Back to work with a nice little (twelve hour) late shift. Late enough to lay in bed, but not late enough that you feel like dying at 4am that morning.

As I'm back to work after a long absence I'm being 'third manned', another ambulance person is on the truck with me in case I freak out and go mad or something. It's a good way to ease you back into work should you need it - something I didn't really need so my 'third man' had a lovely easy shift.

As for the patients, well it seemed that I went to most of the stereotypical jobs during the night, missing only the 'elderly person on the floor', 'urine infection' and 'demented nursing home patient'. We missed an 'assault' just by virtue of the police getting there first.

What was surprising was that we needed to 'blue light' four patient's straight into the resuscitation room - but at least it means we earned our pay.

Our first job of the shift was a very pleasant gentleman who had a problem with his heart - we took him into hospital and, unlike most of my other patient's I got to talk to him the next day when he walked up to me in the hospital and shook my hand and thanked me. It doesn't often happen and so I think that this handshake will stay with me for some time.

The rest of the shift was fine, with lots of nice patients and nice relatives - the only exception was a drunk in a pub who'd injured themselves, we had to scoop him up off the floor while making sure we didn't aggravate his twenty friends who were all around half a pint away from falling over themselves all while trying to prove that they liked him the most. It had something to do with football is all I know.

So it was a good shift, if busy and when some time passes I'll no doubt write more about some of those patients.

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I've just heard from my publisher that "More, Blood, More Sweat and Another Cup Of Tea" is back from the printers and that it should be in shops for the weekend.

I've just phoned the resource centre at work to let them know that I'm fit to return to work. My first shift is a Sunday late shift - and I can't wait.

(Of course, give it two weeks and I'll be screaming to come off the road again...)

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On Saturday I shall be at the MCM London Expo indulging in my inner nerd. If you ant to stop me and have a chat please do feel free - I don't bite*.

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For those that are interested, my calendar is starting to fill up with PR/Marketing stuff around 'More Blood, More Sweat And Another Cup Of Tea' - more of which as it approaches. There is at least one national TV slot lined up.

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How do you check to see if an ID card is genuine? Flick it with your finger and see what noise it makes. (I wish I had the energy to find the actual government website that gives this advice).

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*Insert standard joke 'unless you want me to...' which is, I believe, a legal requirement.

As highlighted by RRD

We were finishing up our paperwork at the hospital when my crewmate's mobile phone rang. It was one of our fast car drivers and he was asking if we could hurry up our time at hospital because he had a nasty job that needed to get to hospital quickly. We were the only crew who weren't currently dealing with a patient and so we 'greened up' and, after getting the job from Control headed over to his location.

We arrived on scene to find the patient's elderly husband and her daughter already there - the FRU and patient were nowhere to be seen. We were directed to the top of the stairs where the FRU was trying to persuade the patient to go to hospital.

"She's stubborn", the daughter said, "we fitted a stairlift for her, but she's too stubborn to use it".

It would seem that this elderly woman was heading upstairs to bed and had tripped up the stairs - in part because she never used the stairlift.

She was arguing with the FRU, he was telling her that she needed to go to hospital, she was insisting that she just wanted to go to bed. If her injuries weren't too bad we might be able to leave her at home.

What she had done was far from a minor injury.

Both of her shins were essentially 'degloved', the skin on her shins had gone and there was little left except for bone. Surprisingly there was less blood than you would think, but this was a very serious injury, quite possibly one that she wouldn't recover from. To be honest it was one of the nastiest injuries that I'd ever seen.

Given how long leg wounds can take to heal in the elderly, it wouldn't surprise me if, coupled with her other medical problems, that this vast injury would lead to her death.

We managed to persuade her into our carry chair and then essentially browbeat her into going to hospital. We dressed the wounds as best we could and took her to hospital.

What sticks in my mind is that if she hadn't been so stubborn, if she had used the stairlift that her family had fitted for her, then we wouldn't have been needed and our patient wouldn't have suffered a potentially fatal injury.

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The other reason why this job sticks in my head is because my mum is likewise stubborn, and I can see her killing herself falling off a chair while changing a lightbulb, or seriously injuring herself doing something daft rather than ask me or my brother for help.

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For those that care about my suffering, since I started on the Ciprofloxacin I've not had a decent night sleep, mostly due to restless legs or just through waking up during the night. I have this for a month, so, y'know, please send sympathies and Diazepam.

