There has been talk for years now about how blogging will kill off 'mainstream' media (MSM) like newspapers - I'm yet to see it happen. After all the benefits of a newspaper and the organisation behind it are obvious, they have people who go out looking for news while a large amount of 'news' blogging is repeating and commenting on stories put out by commercial media websites.

The strength of this commenting culture is that 'experts' on the story being discussed can weigh in where the journalist originally writing the story may only have limited knowledge of the subject involved. An example of this would be where I discuss an ambulance story that is currently in the news.

Mainstream media should do what it does best, research around stories, find experts to corroborate what they believe is happening and provide well thought out copy. Unlike many bloggers they should have the resources and, most importantly, time, to fully round out a story.

Of course it doesn't always work like that.

Paramedics told: 'Let accident victims die if they want to' in new row over patient rights

Health Service paramedics have been told not to resuscitate terminally-ill patients who register on a controversial new database to say they want to die.

It has been set up by the ambulance service in London for hundreds of people who have only a few months to live so that they may register their 'death wishes' in advance.

...and so it goes - while I have linked to the Daily Mail, this story appeared all across the media, for example 'This is London' is especially crazy. I have no idea where this story originated, I suspect a pro-life organisation issued a press release and the various journalists jumped on it as an 'interesting' story.

Of course, the truth didn't enter into it.

So it was up to the LAS to respond, and so they issued this release,

Reports in the media today (17 April) about the resuscitation of patients involved in serious accidents are misleading.

We have a system whereby patients with longer-term or complicated medical conditions can ask for a specific treatment to be carried out if we are called to them, or for them to be taken to a preferred place of care.

These are a very small number of patients who we will normally attend at home and with whom a written agreement is in place. It is inaccurate to suggest that this approach would be taken with patients involved in serious accidents.

These agreements are often used to give guidance to our staff on how to proceed with treatment in very complicated clinical cases.

They document what the patient’s requirements and wishes are and may refer, for example, to places of care, preferred treatment options, do not resuscitate advice, and home care requirements.

These details are kept in a secure database which can be accessed by our control room staff. This information can then be passed on to staff attending patients at the addresses on our system.

The ambulance crew will then be able to provide the most appropriate care to the patient taking into account the details kept on our records about their wishes and clinical needs.

There are currently 1,624 patients with their details registered on our system.

But, of course, the retractions weren't exactly forthright. The damage had been done and with no real right to reply, I suspect that a few of our patient's have been looking at ambulance staff in a different light.

That isn't the point, the point is that the journalists writing this story could have easily found out the truth, that we aren't going to go to a car crash and refuse to resuscitate someone, that we aren't bringing in 'death wristbands' and that, in fact, of the 1,624 people on the treatment database the only a few are 'do not resuscitate orders.

I'd guess that the majority of the people on this database are only on it because they suffer from sickle cell crisis and the database has their preferred hospital on it.

In the case of 'do not resuscitate' orders, it is not the ambulance service that initiates these things, it is the patient's GP and the team at the hospital - we just get informed of these decisions due to their need for ambulance transport to hospital.

Where patients have complex conditions the details often state what treatments are, and are not, recommended for the patient. We have a few on my patch, mostly children with severe medical conditions.

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While I might expect such lurid headlines and misrepresentation of the facts from a blogger (because we don't always have the time to research something we are writing on account of our 'day jobs'), I would have hoped for better from people who are paid to write these things.

The newspapers should stick to what they can do best, fully researched stories and information gathered with the money and time that these organisations have. They should stop printing press releases as if they were facts in an effort to fill column inches of come up with the most lurid story that they can.

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Oh, and swine 'flu? I'm not panicking over it, and I try to have forty days worth of tinned food in my house at all times in case of an actual serious pandemic.

The LAS has issued utterly sensible advice to it's staff that I suspect we will ignore.

The advice is to leave the patient at home if the symptoms aren't too serious and contact the patient's GP. However most ambulance crews are aware that if the patient then drops dead (of something completely unrelated) it will be the roadstaff's fault and we'd end up risking our job not taking them to hospital. After all, we aren't doctors, so how do we know who we can leave at home? How can we predict who will have a cytokine storm?

