We walk up the stairs to the teenager who has 'fallen, swollen arm', to be greeted by a fourteen year old girl with her arm in a tubigrip.

I start with my usual opening gambit, "Hello, what seems to be the problem?"

"I fell over yesterday innit", she says, "now my arm hurts and it's swollen innit".

('Innit' is how a full stop is pronounced in my part of the world).

"Let's have a look then", I say and she pulls the tubigrip off her arm, "so, how did you fall?"

"Dunno just fell over, and it hurts now innit".

I take one look at the injury, the bruising and swelling around the hand in a rather specific place.

"So, you didn't fall over did you? What did you punch, a wall, a door or a window?"

She looked at me as if I'd grown another head.

"You can't fool me, for I have fearsome psychic powers", I tell her, "Also it's a classic Boxer's fracture, so, wall or door?"

"Yeah, alright", she admits, "I was having a row, right, and I punched the wall."

"Fair enough, you'll need to go to hospital for an x-ray and treatment - and in the future don't try lying to ambulance staff, for we are wise in the ways of the world".

I wiggled my fingers like an old-time psychic, "We. know. all."

She looked at me with an open mouth.

He gets out of bed, washes and dresses, kisses his wife goodbye and, promising to be careful, heads off to work.

Some hours later I get a call to a male having difficulty in breathing.

We get there as quickly as I can drive because there is something about the job that makes me think it is serious.

We arrive after the FRU, the patient is on the floor and the FRU is performing CPR - the patient has no heartbeat and isn't breathing.

What happened? Did he have a sudden heart attack? Did he choke on his food? Did he have a clot in his lung?

I'll never know.

We do our job, it's a long resuscitation attempt for a number of reasons, lots of interventions.

The FRU who was first on scene tells us that the patient's workmates were taking turns in doing CPR, one of them puts his head around the door and explains what he saw.

"He just collapsed", he says looking worried, "I tried to help but I was only doing what I've seen on TV. I was going to do mouth-to-mouth, but I didn't want to blow the vomit into his lungs..."

We all tell him that he did the best possible thing, that he should sleep easy tonight - but I know he won't.

At the hospital the staff work hard on him, but it is an effort that has no result - one more person dies today.

The police are asked to inform his wife. It's a job I don't envy. They bring her to the hospital, I'm outside cleaning the ambulance so I don't hear her tears.

I wonder who will tell his workmates.

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After my shift I visit my mum and give her a hug - as I leave for home she tells me to be careful.

"Always", I say.

So,

Sometimes I help with delivering babies - but I'm not a midwife.

Sometimes I deal with drunks - but I'm not a barman.

Sometimes I deal with assaults - but I'm not a policeman.

Sometimes I deal with mental health problems - but I'm not a psychiatrist.

Sometimes I deal with other people's grief - but I'm not a counsellor.

Sometimes I leave sick people at home - but I'm not a GP.

Sometimes I fix stair-lifts - but I'm not a mechanic.

Sometimes I just sit and listen to other people's problems - but I'm not an agony aunt.

Sometimes I just move a person from one place to another - but I'm not a taxi driver.

Sometimes I drive an ambulance - but I'm not an ambulance driver.

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It's that last one, 'ambulance driver' that I'm mostly called, that or 'Paramedic'. Yet 'ambulance driver' is the one that most annoys my boss.

"They call you an ambulance driver", he tells me, "I thought we'd moved away from that?"

He's right of course, an 'ambulance driver' seems to just drive the ambulance, or at least that's what some people think. It's something that the ambulance service has been trying to stamp out for quite some time as we obviously do much more than that, something that I like to think that I show on this blog. The thought that one of the crew does nothing but drive the vehicle while all the medical work is done by the other is wrong, yet one I'm often met with.

So, what is my job title? It's 'EMT', or 'Emergency Medical Technician', which makes me sound like I fix ambulances or mend the medical machines that go 'beep'. When I deal with the media I call myself an EMT and they ask what that means, 'Is it the same as paramedic?' they ask, to which I reply that it is - except that Paramedics have a few more drugs and sharp things that they can play with, but that we ultimately do the same job.

I'm an EMT-3, or maybe an EMT-4 (I'm not sure, the difference is negligible), but there are EMT-2 ('probationers' who can't work alone or with another EMT-2) and EMT-1 (who have a lot less training and only go to the most minor of calls - which almost never turn out to be anything serious).

Then there are ECAs - Emergency Care Assistants, that have such a poorly defined role I don't think that even they know what they are supposed to do.

My role - EMT, Emergency Medical Technician, is such a poor term I find myself having to explain it all the time. It's like calling nurses 'Pill Dispensing Technicians', the police 'Handcuffing and Paperwork Technicians' or someone who works on a film set making sure that the audio is right a 'Sound Technician'.