Back when I was an A&E nurse I would tell people that the job had 'broken me' , that there was no way you could do any other job after working in a busy A&E department. Any other job would be either too boring, or that my own values of what is really important* would make me unsuitable for any work that involves 'profit'.

I'd lose a company millions of pounds and then turn around and, shrugging, say, "at least nobody died".**

Then I left nursing and joined the ambulance service. While it has it's differences, a sizeable chunk of the work that we do is pretty much the same, make people happier than they were when they first met you, the cause of this unhappiness normally being something to do with their health.

Some months ago I got extremely disillusioned with the job, even my friends outside the service noticed my deep unhappiness and mentioned it to me. I started looking for other jobs, one was for a communications officer for the LAS which I was unsuccessful at getting, others were outside the NHS. I started casting out feelers for other jobs, perhaps from some of the networking that I'd been doing at the conferences I attended or spoke at.

Out of the blue I was offered a consultancy job with a business, just part-time, eight hours or so a week, concentrating on 'internet culture', 'social media', blogging' and all that other non-technical web stuff.

The pay was good, the people at the office were friendly and there was a certain boost to the ego on account of being referred to as the 'internet expert'.

But, what I would almost hope for, as I sat typing away in the office, was that someone would fall sick so that I could spring into action and do something more interesting than compose emails and action plans.

It was hard to generate any excitement for other people's business and to remain enthused in subjects that I had no real interest in.

There was a certain amount of dishonesty on my part which I found very hard to keep up. When I say dishonest I don't mean in the way that fraud or lying is dishonest, but to try and keep the energy up when dealing with something outside my normal sphere of interest was draining me.

I was being dishonest to myself.

So when I had the chance to resign from it as a regular gig, I leapt at it.

As I write this I'm keeping my fingers crossed that I can get back to my 'proper' work soon. Despite it's many flaws, it's still a job that I can get excited about, that I have interest in and that lets me be completely honest with myself, and the people who I work with.

So it looks like I'm condemned to work on the ambulances until I drop dead or retire, whichever comes first.

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People often tell me, "I couldn't do what you do", but I think that the next time I pick someone up from an office environment it might well be me saying that for a change.

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*Breathing and having a pulse - money comes pretty much at the bottom of any list I make of 'things that are important'.

**Actually, given the current financial situation across the world, perhaps I would have fitted in perfectly.

A Sunday Mirror investigation has revealed how Lewis Day Medical Services billed for phantom trips supposed to have been made by a non-existent driver.

An average of 20 journeys were faked EVERY DAY, and the scam lasted for more than 18 months. The minimum charge for each journey was £8.60. But some cost cashstrapped hospitals £109 a time.

In one instance Villas's fake ID was used to charge £73.20 to take a patient with lung disease just two miles home. In fact, the trip had been cancelled hours before because the patient was too ill to travel.

Our investigators were passed a secret file listing all the fraudulent journeys relating to Villas. We handed the evidence to the NHS, who called in their own detectives. Lewis Day subsequently agreed to pay back £281,894 to Imperial College NHS Trust.

Despite the fraud being discovered, Lewis Day will carry on working for Imperial College NHS Trust because it is tied into a contract. And there is no prospect of anyone being prosecuted.

Wow.

More and more the NHS is relying on private ambulance companies, initially for this sort of patient transport and increasingly for A&E work. (More on which later). Sadly I suspect that this isn't going to be the exception and I foresee other companies being caught out in a similar fashion.

The very interesting thing is that

Despite the fraud being discovered, Lewis Day will carry on working for Imperial College NHS Trust because it is tied into a contract. And there is no prospect of anyone being prosecuted.

I can say, with some certainty that if I were to be found guilty of fraud I'd, quite rightly, be out on my ear. So why isn't this happening to this company?

My suspicion is that it would cost the trust more money to run the contract bidding system again, that or someone in Lewis Day has a friend or two in high places. I can't see any other reason how such a serious fraud would occur without the police being informed. I mean, the LAS has issued guidance on the sort of kit that we can keep in our cars - it's a small list with such items as 'Latex gloves - three pair only', they would be a bit upset if I were to steal over a quarter of a million pounds.

And then, when I get caught, go 'oops - here, have it back - no hard feelings eh?', and head out to pick up my next patient with hardly a word spoken.

Here is hoping that the other ambulance companies take a long hard look at the way they run things and the people that they employ in order to prevent similar situations happening in the future.

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).