We have a lovely new ambulance at West Ham station. They are quite nice actually, there is much more leg room so it means I don't think I'm stuck in an economy airplane for twelve hours.

They have groovy new electronic systems that talk to you and do things like turn off the lights in order to save battery power - it only sometimes turns off the lights when you really need them.

It has the new electric trolley-beds, which I'm yet to encounter a problem with, although I'm sure that it's only a matter of time before the batteries that drive them start to fail. Maybe I'm being cynical.

The biggest problem is that the engine is incredibly underpowered. There is no acceleration to it at all, and it's that acceleration which you need when you are coming to a stop every five yards as you weave your way through the London traffic.

Sadly it's not there, and it sometimes feels like you need to get out and give it a push.

I blame the LAS management wanting to save money, and the environment - after all they do try to have us out driving around aimlessly, just in case a call comes down the line in the area in which they have deployed us.

(Sorry I'm being cynical, what actually happens is that the psychic computer tells us where the next heart attack is going to happen and so we are dynamically deployed depending on this crystal ball).

This new vehicle has done 2,500 miles. There isn't a mark or a dent on it.

Yet, in the last 41 days, it has needed to be taken off the road to be fixed 22 times.

We tallied it up while we were working on it last night - the picture opposite is the reasons why it has needed to be fixed.

I'm sure that, had we bought this from a shop, we'd be covered under the 'not fit for purpose' legislation and we could get our money back.

Sadly, we work in the world of NHS contracts, and I'm just not that smart to realise why we aren't sending these vehicles back to Mercedes and asking them to get them to do the thing that we have bought them for.

There is obviously a fault somewhere that needs serious fixing.

Here is a picture of the front of the ambulance repair reporting book, where we write down the faults so that the fitters can mend them. It is supposed to be left on the vehicle at all times.

Sadly, the LAS typo monster has struck again and it is down to crews to correct things.

This monster is getting more and more prevalent, the latest big memo - laminated cards sent to every member of staff in the area, told us about the policy for dealing with patients who need to go to a 'heart attach' centre.

I think it's because they have promoted one of my old officers who couldn't spell, and laminated everything.

I think he's doing something like 'business development'.

And, like all writing on the internet where someone comments on grammar or spelling, I'm sure that there is an error on this page.

My excuse (for many things) is that I'm working night shifts - it's all I can do to manage to get into work in the first place...

I've given up on the NaNoWriMo for this year - too many twelve hour shifts (I'm starting nightshifts today), coupled with some deadlines approaching and I'd have to spend twelve hour shifts when not at work writing to keep up with the schedule.

This doesn't mean I'm abandoning it, I'm going to keep writing it, and I may throw the 'beta version' up somewhere else - be sure I'll let you know when and if I do.

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Back to writing about ambulance work, work that often seems stranger than fiction.

The job I'm writing about today would, if shown as a 'Casualty' episode, have me groaning at the screen at how unlikely the events were.

We were sent to a 'male, collapsed', on the screen was the patient's name - it was a name I was somewhat familiar with.

It was a name I used to go by (sometimes I feel like Old Ben Kenobi remembering his time as Obi wan Kenobi with the amount of names I had...).

I've mentioned my father once on this site - in 2005 I wrote this,

The short version of my history with my father is that he left home when I was around fourteen (my brother was around twelve), and married another woman (without divorcing my mother first – an oversight on his part, he is after-all barely literate). Since then I haven’t seen or heard from him, which was a bit strange as the split between mum and him wasn’t acrimonious.

So my attitude toward him has basically been ‘Fuck him’, it appears that he wanted us out of his life as quickly as possible, and he has succeeded admirably on that point.

So…why was I thinking about how I’d love to meet with him, tell him how excellent my life is? I’d love to let him know that my brother is an excellent teacher and is getting well paid for his work. I’d love him to see how his walking out on us only freed both my brother and I to go on to do things that we love doing. I’d love to show him how relaxed and chilled out my mother is now. I’d love someone to read this blog out to him, so that he could know that I’m doing better without him in my life.

Actually…I wonder if he is still alive?

So – for one moment after not thinking about him for years, I’d love to rub his nose in how good my family and I have it now he isn’t on the scene.

And now I find myself going to someone who could well be him...

We arrived on scene, I was driving and I'd been telling my crewmate about my history with my father. It looked like the place where I'd last seen him more than twenty years ago, but I wasn't sure.

Then we entered the flats and from the tickle in my memory it was obvious that this was where he lived.

He was laying on the floor with one of our FRU people already looking after him. The FRU looked at us and started to give us a handover.

'This is *Firstname* *Secondname*', he said.