This is why people end up still calling me an 'Ambulance Driver', because more people have an idea what that means than EMT.

Let's face it, if this blog were described as an 'EMT blog' how many people would know how to search for it?

And this is why, when I turn up at a patient's house and the worried relatives turn around and look at me they say, "It's all right now, everything will be fine, the ambulance driver is here".

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For the last two days I have been avoiding blogging, email, twitter, going out, or entertaining friends; in fact anything that could even slightly be construed as 'work' (while though I enjoy all those things, it can wear you down a bit). My calendar has, for some time, had the past three days marked out as 'Get my feet back under me' because it is the first time in months I've had a few days to myself where I can get over the busiest part of my rota, conferences, PR, visiting friends and catching up on stuff like laundry and re-centre myself.

Three days where I did little other than watch TV, play 'Oblivion' (where I am now a master assassin), eat take-aways, and read a little. It's been absolutely lovely - but now it's back to work, including setting up my new project, which promises to have me even more preachy than normal. And of course, spending twelve hours at work staffing an ambulance.

(This is to say that, if I owe you an email or twitter, you'll be getting it in a day or two)

"Look luv", I say to the woman on the bed, "if you can hop onto the chair I'll carry you downstairs where we can get you to the hospital".

The woman on the bed lifts one leg high into the air and grunts in pain. I'm not worried, I think that the reason why she doesn't want to get onto the carry chair is because she has poor pain tolerance.

"Your contractions are every three minutes?, I ask her, "your waters are intact, so you've got ages to go before you give birth".

I'm really not worried, I'm more annoyed that this woman isn't doing as I tell her, namely to pant through the contractions then get on the chair so I can get her in to see the midwives.

"You've had the contractions for only four hours, it takes much longer than that to... Bloody hell! are you pushing? Don't push - you don't want to push do you..."

I turn to my temporary crewmate, fresh out of training school but he seems fairly sensible, "You'd better get the other maternity pack from the ambulance, and the suction, and the oxygen bag. Oh, and ask Control to get us a midwife 'cause it looks like we are going to deliver here. Don't run but, y'know, don't dawdle either".

He trots down the stairs.

"I'm going to have to take a look", I tell the woman and she lifts up her skirt to show me her genitals.

In training school there were two things that we were told to be wary of causing offence, the first was traipsing around Mosques in our boots. The second thing was that Muslim women don't want men who aren't their husband looking at their bare flesh - strangely enough, when someone is about to deliver a baby they don't seem to care. I would guess that common sense tends to trump religion when you (and your husband) are scared and in pain.

I tilt my head to one side, trying to visualise exactly where the baby is. Then she pushes again and I deftly side-step the gush of amniotic fluid that jets out of her towards me. The professional in me observes the fluid as it shoots past my ear, it's nice and clear which suggests that the baby hasn't pooed in it. The un-professional part of me gives myself a mental high-five for not getting caught by the spurting body fluids.

My crewmate returns with the kit and I ask if he's ever delivered a baby before, he says he hasn't and that his current family came pre-loaded with grown children. He tells me that the hospital hasn't got a midwife to send so it looks like we are on our own.

I explain everything to the mother to be, and to the father to be, and the brother, and her previous child. The previous child was born by caesarian section, so this is the first 'proper' birth she has done. Luckily it's not my first.

I put on the gloves as she pushes again. This time she pops out a bit of poo. I wipe her (something I thought I'd given up when I gave up nursing) and contemplate that when mothers to be start pooing the baby is often not far behind.

We get the equipment ready - clamps, scissors and blankets. My crewmate and I are both gloved up and ready to go.

Once more the mother sticks one leg straight up in the air and gives a strangled cry.

I can see hair. Which means I can breathe a sigh of relief - not a breach birth. But the hole through which the baby will be making an appearance seems rather smaller than the previous times I've delivered.

I'm not worried, women have managed to give birth in the past and in worse conditions that the one that I find myself in. Heck, I've delivered babies in much worse conditions than this. At least in this case there is light, everyone speaks English and we aren't fiddling around in the back of a car unlike the first delivery I was involved in.

There is some more puffing and panting, some refusal of painkillers and slightly worrying moment when I wonder if the head will ever make an appearance.

Outside the brother is chanting and praying, it seems that he's doing a good job as I can hear him through the door. I'm guessing that it's one of those 'welcome the baby into the world' sorts of things.

Then with a tear, a scream and a pop the head arrives.

A quick feel and I realise that the cord is around the babies neck, so I untangle it. I help with the rotation and with a final big push the rest of the baby arrives and I catch it.

The cord is clamped and cut, and I rub the baby dry, hoping or a cry. A crying baby makes a happy ambulanceman, but baby seems quite content with sniffling and sneezing a bit. Good breathing, a nice strong heartbeat and reflexive movement - I'm quite happy.

