Can I thank everyone who left a comment on the previous post. I've read every single one of them, even though I haven't had time to reply. I can understand that sometimes it can be difficult to talk about subjects such as these, but keeping them in the dark seldom does anyone any good. I can say that I think I've learned a few things about attempted suicides, as well as confirming my fears that they are often not treated well on psychiatric followup.

I'd like to hope that everyone who wrote about their own experiences gets the help that they need.

I'd also like to hope that one day mental health is taken as 'seriously' as physical disease - sadly I think we are some way off from that.

I'm trying to work it out, but I can't. It's a common job of ours but I can't see why people do it - I doubt that I ever will.

I'm talking about suicide attempts.

Specifically I'm talking about people who hurt themselves, either cutting at their wrists or taking a handful of pills then pretty much immediately either call an ambulance or call a friend who then calls us.

Take a recent example - a young woman had cut at her wrists, nothing too serious, but it was only a minute after doing it that she called for an ambulance. She then did nothing but cry throughout our assessment, treatment and transport to hospital. If she was still upset, why call an ambulance?

Another example, a young man who took a handful of pills, they'd barely had time to hit his stomach before he picked up the phone to us.

Is suicide a nanosecond of madness that corrects itself as soon as it occurs?

We have our repeat customers in this as well, the young woman who takes what she considers a 'safe' overdose of paracetamol, calls her friends around and then argues with us that she just wants to die and not go to hospital.

I don't often go to people who succeed at suicide, barring the occasional hanging, most people who seriously chose to kill themselves go somewhere where they won't be discovered and then take a huge amount of pills. These tend to be found days later where it is more a job for the police than it is for us.

So I don't understand - is it all just a 'cry for help'? Is parasuicide just a coping method, a way to be the centre of attention or a way to regain the sympathy of friends and family?

When it becomes incredibly sad is when a parasuicide steps over the line from a 'failed' to a successful attempt - I'm mindful of more than a few jobs where people have overdosed on what they thought were 'safe' levels of Paracetamol only to later develop liver failure and die, or the one person that fatally drank Paraquat in a moments anger during a stupid argument.

I'm curious, after the psychiatric services have seen the patient in A&E once the medical treatment is done, are they referred to a long term care team - or is it a case that they are sent back to their GP in order to arrange a referral?

So no, I don't understand it - all I can do is support and transport; perhaps I don't need to understand.

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A question - is there anyone out there who works in infection control willing to contact me? I have a question to ask regarding gaffa tape.

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Pondering - In the TV adverts for recruiting into the army, why do none of them involve shooting at bad guys? It's all humanitarian work, dancing at nightclubs or playing football.

We were sent to, let's call her 'patient A', who been assaulted and had a supposed broken jaw (she didn't). This was following a pub fight in a well known 'dodgy' pub. It was half past midnight on what felt like the coldest night of the year.

We arrived on scene, we found an FRU on scene and a police van that was just heading off to the pub where the mass fight had taken place.

'A' got onto the ambulance, crying and snivelling, 'B', her boyfriend, a big lad full of anger, followed her. Another crying woman 'C' joined us, I think she was the sister of 'A', or was it 'B'? All of them were 'proto-adults' - older than teenagers, but still behaving like them.

'A' wanted to know where 'D' was, another woman (a sister or a friend?); meanwhile 'B' was proving that he was a man by punching his fists together and shouting loudly about how he was going to return with a gun and shoot them all in the head. In front of the police who, like me, have heard it all before.

'A' decided to jump off the ambulance to look for 'D' so 'B' followed her. 'C' realised that not only was 'D' missing, but so was 'E', who I think was her boyfriend, or maybe the boyfriend of 'D'.

Down the road 'A' and 'B' were screaming at each other, then fell into each other's arms, 'C' meanwhile was fielding phonecalls.

'A' and 'B' came back, then 'E' phoned up 'C' and told them that he had two broken legs and was laying in an alley - 'C' who seemed the most sensible of the lot tried to get him to describe where he was. Meanwhile 'B' continued to show that he was a real man by stomping around and swearing bloody revenge.

The police returned, then went to look for 'D' and 'E'; 'B' stomped a bit more, then decided to go look for them as well, 'A' shouted at him that she didn't want him to leave her, waited until he was out of sight and then hopped off the ambulance to follow him.

It was about now that I called for another ambulance to give us a hand - if there were five patients that's one more than we can handle...

'C' went off to look for 'A' and for a short moment peace returned to the inside of my ambulance.