'I know', I replied, 'it's my dad.'

'Hey, your son is here', the FRU said.

'He probably wouldn't recognise me', I said back as my father turned to look at me.

The job itself was fairly simple, carry him downstairs, into the lift - then, after running some tests, off to hospital.

I wheeled him into the lift, it was small so his 'wife' walked down the stairs - me, my crewmate and my dad, alone in the lift.

He looked up at me and said the only two words he would say to me during the time we spent together that night.

'Say nothing'.

Now, if I had even the slightest care about him, those two words would rip out my soul and stamp on it. It would break my heart. That his son, who he hasn't seen for twenty or more years is here, saving his life and all he wants is for me to say nothing to him.

He has his new life, and he wants nothing to do with me, or my brother.

'Fuck him' would indeed seem to be the right attitude to have had over him, and I'm very glad that I've not worried, fretted or even given a moments consideration to the man that walked out on me and my brother. Now I knew why we'd never had even a birthday card from him.

He had obviously wanted to wash his hands of us.

So I switched to 'full on professional' mode. I spoke to his 'wife' (who seems quite a nice person actually) to get his history and I drove him to hospital.

After dropping him off I asked my crewmate if she thought it would be a good idea if I walked in to him, told him how well our family is doing without him and then walked out.

She rightly pointed out that despite wanting to give him a slap when he'd said 'say nothing' to me, it would do no good.

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So we left him at hospital - I don't know if he lived or died. To be honest I don't care - I care less than I would were he one of the strangers I pick up normally.

I told my mum about it, and she was furious - I think she would have quite liked to have turned up at the hospital herself, but I assured her that once my shift was over I'd stopped thinking about him.

So yes, stranger than Casualty - although I'm sure that Casualty would have had us reconciling...

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Oh, that 'other project' I mentioned? It's my new group website. And it's open.

A short break from the NaNoWriMo posts so that I can tell you about two rumours that I've heard. Note that these are rumours, if I had the time/energy/inclination I'd check them out to see if they are true, instead I'm just relying on the trust I have in the person who told me them.

If anyone knows if these rumours are untrue, feel free to let me know.*

Rumour number one is that a man from the Department of Health visited the ambulance service recently and told people that the moment the government changes (i.e Britain has a collective brain fart and a memory wipe of the last tory government and votes in the Conservatives) the London Ambulance Budget will be cut by £25 million.

This despite hitting our (stupid and clinically irrelevant) targets, despite ever increasing calls and despite the suspected pigocalypse of everyone calling an ambulance when they thing they have swine 'flu.

Additionally, somewhere out there in 'I could find it if I had the energy to Google it-land', is the government plan that a certain percentage of A&E ambulance work should be done by private ambulance firms paid for out of our budget and you can see that we will be going for the cheapest bid, which is never a good sign of quality.

Oh, and I nearly forgot - we have the Olympics coming up soonish.

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The second rumour is to do with a bit of our kit changing. This rumour however has been repeated by several people, including officers. The rumour is that because too many are going missing we will be doing away with our electronic blood sugar machines which are quick, accurate and easy to use in any circumstance. Instead we will be going back to the old chemical dipsticks that you have to wait two minutes for the result, and the result is a range of values that you read by comparing the colour of the stick to a chart.

Which doesn't work all that well, I think, considering half the time we are working in 'less than optimal' lighting conditions.

Also the dipsticks are also apparently far cheaper. And much less accurate.

Instead money is being spent on filter masks to protect me** from a milder, less fatal 'flu than is normally present at this time of the year.

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So, less money, less effective equipment and more calls. Probably less training due to the lack of money (training is normally the first thing to be cut). I can see us going back to being men with vans and bandages. Except of course that someone in government wants us to do the GP role on the cheap, but without the training is that really safe?

Expect deaths.

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To be honest I'm getting past caring. The few improvements that we've had in the service have constantly been overshadowed by new policies and ways of working that seem to exist only to destroy morale and chase unscientific government targets. We are being expected to do more for a frozen pay and with equipment that is falling apart.***

Why should I care any more? I can't do anything to change anything. Instead I should just turn up to work, pick up people who think that they are sick and take them to hospital. Then come home and watch some TV and forget about the feverish children that I couldn't record a temperature on because we didn't have a working thermometer.

Why should I get angry over it when I can't change it?

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*LAS management don't talk to me, they mostly ignore me, so I don't expect any confirmation/denial. Here is a challenge to my management - deny that either of these rumours are going to happen - here and in public. I'd ask you myself, but the organisational chart is so complex I don't know who'd I'd need to talk to.