The baby is fine, so I hand it off to a relative and check the mother - some slight bleeding, enough to wreck the mattress, but nothing too nasty. She seems a fair bit confused as I explain about the placenta and not for the first time in my career I wonder if anyone ever reads the instruction manual for their body.

She's happy though, the pain is over and she has a baby to show for it - a huge grin arrives on her face.

"Is it a boy or a girl?', the father asks. To be honest I haven't looked, I was more worried about the baby breathing, so we both go delving into the baby wrap to see what sort of equipment it's got between the legs.

It's a girl.

I can relax now, mother and baby are fine, people are congratulating us and all we do now is wait for the midwife to turn up. I try to remember the criteria for the Apgar score, I know that the baby is fine, but it's something nice to put in the documentation. Memory fails so I pull out my phone and look it up on Wikipedia. Baby scores a solid ten out of ten and I learn that Apgar is someone's name and not an acronym.

Then I learn what a backronym is.

I put my phone away.

The midwife arrives and does the mid-wifey things that midwives do, like yanking out the placenta and reminding us that the baby should be kept warm. We know that the baby should be kept warm, for most of us that is the one thing that we can actually remember from our four-hour training session on how to catch a baby.

Mother and child go to the hospital, as mother needs some sutures in a place I'd rather not have a needle anywhere near - but unlike other occasions, our midwife congratulates us on a job well done and makes us a cup of tea in the maternity department tea-room. I ruminate over a biscuit that I've never had a midwife arrive before the baby is born, and how they manage to get their timing that precise.

A good job, everyone is happy and I got a cup of tea at the end of it.

Can't ask for much more than that.

What has happened here is tragically sad and my sympathies go out to the family.

A GRANDAD lay dying of a heart attack in his home — while a paramedic stood outside for 16 minutes filling in risk-assessment forms.

And last night Roy Adams’s heartbroken daughter Sarah claimed he would still be alive if there had not been a delay.

She added: “It’s awful. The medic could have saved my dad but instead he stood outside for 16 minutes. All that crucial time was wasted.”

I'm yet to see a 'Health and Safety' form that we fill in on the road - yet more 'Sun' exaggeration. But then they do seem to have a real hatred of people actually being safe at work.

When I was working solo, you made your 'health and safety' assessment in your head - if it felt safe to enter on your own then you would enter, if there was something about the call that made you nervous, then you would wait for backup. From the story in the newspaper, it would seem that the solo thought it was unsafe to enter - but after waiting sixteen minutes for a police escort to arrive, decided to enter on their own.

Probably what happened was that the solo wasn't happy to enter on their own for whatever reason, waited for the police and after they didn't turn up for a while entered the household at their own risk.

From the Times Online article about the same job.

The ambulance service spokesman described the risk assessment as a “mental checklist” which included considering the safety of the scene, types of risk and whether extra help or equipment was required.

“We have a duty of care to treat patients but we also have to look after our staff,” he said. “In this case the medic conducted the assessment, had safety concerns and decided to call for back-up.”

Well done that 'spokesman' for getting the real situation across to at least one paper (even if it is the toilet paper 'The Times')

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But it's not just about the poor reporting - what really sticks in my throat is the comments by the Great British Public who take the rubbish that is printed in the Sun as gospel. When every story becomes a trial by media it's interesting how quickly people are to judge something based on 380 words that they have read in a tabloid paper.

this idiot should be given life in prison

This medic should be struck off straight away, no questions ...

Typical Britain today,what a b****y disgrace, everything is Health and Safety, Hitlerite jobsworths ...

These people want us to risk our lives to save them when they make comments like that? What next? Moaning because I have two perfectly good kidneys and I should give one of them up for transplant so that someone else can live? Offering to be stabbed in place of someone else because we 'save lives' and are 'paid for it'?

How many of these commentors, after seeing the damage a knife can cause, would volunteer to walk into a place where there is a real fear of losing your life. They are very brave sitting behind their keyboards, but I bet they couldn't walk a mile in our boots.

And calling us 'Hitlerite' - well, I hope that whoever made that comment makes that viewpoint known to any ambulance crew that comes to help you in the future...

I do despair sometimes.

And should the Solo be vindicated, how many column inches would the Sun spend on that?

As I mentioned yesterday, my crewmate is, I don't know, sunbathing topless on a French beach or something, so I have brand-new people to work with. And there are a lot of brand new people coming out of training school ready to be scarred for life educated by myself.

Working with someone fresh out of training school is normally quite enjoyable - I can show off, while they can tell me how whatever I'm doing isn't part of current educational theory on pre-hospital care. It's a win-win situation.

