shame really, wasted lives and all that. Why can't we provide a decent detox programme, I'm sure if we spent the money on him it'd save the NHS in the long run. Oh well, easy enough job - walk on, walk off, no hassle. Time for our next job.

NOVEMBER

A call? Bet it's some bastard pissed in the street. And why is no wanker getting out the way of our ambulance - can't you see big yellow ambulances with blue flashing lights you twat? Oh great, it's Fred, yet another pisshead. Some 'good Samaritan' who didn't actually want to stop to see if the obvious homeless guy is alright. Suppose they'll feel like a hero now calling us out to this waste of space. Blimey, he smells worse than usual - has he been rolling in his own piss? How weak willed do you have to be to get like this - the bottle is never a god idea for solving problems. I bet he gets thrown out of hostels because he takes a dump in their corridors, just like he did to my ambulance yesterday. Pull him up and throw him on the back, off to the hospital while we wait for him to die. Then we et to do it all again once the hospital discharges him.

The trick, of course, is to remain the professional while these different thoughts are rattling around in your head. It gets a bit hard in winter. Actually the hardest part is dragging yourself out of bed to go into work, knowing that these are the sorts of people you'll be spending most of your time with.

It can be awkward trying to hide your feelings when all you want to do is curl up in a corner and sleep.

My phone keeps buzzing from the Twitters of my friends. The big topic of conversation is the hailing rain and the gales.

I know all about it, I'm dripping wet at the side of the road. Two cars have collided and I'm standing in the dark in an attempt to stop any bystanders from stealing something from the wrecked cars. It's a November night at that indeterminable time of the night that could be ten, or midnight, or 3 a.m.

The leaking oil is reflecting streetlights and it makes pretty patterns beneath my feet.

I'm waiting for the police, our Control has let us know that they have no units to send. It's a shame, but the police station is only a little way up the road. I can just about see the 'Police' sign through my water-covered glasses. My crewmate is in the ambulance dealing with the two people who only have minor injuries from the crash.

Then from up the road appears a police sergeant. He's walked up from the station to come and give us a hand.

It seems that the local police are a bit thin on the ground and the sergeant talks into his radio to call some police away from paperwork to help make the place safe. It's dark and the immobile cars are a hazard to traffic. We've already tried to push it out the way ourselves but some hidden bent bit of metal is making that impossible.

The officers arrive and we all turn our hands to pushing the cars out of the way, finally they start rolling and we soon have them on the side of the road.

I'm left standing in the rain as the back of the ambulance is getting a little crowded, patients and relatives - none with coats. As I'm the only one wearing something approaching weatherproof clothing I'm left standing outside.

My phone buzzes, more Twitters arrive. Apparently it's raining. I'd never have guessed.

Eventually more relatives of the two women who have been sheltering in our ambulance turn up. They shake our hands and thank us, then the people are away. No need for hospital and they have things that they need to do.

I climb into the cab.

I steam slightly. At least it's the end of the shift, actually it's past the end of the shift and I now have less than eleven hours before I have to do it all again.

A big drop of cold water runs down my back.