**Sadly not only is my face such a strange shape that I can't get a mask to properly secure, but in attempting to get it fitted I managed to break my glasses.

*** An example - We drove the newest ambulance in the fleet, around 1,500 miles on the clock. We had to take it off the road twice in two days for various faults and, looking at the logbook, these were not new problems. Thank you Mercedes.

It's really simple - I hate forced overtime.

I know that it's just part of my mental make up, but if I'm forced to stay longer in work than I'm contracted to be there I start to get itchy and fed up.

It can't be helped though - sometimes we just get that 'late job' which means that we are dealing with a patient after we should have clocked off. I'm somewhat more used to that, it is one of those things that just happens, and we get paid overtime to make up for it.

(I think it's flat rate overtime mind).

The one thing that really annoys me though is when the clocks go back.

All because our ancestors were afraid of demons that might attack them after the sun goes down (or some such, I don't really care) the clocks go forward in Spring and go backwards in autumn.

Which is fine if you work normal hours - it means you get an extra hour in bed.

Lovely.

However if you are one of those stupid <illegitimate child>'s that work shift work it means so much more...

It means that if you are working a twelve hour shift, suddenly you find yourself working a thirteen hour shift - and that's not counting any extra you have to work if you are unlucky to get stuck with a late job.

I'm working night shifts this weekend...

Some time ago my crewmate told me that the clocks go back on Sunday.

I thought I would be a cunning swine and book annual leave. I really despise working that extra hour (oh, it might not make sense, but in my head it does).

So I booked Sunday night off.

Because that's when the clocks go back.

Isn't it?

No - of course they <copulation>ing don't. They <copulation>ing go back on <turf>ing Sunday morning.

Which means the <female genitalia>ing Saturday night shift.

Like a dozy <male genitalia> I took the wrong <illegitimate child> shift off.

<Male genitalia>.

So - because I'm a daft <person who copulates>, who takes his crewmate at her word, I get to work a thirteen hour shift on Saturday night.

<Copulate> it!

I may not be in the best mood.

The patients had better need an ambulance - or I may well be educating some of them as to the best use of an ambulance service.

£5.4 million pounds. For artwork to showcase 'British Culture'.

With £5.4 million pounds spent on the ambulance service I might not be left looking for a spare ambulance on my late starts.

We might have enough blankets for the coming winter.

I might have a fully kitted ambulance.

Looking wider - we might be able to look after our returning soldiers without needing charity.

We might be able to get some people out of poverty - thus saving lives.

Instead we'll have,

'LED panels on the roofs of bus stops aim to provide Londoners with a new way to display their creativity, express what is special about their London and to talk to one another.'

Oh well.

Neenaw has written recently of 'banana man', in that post she mentioned someone dribbling on my arm...

There is a person on my patch who takes great pleasure in calling out an ambulance - I suspect that he likes the attention that he gets from us. The other night we were sent to him on four separate occasions.

For the first call he'd already left the scene, which was perhaps unsurprising as the call was over an hour old.

The second call was made from outside a pub - we rolled up and he wandered over to us to have a chat. The complaint was one of his regular reasons for calling us - 'feeling suicidal'. He never appears suicidal with me, laughing and joking, telling me how he is a trained scientist and therefore is a genius.

I suspect that he doesn't actually have a mental illness, although he is an alcoholic with liver failure.

It was this call that had him dribbling and spitting over my arm. Not good, as I understand that he has hepatitis.

While talking to him another one of our regulars staggered over and started shouting at him for wasting the ambulance service time, which made me laugh as he's used up more than an average number of ambulances himself.

Our 'scientist' decided not to go to hospital and instead head back into the pub - so we drove off into the night.

Two hours later we were back at his house, this time saying that he was bleeding from his anus. We arrived and, once more, he decided not to go to hospital.

I'm fully aware that one of these days an unlucky crew will go to him, he'll refuse to go to hospital, and then he will die - dropping the last crew to see him in the brown sticky, smelly stuff.

It's like a game of Russian roulette.

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Our final call to him came down the MDT as this.

You will notice that the 'Determinant' - the thing that is used to triage the call says that he does have a weapon.

A nuclear weapon.

(I know that calltakers have to put down what the person calling says - although I'd like to know if the calltaker was serious, or having a joke).

Needless to say, I cancelled the police who would have attended due to weapons being used - told Control to look out for the mushroom cloud in the East and trotted around there again.

After a bit of an argument he finally agreed to go to the hospital - with him now in the A&E waiting room we know that he is...

a) Safe, and

b) Not going to call us for the next few hours, thereby letting us deal with actual genuine calls.