The first job I had with the shiny new recruit was a woman who'd fallen downstairs - often a nice and easy job and, as I blue-lighted us towards it, I checked up on what my crewmate knew about such things. As it was she wasn't confident about clinically clearing a neck injury, so I thought this would be a good chance to show her how it is done.

Our patient had fallen the entire length of the stairway, about thirteen steps rolling head over heels down them. She was complaining of neck and shoulder pain but had got herself up off the floor to sit on the sofa.

I'd gone over the finer points of clinically clearing a neck on the way to the patient, so what was left was for me to actually feel down the neck to see if there was any bony tenderness.

Down the bones of the neck I felt - C1, C2, C3, C4, C.... Oh dear, judging by the way she yelped in pain she seems to have a rather sore neck at the level of C5.

A really nice patient (and family) and we were going to have to truss her up like a turkey in order to make sure that her suspected neck injury didn't get any worse.

So that is exactly what we did, c-spine collar, strapped down and as smooth a ride into hospital as I could manage.

-----

We returned to the hospital a little later and they confirmed that our patient did indeed have a broken neck, it was just then a question of if they were going to treat it conservatively (with a collar), or if she would need surgery.

"You see", said the doctor to me as I asked about our patient, "anyone with a bony pain in the neck needs to be collared".

I didn't bother explaining that this is exactly why we had brought her in strapped down and with her neck immobilised.

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I don't know why, but my regular crewmate and I don't do 'trauma' - but as soon as one of us goes on holiday the other is left having more trauma in those few days than we would otherwise have all year.

'Swine flu', which for those following me on Twitter, seems to be one of the things I'm encountering more and more often these days. Let me explain some of the ways in which it is impacting my working life of late.

• While the government leaflet says that masks offer no protection from the 'flu, our latest flowchart for dealing with it mentions not only masks, but also aprons and gloves. We have gone from having a pair of masks and a pair of aprons in our infection control kit to having as many masks as you want. To be fair we did have to steal resource masks from the hospitals that we went to at the start of this outbreak, but supply problems seem to have been sorted out.
• Our call rate has gone from the normal 4,200-4,500 calls per day to around 5,200-5,700 in the last few days. This is an increase of around 26% Rather obviously this is having us run ragged. I have no idea if our sickness rate has increased (with staff being off with the Death Plague). What this has done is raise our DEFCOM level to 4. Which I don't think makes a huge difference to those of us on the road.
• Hospitals are refusing to see Swine 'flu patients unless they are incredibly unwell. I was nearly turned away from the hospital when taking in a woman with vaginal bleeding and dizziness because she had possible Swine 'flu. Do GPs do vaginal examinations and diagnosis? Or would this woman have been sent in by the GP anyway (given some of the... 'quality' GPs we have in my area it wouldn't surprise me if she were just sent up to the hospital without an examination). There is huge paranoia about letting anyone with a high temperature and the sniffles within hospital grounds. My question is, will hospitals be turning patients away in the Winter when the more dangerous 'flus are epidemic?
• We are seeing plenty of people who call us for Swine 'flu symptoms, as well as those who just mention 'chest pain' to our calltakers - thus guaranteeing an ambulance response. Quite a lot of people think that Swine 'flu is a death sentence even though this particular strain of 'flu seems to be a lot less dangerous than the normal seasonal 'flus.
• We have the normal increasing number of people collapsing from the heat - often their first thought is that they are dying of Swine 'flu.
• We are being told to leave people at home to look after themselves (heh, people actually looking after themselves, whatever fantasy scenario will our people think of next); this makes us ambulance staff somewhat nervous - after all there is the perception (if not the fact) that leaving people at home will only have us losing our jobs when someone dies.
• An example of one of our 'clients' - she called four ambulances over four days as her child has Swine 'flu, which isn't 'getting any better', despite being told that it can take over a week to feel better. Needless to say the child involved is fine if a bit generally unwell - certainly nothing that requires hospital treatment. Multiply this by the number of people across London and you can see one more reason why the number of calls is raised.

So, lots of panic, lots of fear, lots of misinformation along with the normal misuse of the ambulance service has resulted in many more calls for us, which then results in delays for people actually needing treatment. For example the police were with an assault patient for an hour waiting for an ambulance to arrive.

Unfortunately there isn't much that we can do, we can't suddenly make the public realise that they may be capable of looking after themselves without us holding their hands - and we can't magic up new ambulance staff from nowhere.

Except maybe get all the officers (that were road trained) up in Waterloo Control to man resource up trucks and get out on the road - I'm sure that for a few weeks we can do without the assistant staff officer to the staff officer for the diversity department* (or similar) and that they might be more use on the road at the moment.

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*I have no idea if this is a genuine position, although it sounds about right - I couldn't tell you how many levels of management there are between me and my boss, nor all the 'performance improvement' staff that float around up there in Waterloo.