There are things that I know, and things that I don't know. Of the things that I don't know I know what I have to do.

Take them to hospital.

Take for example the patient with an unusual underlying illness that I attended to. She was having some strange symptoms that weren't specifically connected to her normal condition. Whatever ailed her I wasn't able to do anything about, so I knew I had to take her to hospital.

But which hospital?

You see, if the symptoms were caused by her bleeding into her brain then I'd bypass the nearest hospital and take her to one with a neurological unit. If not, then the nearest hospital would be the best place for her.

So you do a neurological assessment and make your decision.

But that's not all. Back when I was an A&E nurse, sitting in triage and making decisions on what priority a patient is I would often see a 'syndrome kid', a child with a strange collection of sypmtoms and underlying health problems that are often named after the Doctor who discovered it.

Now, paediatrics isn't my speciality and there was no way I'd be able to remember all the differently named syndromes, so I'd ask the parents - after all, in living with their child's illness, they would often be the experts.

So, with my current patient I asked her about her disease process, 'Was this normal for her?', 'Had she had this sort of thing previously and what did the hospital do?' and 'How concerned was she about her current symptoms?'

The decision I made was to 'Blue light' her into the nearest hospital, at her insistance I pre-warned the hospital and gave them the number of her specialist team at her own hospital.

By 'blue lighting' her in I was getting her to the experts as quickly as I could.

I have a theory, possibly saving the ambulance service from crashing and burning at some point in the future.

There are a large number of patients that I go to where they essentially want a free taxi to hospital, sometimes they call an ambulance because they think that they will be seen quicker than if they arrive under their own power.

I've lost count of the number of times someone a relative has 'followed up the ambulance' in their own car when our patient has an incredibly minor illness is in the back of my van.

It'd be a fairly simple system to set up, all you'd need is a copy of the Yellow pages.

It would start in Control, the calltaker would take the patient's name and address, they would then determine if the patient has anything seriously wrong with them, like they aren't breathing or a leg has suddenly dropped off.

The calltaker would then read out the following bit of text.

"By getting an ambulance you will not be seen any quicker in A&E. All our ambulances are busy dealing with emergency cases at the moment, would you be happy with a free taxicab? You will likely get a taxi quicker than you will an ambulance."

If the patient agrees then the calltaker, or a newly delegated (and even more poorly paid) role, then looks for the closest minicab firm in the Yellow Pages and arranges it for them.

There are various figures for the cost of running an ambulance to a job, it's normally pegged around £400. Wouldn't paying for a minicab save the NHS a lot of money?

And if we start supplying minicabs with disposable seat covers they could also deal with the vast majority of our Friday night clientele.

Of course, this is somewhat similar with what we are trying to do with the fleet at the moment - reduce the number of 'proper' ambulances and replace them with single-personed people carriers who can take the walking wounded to hospital. Of course, that costs a lot more money...

I, however, am not mad.

A perhaps more sensible suggestion would be to team up a paramedic with a police officer and have them assess all assaults that don't obviously need an ambulance - things like simple cuts and the like because at the moment we send an ambulance to these. Actually we often also send a FRU because the call gets categorised as 'Possible Serious Bleeding".

We are in the middle of a shift and one of our mates asks us if we could do a job for them as a favour - they are off shift in a hour and the job is for an emergency transfer from someone's home to a hospital waaaay outside of our patch. We do it because it's awful to get off shift late, and to be honest, for us a change is as good as a rest.

The job is a simple one - pick up patient from their home and take them to hospital as quickly as possible - no thinking required and I don't even need to do any vital sign measurements on this job.

The patient is a one year old child in liver failure and her parents have just been told that a donor organ may have become available.

When we arrive at the home the whole place is in uproar, it's late in the evening and every member of the family is scrabbling around gathering things into no small number of bags. Clothes, food and the sort of supplies you need for a very sick little one year old.

I do my best to try and bring a little calm to the chaos but the family aren't having any of it, they are in near panic and their emotions are somewhere between fear and joy. I know when to admit defeat and I leave them be.