Nope - if this does go pandemic I predict A&E waiting rooms full of people with 'flu who make their own way there if the ambulance refuses to take them, all crying out for anti-virals. Then medical staff will get sick and some folks will die because of that rather than from the 'flu itself.

But that won't make the headlines - what will make the headlines will be the death from 'flu, someone who would have died from any 'flu.

And of course, once the storm has settled NHS management will start disciplining those who had the temerity to catch the 'flu themselves and go sick...

(erm... the title of this post has nothing to do with this section about 'flu, just in case you thought I was wishing for some sort of 'humanity die-off' from the 'flu).

I have the good fortune of being the co-chair of this.

For some reason I find myself back on that street, standing on the spot where the young girl died.

I haven't thought of her for years, a teenage girl being driven by her parents told them that she was feeling sick so they pulled over and parked up. She opened the car door, vomited, and just dropped dead.

I drive past that spot a lot and I remember the call but I don't really think about it, about her, about her family. It's just one of those places that you tend to remember, a little tickle of recognition as you go past it on the way to another drunk asleep in the street.

I haven't had a repeat job down that street, the ones either side are common places for us to go, but that street I've never revisited.

So why do I wake up from a dream where I'm just standing there. There are no people, no wailing parents, no ambulance parked behind my FRU, there is no patient.

So why am I there?

As I lay in bed the job goes through my mind. This job was before the latest changes to the resuscitation guidelines, if we had been using the ones we do now would she have survived? What caused her to just die like that, normally healthy children shouldn't die. How are her parents, do they mourn her every day?

In my dream it was the same time of day, sun going down behind the trees just dark enough that I wasn't sure that she wasn't breathing. The bottle of water was there, the one that her parents were going to give her after she finished being sick. I remember that bottle - if was the only thing left behind after I returned to the scene with the ambulance crew to pick up my car. Why is that in my dream?

And as close my eyes and think of the job I realise that I don't know her name. I was there at the end of her life, pounding on her chest in the back of a speeding ambulance in an effort to keep her alive, I was closer to her than her parents - but I don't know her name.

I must have known it once, if only to put on my paperwork, but now that name is gone. I can't remember ever knowing it.

She'd have been eighteen now.

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While I don't know why she died, there are organisations that raise awareness for such things - CRY and SADS

"Kelly" Grayson and me are quite different people - we live half a world apart, we are on opposite ends of the political spectrum and the debate on gun control and socialised medicine.

None of that matter because he's a top bloke and a regular blog read of mine. Kelly is a Paramedic in the South United States and has been writing the 'A Day In The Life Of An Ambulance Driver' blog for as long as I can remember. I often leave his site either laughing of shaking my head in amazement.

As I am obviously an influential member of the blogging community (subsection: medical whining) Kelly saw fit to throw me a free review copy of his new book - 'En Route'.

I read it in one sitting (actually a lie, I read it in one 'laying' as I read it in bed). Starting with his first days on the job and the sheer fear and confusion that brings through calls that are memorable, heartbreaking and hilariously funny Kelly has done some seriously entertaining writing.

Taken from his blog the book is a collection of short stories - like sitting in a bar listening to a mate tell you about the jobs that stick in his head, I reckon that Kelly must be a born entertainer.

He's also an excellent medic - I've learned a few things reading his writing, and not just about the crazy way the American ambulance services work.

What underlies a large part of the book is his very distinct voice - the US South is a culture of it's own and that really shines through in this book. The superb medic, the tone of voice and the humour and anger that strikes us ambulance lot makes this a unique book, and one I was sad to finish. Even though it's a bit of a busman's holiday and I remember a number of stories from the blog I still wanted to read more.

At the moment 'En Route' is only available in the US, but Amazon do international shipping (it's about £5 to the UK), and in my opinion it's well worth the extra cost.

UPDATE: The book is available in the UK - and it's well worth the cost - The Route: A Paramedic's Stories of Life, Death, and Everything in Between