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.

-----

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

'Male 56, fallen'

I turn around to the student who is working with us for this month and tell her that it's probably some bloke who is drunk - after all, that is the sort of job that I tend to get sent to.

As is traditional the call is on the other side of our patch to where we currently are, but thankfully we can whizz along the A13 to get there that much quicker. It's not even rush hour.

As we pull up outside the house my subconscious starts shouting at me, I don't know if it's the behaviour of the relatives or something else, but I yell to my crewmate that she should bring her big bag of paramedic tricks with her - I grab the oxygen bag and the defibrillator and make my way into the house.

I follow someone who I understand is the wife into the house, she leads me along the corridor telling me that she was making a cup of tea and when she came back from the kitchen her husband had fallen over.

Before I enter the living room all the alarm bells in the back of my head are ringing - I couldn't tell you why I had that feeling, but I've learnt to listen to my inner voice when it is screaming at me, it doesn't send me wrong.

Sure enough our patient is face down on the carpet, not breathing and his skin is that deeply unhealthy bluish-purple that tells me that he hasn't got a pulse.

Over my shoulder I hear the wife ask if he will be alright, another woman ask if he'll be alright for the disco tonight and a boy wailing.

I'm on my own for the minute, my crewmate and student are still gathering the kit from the ambulance. I have long legs and I tend not to hang about getting to the patient, especially when I'm getting the 'bad vibes'. Unfortunately this can put me some way ahead of my shorter-legged colleagues.

I roll the patient over and start the CPR - he looks pretty far gone to me, but you never know. The training takes over, I haven't been flustered at a cardiac arrest for years and I settle into the familiar patterns.

Crack, crack, crack, crack go four of his ribs. I always wince when I break someone's ribs, sadly it's pretty much unavoidable if you are doing CPR properly - it's worse when you feel the ribs go on the little old ladies that have bird-like bones.

I pump away and can hear my crewmate asking where I am. I think for a moment, trying to remember my route into the flat.

"Down the end of the corridor, and it's a suspended!", I shout.

My crewmate and the student arrive, I tell the student to place the defib pads on the patient's chest which she does perfectly. Someone gets out the ambu-bag and I suggest that I 'bag' the patient (breathe for him), while our student can do the CPR and my paramedic crewmate can do all the other things like popping a needle in his veins and preparing to intubate him.

At some point I send our student back to the ambulance to call for another crew - with a cardiac arrest it's always handy to have a second ambulance to help out.

The defib tells us to stand back as it wants to analyse the heart rhythm to see if we should 'shock' the patient - I look at the screen, it's a pretty obvious case of VF, something that we do shock. For some reason the machine isn't completing it's analysis, it keeps telling us to move away from the patient even though we aren't touching him.

Just as I'm about to put the defib in manual mode and do it my own damn self it decides that yes, perhaps a shock is advisable.

Our student gets the honour of hitting the button. She checks that we aren't touching the patient, presses the button to shock him and our his body gives a shudder.

The relatives keep asking if he will be alright, one of them mentions a disco again and I think then leaves the house. I have my mind on other things, but find the time to tell them that because our patient is very sick we are pumping his heart for him and breathing for him.

I ask my crewmate if she wants to secure his airway by intubating him, she's been trying to get a line in because she knows that I can handle airway management pretty well. She throws me a cannula in it's packet and tells me to get venous access, while she starts lays out the kit she needs to pass the breathing tube.

Our student keeps up the CPR, and it's good CPR at that - training school seem to have been doing a good job in teaching CPR.

I insert the cannula and secure it while my crewmate gets the breathing tube down in one swift, smooth movement. At the hospital the anaesthetist will compliment my crewmate on her intubation skills. She won't tell the doctor that she had to tube the patient while half curled up in a tiny space half under the TV.

One lot of drugs go in through the cannula, the patient gets shocked again and would you believe it, he gets his pulse back and starts breathing.

The trolley is fetched and we continue to stabilise the patient. It's looking pretty good, he's got nice strong breathing and a very strong and regular pulse. He could be sleeping were it not for all the bits of medical kit sticking out of him.

We lift him onto the trolley and are loading him on the ambulance when two FRUs and another ambulance turn up.

"You're too late", I tell them, "we've got it sorted - look he's even breathing for himself".

"Sweet", comes the reply from a FRU responder.

We plug him in to our ambulance equipment - his vital signs are all exceptionally good, better than mine at that moment I would guess.

We pre-alert the hospital and make a run for it, our student is driving while me and my crewmate monitor our patient - it's looking pretty good for him.

At the hospital our patient starts to wake up, so the doctors knock him out so that he can rest and so they can do some more diagnostic tests without him fighting them. There is no obvious reason for his cardiac arrest and some of the other tests performed are pretty hopeful for his recovery.

We later find that he was moved to another hospital as that is the nearest with an empty ITU bed. It's a bit of a shame as it means I won't be able to follow him up to see if he survives to discharge. It's a shame, I'd really like to know how it works out.

To see if he survives his 'fall'.

-----

On May the first I'll be at this event - Cory Doctorow and Charlie Stross (two of my favourite authors) will be talking about how to escape the surveillance society. Proceeds go towards the excellent Open Rights Group. Doctorow is an annoyingly effective and engaging talker and, while I've never heard Stross talk in public, I would imagine that it will be an very entertaining and educational evening.

You can register for tickets at eventbrite. Well worth £10 of anyone's money, or if you are feeling particularly wonderful, for the cost of a subscription to the ORG. If you come along do say hello.

Copied from the LAS News website.

A paramedic has been attacked after he disturbed thieves trying to steal drugs from an ambulance station.

