Over on Mental Kipple I thought up some ideas for iPhone applications that I'd like to see.

The one most relevant to people who read this ambulance blog is #10

10) A copy of the BNF for offline reading, and not for £100+ please.

And what should I find on release but Epocrates Rx, a free application that does much the same as the BNF (British National Formulary, a list of all the drugs in circulation) but will also help me out when I come across pills in unmarked boxes and makes it easy to look up potential drug interactions.

Trust me when I say that it is infuriating to ask a patient what medications they take and they don't know and instead hand me a plastic box with half a dozen different pills in it.

It can be especially dangerous when we want to give them drugs of our own but have to be careful about it interacting with the patient's own medicine.

Really rather quite handy and quick to look at when I don't have my BNF to hand. The only problem is that it is American software and they have some different drug names that us Brits, but it is good for some things and is definitely worth what I paid for it.

I still want #2 though,

2) An Augmented Reality Game, perhaps crossed with social software overtones - consider if you will a game that is location based to where you *really* are. Using the location services in the phone (either original iPhone, or the AGPS of the 3G iPhone)

Anyone writing one want a story consultant? Or have we enough coders here who could group together to write such a thing under my benign dictatorship...?

A hospital has admitted clamping ambulances for parking infringements and charging £50 for their release.
Security staff at King's College Hospital, south London, are clamping the non-emergency ambulances for spending too long in drop-off bays.

These ambulances are privately run ambulances who took up the contracts for patient transport. This is something that the LAS used to do in London, but then with the sneaking privatisation of the NHS the private companies started to do things cheaper and so the LAS lost a lot of these contracts.

They have, as far as I know, no exemptions to where they can park (unlike us proper emergency ambulances).

I'm not quite sure how "They clamp ambulances parked for more than an hour "to allow other vehicles into the area," works though, surely if they are clamped then they are still blocking the area?

I don't know, I'm an ambulance driver, not an ambulance parker. And if you've ever seen me park, that much is pretty obvious.

Kal has wetted my eyes. Bloody swine, he knows I'm soft for the old ones.

A woman has said she was left in agony when an ambulance took three hours to respond to a 999 call after a fall.
A spokesperson for East Midlands Ambulance Service (EMAS) said: "We don't have sufficient time to look into the detail to respond to this."
"EMAS is a 24/7 service. We answer 500,000 emergency calls per annum and that's our priority."

(My emphasis)

Wow...

I never thought I'd hear an ambulance service say this. I guess that the person on the other end of the phone to the reporter was having a really bad day.

I wonder if this means I can get away with telling a patient that, "I don't have time to deal with your cut finger".

(My back of a fag packet numbers for London is that we have over 1.2 million calls a year, I'm sure the official figures are out there someone but I can't be bothered to look them up. I'm working in a few hours and yes, I know we have more ambulances than EMAS).

Very unsatisfied today - mostly because I tried to get an iPhone 3G. The rest need not be said.

With regard to the 'Warranted' post - We decided not to tell the police, after all they almost certainly have his address and will make an appointment to arrest him in the future (I learnt this from reading police blogs). He wasn't a threat to anyone apart from himself and in his distressed frame of mind (and fear of the police) it wouldn't have done his health any good to have the police hovering over him.

We did however let the nurse who took over care for him know, she needed to know as it could impact his further care.

I'm now going to potentially identify someone, not a patient obviously, but there is a reason behind this.

We were sent to a car crash on the A406 yesterday between Ilford and Barking, the traffic was moving exceptionally slowly due to the accident, so we had to squeeze through the lanes of traffic. As we travelled on blue lights and sirens the traffic parted before us like the red sea.

Which is why I was fuming when my crewmate told me that we were being followed.

Some [expletive deleted] in his car was tailgating us through the jam, keeping close to our behind he was jumping the queue that everyone else had been sitting in.

Now, ethics aside, this is incredibly dangerous - I often have to brake hard and he could have gone into the back of me, so I had to slow down the speed I was driving. This sort of behaviour has caused more than one accident when the ambulance driver has had to hit the brakes because, for example, a dog has run out into the road.

My crewmate went into the back of the ambulance and got his license plate number...

We reached the accident and dealt with the patient and while my crewmate was taking the patient's details I had a little chat with one of the police officers there. I explained what had happened, and he took the driver's license plate number.