'A' and 'C' managed to find 'D' and had a bit of a hug outside of the ambulance before getting on board to escape the cold.

A car drove past with snow on it's roof.

I wasn't surprised that they were cold, there dresses they were wearing barely showed under their belts. Which just goes to show how old I'm getting.

They sat in the back of the ambulance, took more phone calls, cried and hugged and waited.

My headache got worse.

The police returned with 'B' and 'E'; 'E' looked like he'd been given a mild kicking, nothing too serious, but he wasn't dealing with it that well.

'E' went onto our trolleybed, 'B' continued to posture, 'A' shouted at 'B' to shut up, 'C' told everyone to calm down and 'D' needed to have a wee.

The second ambulance arrived and took two of our patients - 'A' and 'B'; 'B' was under strict instructions to behave himself.

'E' continued to let everyone think that he was dying while we drove to hospital. 'C' was sensible and 'D' crossed her legs.

At the hospital 'E' made a remarkable recovery and started whispering to 'B' about revenge while 'A' and 'C' told them not to be stupid and 'D' went to the loo.

We left them there, it was our last job of the shift and as I sat chewing down some painkillers I wondered what had started it all of in the first place.

Then I realised that I just didn't care.

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Pondering - If we had a military draft of our young people, we'd largely be screwed. Although to be honest I do tend to see the worst sides of people. Or people at their worst.

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The lurgy laid me out for two days (thankfully two days that I was off work anyway, so my sickness record is safe...). I then spent two days at work coughing and spluttering over people while dealing with a banging headache - I think I'm going to take on a new nickname - 'Typhoid Mary', and now I have another day off where I appear to have lost my voice. I leave it as an exercise for the reader to guess the effects of making probably still infectious health workers return to work in an effort to avoid disciplinary procedures. Let's just say I'm not visiting my mum on my day off..

Yet more reasons why large scale IT projects containing sensitive data are prone to failure. IT projects like the NHS Database.

Firstly the BNP had their membership list published on the internet, and this has led to some nastiness. While some people may think that publishing a list of these odious people is some sort of 'justice', I happen to think that data security should apply to everyone, no matter how nasty their legal views are.

It's though that this was an inside job from a disgruntled former employee. It's hard to protect against such things, and with the NHS being such a large employer, it will only be a matter of time before one person decides to open the floodgates and open up the system to abuse.

The second example is the virus infecting the Royal London Hospital. This was the Mytob worm that disables anti-virus software, shuts down firewalls and allows remote access. It's been around since early 2005.

All I know is that for a large part of Tuesday, the Royal London Hospital wasn't accepting ambulance patients into A&E. While I wasn't there, I can't see how the failure of a computer system meant that they couldn't deal with emergency patients. Even worse, this came a day after all the local hospitals were inundated with patients. At my local hospital there were no beds available at half past six and there were nine ambulances waiting to handover their patients into the packed out A&E.

Therefore, hospitals that were still recovering after an exceptionally busy Monday had more pressure put on them because the Royal London went on divert.

I know of one critically injured patient who should have gone to the Royal London, as it's a trauma centre, but instead had to go to another hospital. So, despite the official statement, I would suggest that "By using back-up systems, manual procedures and working flexibly, we have continued to provide high quality care to our patients.", isn't true for all patients.

All this was caused by an old worm that should be fully protected against - imagine if it were something specifically written to take advantage of the NHS computer systems. Imagine if the whole computer system was linked and the worm had access to the entirety of the NHS via a joined up database?

If you have been to the Barts and London Trust can you be sure that the remote access feature of this worm hasn't been used and that your medical details aren't now out there?

But of course the NHS IT programme won't be doomed to failure, because they are using the best of the best to design the system, not the cheapest or most politically expedient...

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Today was supposed to be my 'getting things done' day, but instead I have the lurgy (which may explain some things if this post is utterly unreadable).

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Pondering - I wonder if there is a market for insulated and waterproofed Burkhas? I imagine that they'd be quite nice in the worst of the English weather. A cross between a Parka and a Burkha - but what would I call it?

Peter Canning has written another excellent post, this time about fractured hips.

We get a fair few fractured hips (or #NOF for 'fractured neck of femur), most common among the elderly, it's one of those things that I feel that we as an ambulance service don't deal with as well as we should.

Apparently the thought is that this isn't a 'medical emergency', but explain that to 'Doris' when she has been lying on a hard floor for six hours with a broken bone causing excruciating pain.