The transport itself is fairly smooth although the child alternates between crying and griping for the whole trip, I can't really say I blame her as I would imagine that she isn't too happy to be going back into hospital again. Her parents do pretty much everything that they can to keep her happy but unfortunately for my sanity nothing seems to work.

They seem like nice folks, they have another older child and from what little I saw of them they were well behaved and happy, always a good sign when there is a seriously ill sibling in the family.

We reach the hospital and the nurse beds them down, there is going to be a lot more testing before any operation but I've done my bit.

I like going to strange hospitals, the nurses on the ward always offer us cups of tea and I am way too polite to refuse...

So it's a nice job and we manage to get back into our area for the end of our shift, but I do wonder about the donor.

The donor must have been young, and their last journey was probably in an ambulance staffed by colleagues of ours. Their parents would have been distraught and panicky, and then they would have had to made the decision to allow the doctors and nurses to stop trying to save their child.

And then they made a decision to allow their child's body to be used to help others, a wonderful and brave decision. And because of that decision a one year old child they will never know is going to get a chance of life.

I've been on the organ donor list for years, why don't you think about it?

We are called to a young woman in her thirties. Our computer screen sends it to us as a possible broken arm.

As we arrive at the house we are met by the rather excitable husband. He is all sweetness and light, thanking us for turning up so quickly, saying how worried he is and smiling at us a lot.

His wife is in bed, hidden under the duvet, she's fully clothed so we remove the cover to speak to her. She's not very communicative and every time she says something she looks at her husband for approval.

My crewmate is attending, so she's the one carrying out the assessment, but from across the room even I can tell that the bruises around her wrist are from a hand grabbing the arm. Bruising from fingertips is really rather obvious.

We ask what has happened and she tells us that she slipped over in the bathroom and banged her wrist on the radiator, something that doesn't explain this pattern of bruising, she also tells us (after conferring with the husband in their native language) that it happened earlier today. She's obviously not happy, no-one is ever happy about hurting themselves, but this is something unusual.

We move them down to the ambulance after raising an eyebrow at each other to make sure that we both know the suspicious situation.

In the ambulance my crewmate asks about any analgesia, if she's taken a painkiller for the pain. The patient says yes, she took some last night.

Oh, asks my crewmate innocently, I thought you hurt yourself this morning.

More muttered dialogue in a language we cant understand before we are told that the painkiller is for a problem the wife gets on only two nights of the year.

If this were a 'Casualty' or 'E.R.' script I'd be laughing at the screen for the scriptwriter having such an obvious cliché while making it all too obvious.

As it is there is little that we can do - we handed the patient over to the triage nurse and made our concerns known to her, then delegated any decision upwards by noting our concerns on one of our 'vulnerable adult' forms. I'm not sure these forms are designed for this purpose, but we do what we do and if someone in the upper rungs of management wants to throw it in the bin it's up to them.

He is the thing, we have no idea what happened - no-one was volunteering information and we are only with the patient for a few minutes so it's not really appropriate to start investigating. Did the husband do this to his wife? Was it an assault in the street that they are ashamed about? Was she trying to hit the husband and she got the bruising while he was restraining her?

Who knows, I can't judge. I'm not the police so the best we can do is draw it to someone else's attention within the confines of patient confidentiality. All I am, as one politician said, is a taxi driver with bandages.

"...shouted at the paramedics who helped her. The source added: “When she came to she started mouthing off and told the ambulance crew, ‘You have to respect my privacy’. She then told them to get out."

Although, blimey, reading that copy make my teeth hurt. 'pretty 19-year-old', 'raced to the scene', 'pal'. Seriously, does anyone ever refer to people as 'pal' these days?

So, is this story in the 'public interest' and if not why does the Sun have the right to breach patient confidentiality? Because no ambulance crew would go to the press about this - we have ethical standards.