"Right", he said, "I'll give him a call in the morning..."

It's an offence to impede the progress of an emergency vehicle, something this driver was doing even though he was behind me - hopefully he'll be charged with this as I believe it is a £500 fine. That'll teach the [expletive deleted] a lesson.

I mention where the accident took place so that if anyone in the queue was passed by this driver they can also have the similar warm glow that we had in setting the police on him.

Ambulance 'loses way' to hospital
Ambulance drivers are to get additional training after a vehicle got lost as it was taking a woman to hospital, who later died.In a statement East Midlands Ambulance Service (EMAS) said: "During the journey... the ambulance satellite navigation system failed and the driver, who usually operates in the Skegness area, took a wrong turn.
"This was realised and the crew member in the rear of the vehicle, who was familiar with the area, was able to direct the driver back on course.

I rely on the Sat-nav system on my ambulance - not so much if I'm working in my area, but if I'm elsewhere in London then I'm like a fish out of water.

Strange hospitals are the worst as I keep circling the area trying to find the A&E department.

If I do a transfer to a hospital outside of East London, there is then a big chance that I'll get another job in the area. I don't have 'the knowledge' so end up following the sat-nav or relying on one of our mapbooks.

This is a tragedy, but despite this it is a bit of a non-story in my opinion, someone from outside of the area took a wrong turn, it was corrected and they found the hospital. That the father of the patient reached the hospital 15 minutes earlier isn't unusual - I'm often beaten to hospital by relatives 'following' in the car, partly because we do various things before we leave the scene and partly because I don't drive like a loon with a patient in the back. Ambulances have different handling to cars and so we'll often drive slower.

If someone could tell me how 'better trained' can be implemented in order to make sure that when driving in an unusual area with a failed navigation system the driver never takes a wrong turn I'm sure every service in the country would be grateful.

And yes, I've taken a wrong turn or two myself and had to rely on the experience and knowledge of my partner to help me out, and I've done the same for people who have worked with me. It's why a good ambulance crew is a team.

And not being able to find a place can be one of the worse things that happens to you - as this example from the archives shows.

I got a job, '14 month child, floppy and lifeless'.
The address was given as 'Flat 1, Rose house, Starling road'.
I sped up and down the road. I spotted some of the names of the flats in tiny writing, on little blue plaques many of them pointing away from the road. My pulse started to rise. It had taken me four minutes to reach the area, but how much longer would it take me to locate the potentially very sick child?
I found 'Lilac House', 'Lily House' and 'Tulip House', but I couldn't find 'Rose House'.
Now I was starting to panic.

I don't know where I'm going with this, or even what site I should post this on - perhaps I'll just cross-post it to everything.

Once upon a time I was a clever bastard. I used to devour computer languages, I used to write 6502 machine code, in Hex for burning straight onto EPROMs. I used to learn things every day, I devoured books. I used to build computers and fix them. I used to solder little electronic gizmos together - 555 chips and LEDs, all in bare feet so I could hold the board still with my toes.

But last night I was trying to understand 'regular expressions', something that I should have found really easy. But I sat there and scrolled backwards and forwards and it just didn't sink into my brain.

It's not the first time I've noticed this, I sit and read and reread a bit of text a couple of times before it sinks in. I try to remember something and it just doesn't work. I try and write a blogpost and the words stop flowing.

I've a sneaking feeling it's to do with my lifestyle at the moment. I've heard it said that learning computer programming will alter the way that you think but I think that my earlier life has slipped away from me.

It might be a result of rotating shiftwork slowly eating away at my brain, it might just be my age - but I'm hating it.

The other thing that it might be is that in my day to day work I don't need to use my brain anymore. I turn up to a patient and can tell what is wrong with them within a minute, the lack of any 'serious' cases has meant that I go from job to job picking up people with very little wrong with them (or the usual suspect illnesses like angina, or COPD), doing some vital signs and then writing the same paperwork. I drop them off at the hospital and repeat it all over again - the only thinking that I have to do is in trying to work out how to get some food inside me.

When I started the job every call was a problem to be solved, but now I think I've reached the stage where I don't need to think about how to get the trapped woman with a broken leg out from under her bed, I don't need to consider how I break bad news to someone, it all just comes subconsciously to me.