The paramedic was hit over the head with a fire extinguisher, punched and kicked during the burglary at Pinner Ambulance Station, Harrow.

Police are now searching for four men in connection with the assault which happened at approximately 1:30am on Saturday (14 March).

The staff member, who is a team leader at the station, does not wish to be named. He said: “I was on my break at the station and as I walked into the garage four men sprung up from behind one of the cars and just came at me.

“They ran straight at me, throwing punches and kicking me as I tried to fend them off. Then I felt an almighty thump on the back of my head from a fire extinguisher. I was dazed and was stumbling around which gave the men the chance to run away.

“The whole thing lasted not more than two minutes, it was all over before I knew it.

“Afterwards, I was fuming. Then I found a slash on my forearm and saw the slit through my shirt with a wound on my stomach – it transpired later that a knife with blood on it was found outside the station – I realised then how lucky I had been.

“When you are at your ambulance station you just don’t expect anything like this to happen. I’ve been doing this job for 19 years and have never been assaulted like this.”

Following the attack the paramedic was taken to Northwick Park hospital for a check-up.

Ambulance Operations Manager for Pinner Sean Brinicombe said: “We are doing everything we can to support him through this and to aid the police in pursuing a prosecution.

“I am shocked that people would sink so low as to steal from an ambulance station and attack a paramedic in the process.

“Thankfully he is okay, but this incident could have been a lot worse. Our staff shouldn’t have to work in fear of attack, especially from the very community they are trying to serve.”

No comment needed beyond hoping that he gets well soon.

Yesterday Google released it's 'Streetview' service in the UK. This allows people who use Google's mapping website to look at panoramic photographs of the areas covered.

The first place that I looked was for my house, sadly the Google camera car stopped one street away. I looked for my Mum's house, and again the photographs stopped one street away.

Then I looked for my ambulance station.

View Larger Map
All very clever, and as the streets are public, not a problem. Anyone with nefarious purposes are better served by actually visiting the place in question. For example, in these pictures of our station, you can't see the security cameras...
But then I thought about the road outside Newham hospital, had the camera car been down there?

Sure enough they had, and what was shown was a patient being unloaded from an ambulance.

Now, I'm not too sure if the road that the hospital on is public property or not, but ethically there is surely an expectation of privacy when you are on an ambulance or being wheeled into A&E? It is this expectation of privacy which is important¹.
Being a bit busy I just twittered about it and thought nothing more about it.



However it would seem that someone with a bit more energy behind their ethical standing took notice of it and reported the image to Google, and being generally good guys, they quickly removed it.
Then today I saw exactly the same picture printed in The Metro, with a screaming headline about privacy concerns. Really, if they were that concerned about privacy, they shouldn't have printed the picture along with the story...
I suspect that someone on the Metro reads my twitter feed (actually, I personally know someone who does, but they are quite smart and are unlikely to have been involved in printing the picture). But what it does show is the surprising speed of information via various 'social media' networks.


¹Here is an excellent guide for UK Photographers and the law.

A quick recap for those who haven't yet seen me write about ORCON. ORCON is the government target that tells all ambulance services that they have to keep the time between the phone ringing up in Control and the ambulance arriving on scene to under eight minutes for our highest priority calls. There is also a nineteen minute target for not-so-serious calls. For the low priority calls, like grannies with broken hips, we can leave them on the floor for up to four hours.

This eight-minute target is based around outdated research and has little clinical significance for the majority of our patients, something admitted by our own chief executive as 90% of our calls come from people who do not need an emergency ambulance. This 90% figure is based on the London Ambulance Service's own research¹.

It's easy to tell when to 'start the clock', as soon as the BT operator connects the 999 call to our Control, but when do you 'stop the clock'?

The target states that the ambulance should be on scene. Does this mean when the ambulance pulls up outside your house and I hit the big 'At Scene' button? Does it mean when the keys are out of the ignition of the ambulance (because we track that)? Does it mean when I poke my ugly mug around the bedroom door to find you on your bed with bellyache (and if you live in a block of flats with no working lift it might take me over a minute to actually reach you)?

All these are reasonable ways of measuring the time. When we pull up, or when the keys are out the ignition are easily measured due to the tracking devices in our ambulances. Being face-to-face with a patient would need us to have an accurate watch and to note the time ourselves, so accuracy would be a problem but it would better match the 'patient experience'.

How about marking us as 'on scene' when we are within 200 meters of the address? This is what many of us on the road suspect of happening - when we get within 200 meters or so of the address our MDT 'updates'.

It doesn't matter if you have crashed your car on one side of the dual carriageway and we have to drive an extra five miles to get on the correct side. It doesn't matter if we have to creep around tiny winding estate roads, wary of knocking off the wing mirrors of parked cars. It doesn't matter if the address is a bit wrong, if we are where the computer says we should be then we are 'on scene'.

As the time arrives when we have to finally collate our ORCON success rate approaches (appropriately enough April the 1st), so we find the percentage of calls that we make on target start creeping up towards the magic 75% mark.

Why is this? Well, in the words of our own Chief Executive,

"...our Management Information team check all our records to ensure we capture everything correctly. [The] team are checking every missed call, and with over one million calls, inevitably they are finding some that can be legitimately included."

Which makes me think that they go over every call, and if we were within 200 meters of the address when the eight minutes are up, they then count us as being 'On scene' and therefore the job can be seen as a 'success', regardless of patient outcome.

As always, the LAS and LAS management have the full right to reply to anything that I write here. It would be nice if they could confirm, or deny, us being within 200 meters as being part of hitting our targets, and to what 'legitimately included' means.

¹Taking healthcare to the patient: Transforming NHS ambulance services (Page 8)