A little later on in the shift, after we'd dealt with the patient mentioned in the previous post, we were sent to one of the police stations on our patch. The person there, who had been arrested, was complaining of chest pain.

Patient's in their twenties rarely suffer from heart attacks, and one look at him as he dejectedly sat in the police cell was enough to tell us that it was really rather unlikely it was anything serious.

But we are professionals my crewmate and I, and treat everyone the same, arrested or not.

We tried to get a history from the patient but, like a fair few of our 'clients' he didn't speak a lick of English, so we asked the custody sergeant what was going on with the patient. The police doctor had seen him and was worried that he was having a heart attack - as I say, quite unlikely, but 'unlikely' isn't 'certainly' and the doctor was quite rightly covering his bases by asking for him to be seen at a hospital.

Talking to the sergeant it soon became apparent that this patient of ours had been arrested on suspicion of beating up our patient from earlier and it was only after some hours being incarcerated that the pain had developed.

It's not often that we get to treat both sides of a fight. Dealing with 'assaultee' and 'assaulter' is incredibly unusual, especially if they aren't being seen at the scene of the fight.

We also learned from the sergeant that the victim of the assault had been sent to ITU, but had woken up with apparently no life-threatening injuries. It would appear that a large part of his unconsciousness was due to the prodigious amount of alcohol that he'd drunk and wasn't in fact suffering from a brain injury.

Still, I feel justified in blue light transferring him to a neurological centre because he'd obviously done a good enough impression of being seriously injured enough to worry the A&E doctors enough to warrant a stay in ITU.

And after doing an ECG on my current patient it was highly unlikely that he was having a heart attack.

We took him to a different hospital.

'Male, collapsed in alleyway ?attacked"

We are supposed to wait for the police before we go to such jobs, just in case the attackers are still on scene. Like many ambulance crews we don't worry about such things if the text of the job doesn't set off our 'danger-sense'. This job was during the middle of the day and in the middle of a rather busy part of our patch.

If there is an assault in a public place we'll normally cruise up to it - if there is still something dangerous happening we'll be able to drive off quickly and wait around the corner.

In this case we arrived a few seconds before the police, they had followed us down the road. At first we couldn't see the patient, but then it soon became apparent that he'd wedged himself between a wall and some street furniture. The police were talking to a group of men who were standing nearby.

We approached the patient - there are two reasons why a person wedges themselves in place like that, the first is that they think that they are going to die, don't ask me why, but people just seem to do that, the other reason is that he is so drunk he thinks that he'l be safe and comfortable like that.

His face was turned away from us, and as we turned him over to see if he was still breathing we caught a whiff of alcohol, and if I can smell it then he must *really* be drunk.

Then we saw his face.

Swollen, misshapen and with missing teeth, he'd obviously been seriously beaten. The way that he didn't resist when we pulled him out of his cubby hole made me aware how badly he had been hurt. Something clicked in his arm as we rolled him onto his back.

Now, in an ideal world we would put a hard neck collar on him before we moved him, but as we were unsure if he were breathing properly clearing his airway takes priority (as it always does).

We stepped our speed up a gear - a quick assessment showed that the patient was deeply unconscious. Time to load him onto the ambulance, stabilise him and drive past one hospital to get him to a hospital with neurological surgeons.

As we got him into the ambulance he started to twitch, a sign that there may have been brain or nerve damage. We cut his clothes off to make sure that he hadn't been stabbed somewhere, secured him to the bed and made ready to leave under blue lights.

One of the policemen poked his head into the back of the ambulance, "How is he", he asked.

"Potentially life-threatening", I answered - that's the phrase that gets the police's attention, and in this case it was certainly true. Without a CT scan and other investigations I couldn't be sure if the patient's unconsciousness was due to drink or due to his brain being rattled around his skull.

"I'll follow you up to the hospital then", said the policeman and he ran to his car.

So we blue-lighted him into hospital where we later learned that the patient was sent to intensive care.

But that wasn't the end of the story.

To Be Continued...