I guess I'm just not stretched by my work anymore, even though I don't know what patient I'm going to go to next it's all just become a bit 'samey'.

Because I'm not thinking in work, my brain isn't getting any exercise. Because I work rotating shifts I can't go to night school to start learning again, because I work twelve hour shifts it is incredibly hard to motivate myself to learn on my own.

I need a kick up the arse. I need something that will stretch me, motivate me and force me to do some learning.

I need to get out of shiftwork - but I can't do a fixed rota in the ambulance service because I just couldn't live on the cut in wages that I'd have to take.

I'm not sure what else to do, and this is part of the reason for this post - I love to hear what other people think. This is a request for advice, a request for things that I can do to get my brain working again because I hate this slow slide from how my brain used to work into a dullness.

I need to get motivated again.

I have some books on programming in modern languages - maybe I should hit the Python one, try and force myself into thinking again.

C9

Drunk, but pleasant Lithy - chatting up the copper, sudden decrease in liking him after hearing about his repeated drunk driving convictions

It's funny how your impression of people can change from one moment to the next.

We were sent to usual job of 'Man hit over the head with a glass, cut to head' - we were directed to the rear of a chain pub. Standing there were two men, both worse the wear for drink.

The police arrived just behind us, and a female police officer got out to take the statements.

Our patient was in his thirties, drunk, Lithuanian and had a two inch cut to the top of his head, his friend was similarly drunk and the first thing his friend tried doing was to chat up my crewmate. Then chat up the police officer.

Both women gave him short shrift unsurprisingly.

Even our patient told him to go away.

We then sat the injured party down in our ambulance and started getting a history. It was the usual sort of thing, he'd had a bottle thrown at him because his friend and him had been talking to the wrong women. Thankfully he wasn't too badly hurt, and while he needed stitches, he wasn't bleeding at the time.

All throughout our assessment and treatment, and while the officer was taking a statement he was jolly, engaging and full of good humour. He tried to chat up the police officer but unlike his friend he was charming and quite slick.

So a rather nice chap - quite unlike our normal customers in these circumstances.

He asked about joining the police as a translator, apparently he spoke six languages, the officer thought that this was a good idea and asked him if he'd ever been arrested.

"Yes", he said, "Drink driving. Four times".

Suddenly we didn't like him any more. He explained how it is apparently normal to drink drive in Lithuania and if you get caught then you give the arresting officer £15 and they let you go. I have no idea if this is the truth.

So he went, in a matter of seconds from a very pleasant patient to a dangerous prat. Of course we didn't treat him any differently, but it was surprising how quickly the atmosphere in the ambulance changed.

He didn't want to go to hospital, he'd been saying this since we'd picked him up and so, despite our attempts to get him to go, he walked off home with nothing more than a bandage over his head wound. Nothing much we could do as he was fully compos mentas.

"Women love scars", he shouted over his shoulder and grinned at us as he started his long walk home.

UPDATE : I just realised that I left my note on this blogpost in at the top of the post. It's how I remember what I should be writing about, a short sentence or two jotted down to jog the memory. On this occasion I accidentally left it in which kind of spoiled the 'surprise'. Oh well, I've decided to leave it there as it's all about the transparent disclosure this blogging lark.

We have been sent to a young man who has called us from a public phonebox, he has told our calltaker that he has been cutting his wrists.

As a point of general safety the police are sent to this job as well as rather obviously he could well be armed with something sharp.

We meet with the police who are also searching for the patient - they have already been up and down the street and can't find him so they declare 'area searched, no trace' and disappear off to do something else (it's been a very busy night for the both of our services).

We decide to have a further scout around and, because of our experience of peering into the dark while driving slowly, manage to find the patient standing in a pool of his own blood in the phonebox.

The rather large blade that he has used to hack his arm to pieces rather thankfully is on the floor a little way away from him - I'd already approached him, but if we worried about people stabbing us all the time we'd never get any work done. I pick it up and throw it into out sharps bin where all our used needles go.

We bandage up his shredded arm and chat to him in the back of the ambulance. He's obviously emotionally shaken and keeps asking if the police are going to shoot him. It takes us some time to explain that the police have already gone on to their next job in the queue.