Part of the problem is how we prioritise calls, using much the same computer triage system as Peter mentions these calls often come out as one of the lowest, or 'green' categories.

This means that they have to wait while our limited resources deal with 'Red' and 'Amber' calls - an example of a recent 'Red' call for me would be the man in his twenties suffering from a hangover.

So Doris continues to get pressure injuries from the floor because every move is agony.

'Green' calls don't need to be attended to on a 'blue light and siren' response unless they are in a public place (because people waiting for an ambulance in view of the public is obviously a clinical risk...ahem).

Personally as soon as I see that there is an elderly person on the floor I'll respond on blue lights, call me old fashioned but I think that leaving old people on the floor, sometimes in their own urine (for many fall after getting out of bed at night to visit the toilet), is just not the right thing to do.

Of course, I also think that a blue light response to a hangover is a bit excessive, but then we do tend to over-prioritise most calls.

Peter talks about the lack of painkillers being given to these patients, like his service we also have Morphine to give and, I would suspect that some paramedics are a little reluctant to give such 'strong' analgesia to a frail patient - but I have no experience or evidence of this.

My pet Paramedic and I are more than happy to dose up little old ladies with some high grade narcotics...

(No prizes for guessing the Prodigy song that runs through our heads when we do this)

When I was a nurse we set up a pathway for #NOF, we would x-ray, give fluids and analgesia, refer to the surgeons and book the orthopaedic bed all in one go - it was designed to get these patients, vulnerable to pressure sores, off the hard A&E trolley as quickly as possible. All of which boosts their chance of survival.

Yet, in the ambulance service we leave them on the floor.

It's one of the things that I've mentioned before - that the government grades us on how quickly we get to calls, but it doesn't grade us on the relief of pain, or the appropriateness of our telephone triage system.

Perhaps that needs to change.

It's not because she's young.

It's not that she's seriously ill

It's not that I don't know what it is that's made her helpless.

It's not that the only reason that she is standing is because her husband is struggling to hold her up.

It's not when she goes into a seizure and becomes incontinent.

It's not me being covered in her urine as I help her husband lower her to the floor on the crowded landing.

It's not the possibility that she could die from this illness or be permanently disabled.

It's not the way she looks at me with utter terror in her eyes.

None of those things kept me awake tonight.

It's the sound of her four young children behind me, wailing in fear as they realise that their mother isn't playing a game.

We ambulance people are finding ourselves called to the Barkantine centre quite a bit these days. Amongst other things it is a birthing centre.

It's really rather nice actually - it's clean and airy, the rooms are large and have all the amenities like an en-suite bathroom, birthing pool, televisions and big bouncy inflatable balls (I have no idea, the midwife who taught us how to catch a baby never told us what that could be used for).

The staff are lovely, when I have seen them dealing with medical situations their clinical skills have been good, they also seem very happy at their job, something that is a rarity in some of the hospitals I visit, and yet I find it incredibly important. Their bedside manner has also seemed excellent, again something that I've found lacking with some staff in some hospitals.

So, why do I find myself going to such a paragon of 'how things should be done'.

Well, we are used as a a transport service when things start to go a bit wrong.

To be fair, from the policies that they have they do tend to err on the side of caution. For example if the labour is progressing too slowly we will get called to transport the mother to the Royal London Hospital Maternity department (and that department is quite a change from the Barkantine I can tell you), the Barkantine midwife will travel with them.

A little while ago I took a mother and baby to the hospital because the baby was a little strange and needed some medical attention that the Barkantine couldn't provide. Hopefully nothing too serious, but my knowledge of neonatal medicine is rather thin.

So, while it is indeed a superb place to give birth, I have just one small problem with the Barkantine - it's not in a hospital.

While they only accept patients with no expected complications, such things can always occur which is when we are needed, and while I don't begrudge them using us as a transport service, because we do this for other hospitals, it does seem to be a bit wasteful of resources.

I'd also hate to see something bad happen to a mother or child because of a delay brought about by the wait for an ambulance and the following transport through the streets of London.

The Barkantine is excellent, it's just in the wrong place - it should be in a hospital, with access to theatres and a SCBU, Consultants and 'Crash teams'. These options should not be twenty minutes away by blue light transport and dependant on there being an ambulance nearby that isn't dealing with yet another drunk.

So, when the new Royal London Hospital is built, can we transplant the Barkantine to the roof there please?

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I'm working Friday, Saturday, Sunday nights - so don't expect an answer soon to any comments or emails.