As we dropped him off at the hospital his 'friend', who had berated him earlier for his misuse of ambulance resources was pissing up the wall of the A&E waiting area - having called an ambulance himself.

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The thing is - he has been known to be violent in the past. While he has been nothing but nice to me (except of course the dribbling on me) he has been nasty to nurses and other ambulance crews. I'm happy to go to him without wasting the police's time, but there are some crews who - more wisely - ask for a police escort.

I've written about him before.

Currently I think that there is a team looking at him to try and reduce his calls to the LAS and his attendances at hospital - it's a process that has worked in the past, so I'm keeping my fingers crossed.

This is a post about how chasing government targets impacts directly on patient care.

I've often written about our chasing of our 'Cat A' targets - that we are tasked by the government to reach 75% of these calls within eight minutes. I've also written about how I think our senior management have put this priority above many others.

There is another target that we should be hitting - calls that are given 'Cat B' (serious but not immediately life threatening), we should be reaching these calls within 19 minutes.

In my part of the LAS we have been failing in this second 'Cat B' target.

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One of the things that really surprises me is that someone having a CVA, also known as a stroke is normally given a 'Cat B' priority. Given that the move is for better treatment for strokes - going so far as to rename them 'brain attacks' to put them on a par with 'heart attacks'.

It is a good thing that we are starting to treat strokes more seriously - I can remember when I was a nurse that we would essentially put people who had just had a stroke into a bed and arrange for physiotherapy - there was no treatment then, only rehabilitation.

Things have changed a little but there is still an amazingly long journey before we can start offering the same level of treatment as we do to people having heart attacks.

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Due to our poor performance in 'Cat B' our senior managers have decided that we should have 'Amber Ambulances', these are ambulances that are to be tasked with bringing our 'Cat B' response times up.

These are extra ambulances that are staffed with the same skill level as our 'regular' ambulances, but they are only supposed to attend to 'Cat B' calls.

All in order to meet that government target.

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We were sent on a possible CVA/Stroke - a 'Cat B' call. So I put on our lights and sirens and headed off to the call.

Partway there were were canceled for a nearer vehicle, so I turned off the lights and sat in the normal traffic. I got stopped by a set of red lights.

As the house we were going to was on our way back to station We would drive past it and see who had been given the job.

As I drew up to the street it was obvious that there was no ambulance there.

I called up Control and let them know that we had beaten the 'nearer' ambulance and that we were more than happy to take the job. After all if someone had suffered a stroke they needed to be in hospital, not waiting for another ambulance.

I was told that I should continue driving and not attend to the patient as 'the amber ambulance is nearly there'.

Four minutes later the 'amber ambulance' arrived.

An identical ambulance, with an identical skill level, but four minutes behind us - even though we had travelled most of the way observing the speed limit.

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Needless to say, I was absolutely fuming. Here we were, already on scene and yet being told not to enter the house because it was more important that the target-busting 'amber ambulance' would do the call.

An identical ambulance, but one that is to be used to hit this other government target.

Why were we canceled? We were canceled because it is not good enough to have an ambulance, it has to be the right ambulance in order to reach that government target. Because they are only to go to 'Cat B' calls, and if we attended then what would happen if there was a 'Cat A' around the corner? They couldn't send the 'amber ambulance' because then they wouldn't be free to hit the target.

And the government would be unhappy.

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I reported this through our clinical incident reporting procedure.

We managed to return to station where I saw one of my Station Officers, I told him about the situation and he phoned the top person in Control for that day. Top person in Control agreed that it shouldn't have happened and would look into it.

To be fair , this was the first day that the 'amber ambulances' were being run and this was probably just teething problems, but I still think it highlights how fixated on chasing these targets we have become.

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Every person in the ambulance service who works out on the road understands the simple fact that, if you want to get ambulances to patients quicker you need more ambulances. It's not rocket science, there is no way that we are going to make any appreciable difference in the number of people calling for an ambulance, so we need more ambulances to deal with the year on year growth in demand.

What doesn't help is bringing in more ambulances (in itself a good idea), but then limiting the flexibility of those ambulances over an artificial target that, I suspect, has no basis in science.

This is one of the worst cases of government targets directly impacting patient care that I have personally witnessed. And it shames me to think that actual patient care comes after pleasing the government.

However, sadly, it doesn't surprise me.

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Thanks to Lordneil for reminding me that the 'Cat B' target is destined to be scrapped and that better clinical indicators are to be put in it's place. This was supposed to be done in 2009 but has been put back to April 2010 for some reason. (It's here on page 40). This is something that I suggested in this blogpost although I am yet to hear what clinical indicators will be put in it's place.