He tells us that he is in fear of the police because there is a warrant out for his arrest, I ask him what for and he answers, "you name it I've done it'.

So, my questions to you, the way I see it there are three ways to answer them - legally, ethically and practically.

• Do we, as ambulance people tell the police that we have someone who is wanted for arrest, taking into account that we are supposed to be all about patient confidentiality?

• If you decide not to tell the police, is there a certain level of crime that you would tell them - for example if the patient were a child murderer would you tell them as opposed to shoplifting?

• In general, how far do you think we can we go against the patient's wishes when there are external pressures on us to do something (for example not reporting a domestic abuse case or not reporting a child abuse case)?

I'll tell you what we did, and why in a later post. Responses from police officers are especially welcome.

A little while ago I received an email from Katherine Howell, an ex-ambulance officer from Australia . She's written a book and wondered if I'd be interested in reading it. While I don't have much time to read these days the idea behind the book sounded interesting, so I agreed.

It's rare for me to try and finish a book in one sitting, I'm just too busy - but I must admit that I did find Frantic hard to put down. It tells the story of a paramedic with a troubled marriage. The story starts when her husband is shot on the doorstep of their house and her young son is snatched.

What follows is a real page turner of a story, with a lot of twists and turns. I lent it to my mum and she also read it in one sitting - I walked through the door and the first thing she said to me was, "That Frantic was a great book". She then went on to 'spoil' some of the twists in front of my brother, so it's a good thing that he doesn't read fiction.

I really enjoyed it, both as a piece of paramedic/crime fiction and as a book in it's own right. I've also got an advance copy of her next book 'The Darkest Hour' and I'm purposefully waiting until I can dedicate time to reading it in one sitting.

'Frantic' is a cracking book and if you like ambulance related stuff, or just good page turners then I'd recommend it to you.

Disclaimer: I would like to state that I received the book, and it's sequel, for free and that I have not been paid for this blogpost. If you purchase the book through the link above I get a small payment from Amazon.

Sometimes my atheism tends to distance myself from my patients.

Take, for example, the woman who called for an ambulance because she had a sudden bout of severe belly ache. This had been going on for over an hour before she called and we'd been busy all day so it took us some time to get to her.

We were met by the patient herself who didn't seem to be in any pain. I asked her what the problem was.

"I had severe pain", she told me, "it was so bad I was curled up on the floor, I couldn't breathe".

"Go on", I said.

"But then I called out for Jesus twice, and the pain went away".

"Erm... OK".

"So I don't want to go to hospital, if the pain comes back I'll call for Jesus again".

It's here that I have a slight quandary - if a patient tells me that they called out for the Flying Spaghetti Monster*and he healed them, I might think that they are bonkers. But there is no way I can suggest that calling out to another imaginary being (in this case Jesus) might not be the sane response to pain of this type for fear of having a complaint put in against me.

At the end of the day, I wasn't going to get her Sectioned, so I left her at home.

A similar thing happened a little while ago, another patient who believed that praying to Jesus had stopped his chest pain and then refused to come to hospital.

If a patient tells me that the voices that he hears direct him to do things, then I consider that he may have a mental health problem; however if they tell me that God (whichever one takes your fancy) has told them something then I can't challenge that. And if there is no evidence for the existence of either of these sources outside of the mind of the person hearing them, then aren't they both from the same source?

It's strange, but when I did my mental health placement as a lowly student nurse I was told that we should challenge things that our patients would say that are just not true. Until someone can prove that 'God' exists then why aren't we challenging these apparently delusional thoughts?

It also confuses me how anyone who works in emergency medicine can believe in a benevolent supreme being, given the things that we see and the cases that we deal with. Also we are suppose to use scientific evidence** to determine our practice, which seems to go against the type of mind that believes in invisible sky bullies.

*May you be touched by his noodly appendage.

**Yes, I am aware that people who are allowed to practise their faith in hospital can recover quicker, but I might recover quicker if I have distracting and happy-making activities to take part in rather than sit around staring at the ceiling. I don't think that World of Warcraft can be considered a religion. Likewise I'm aware of the 'prayer' experiments that prove that in double-blind tests being prayed for makes absolutely no difference in healing. Show me one shred of evidence that proves the existence of God and I'll convert, until then it's a load of old hokum like the existence of the Higgs Boson.