The media has reported a fair bit about MRSA in ambulances of late, one of my commenters has asked how the London Ambulance Service deals with patients who are MRSA positive.

(Note: I'm also writing this to avoid losing my job by posting about a family who have called an ambulance more than seven times in the past week for the same illness).

Primarily the problem is that we just don't know who are MRSA positive, MRSA is prevalent in the community, and I would suggest that most nursing homes have plenty of colonised residents. I remember working in hospital, having to swab everyone coming in from a 'high risk' environment, which basically meant anyone from a nursing home, or another hospital.

It takes time to swab and grow a culture (three days if I remember correctly), and each test costs a not inconsiderable amount of money.

If a patient is MRSA positive, then our infection control booklet tells us that we should use our 'personal protective equipment' (our uniforms) plus what are known as 'universal precautions' - essentially latex gloves.

To clean an ambulance after transporting an MRSA positive patient we use 'System 1' and 'System 2 or 3'.

System 1 - Detergent. System

2 - Chlorine spray System

3 - Alcohol.

So anything the patient has come in contact with is wiped with detergent, and then we either spray it with chlorine solution, or wipe down with alcohol wipes.

The other problem that we have is that we are so chronically overworked, that we often only have a little time to clean the ambulances. If you are having a heart attack, then you won't be impressed if all the ambulances on duty are off the road waiting to dry.

When the LAS do something, we often do it right. Our boss realised that the ambulances aren't as clean as they should be, and that road staff didn't have time to 'deep clean' ambulances every shift. The solution was to contract an outside firm who now cleans and stocks our ambulances for us and from what I have seen, they do a pretty good job.

So every night a gang of underpaid workers clean as many ambulances as possible. This 'make-ready' crew are paid a frankly pitiful £6 an hour, working from 1am to 6am they can clean around 16 ambulances a night using industrial cleaning materials. Every month they are quality controlled by random swabbing. So far they have only had good results.

So I personally think that the LAS is doing something positive and effective against the spread of MRSA

MRSA will never be eradicated, unless we force everyone at gunpoint to use alcohol gel after every physical contact (and this includes 'civilians') and enforce daily antibacterial showers for the entire population of, well, the entire world. But we can do our best to prevent the spread of MRSA (and other, nastier diseases).

It's that special time of the year again, when death-dealers descend on Newham to enjoy the 'Defence Systems and Equipment International exhibition'.

It's an arms fair.

In Newham of all places.

I'm always worried that the local gangs are going to storm the fair and loot it of some 'interesting' souvenirs. Then for the next couple of months I find myself dodging cruise missiles and landmines rather than the usual broken bottles, knives and dog turds...

Both the mayor of Newham, and the mayor of London want the exhibition to stop coming here - but it still comes, bringing with it massive disruption for the people of Newham.

So there will be lots of demonstrations (some have already taken place, such as a street party), but as the exhibition starts tomorrow we are expecting things to start warming up a bit. I haven't seen any soap-dodgers protesters yet, but I'm guessing that tomorrow will see the banner wielding population of Newham increase a thousand-fold. At the moment it seems that a lot of their tactics involve blocking various roads that control entry to the exhibition.

So far I have seen a veritable army of police arriving, shields at the ready (4,000 police taken from other duties to cover the event). Obviously this leaves the rest of London a bit short on policing. I've seen convoys of riot police making their way to the area, and this morning there appeared to be random vehicle checks.

On our part, the LAS have manned an extra ambulance or two for the duration of the exhibition. Sitting in the sun watching people shouting seems like an easy way of getting some overtime. We are also doing other things, but it's probably not a good idea to tell the world and his wife about it. I just hope that the exhibition organisers are paying for our services, after all, it's not like they are short of money.

It might be interesting to print out a spotters card of dictators, warlords and despots just to see how many you can catch turning up in unmarked limousines

I must admit I'm torn. I like the police, they are always helpful, they do a job that is remarkably difficult and when I've needed help they've always turned up and been very useful.

But...

I really sympathise with the protesters, and if I wasn't working, then I'd probably be there amongst them waving a banner and trying not to get stood on by a police horse.

So I'll sit on the fence and say that they are both going to be a huge pain in the backside because they are both going to block roads, probably injure each other and will cause traffic jams when I'm planning on going home.

The philosophy of Reynolds - 'balance through the dislike of everyone'.

A charity is calling for the Scottish Ambulance Service (SAS) to be prosecuted after a damning report from safety inspectors.

I'm off to bed - early start in the morning *gaah*, so no comment. Anyone from the SAS fancy commenting?

Can I have one of these please boss?

It is designed to plug into an oxygen cylinder and will automatically perform effective CPR (they tested it on pigs, which I can't really support - I like pigs, and I have friends who love pigs.)

I mean, not only will it mean that I can be lazy and not actually have to jump up and down on someone's chest, but if I'm the sole responder I can then concentrate on breathing for the patient.

Also it is more effective than manual CPR, and unlike me it doesn't get tired.

Only £6,000 - we can't let Staffordshire ambulance service beats us now, can we?

Note - photograph from the Daily Mail website, copyright does not belong to me.

I’ve not posted anything about hurricane Katrina, mainly because I have to say that hasn’t already been said by better people than me.

Instead, here is some haunting writing by two Paramedics caught up in the middle of it.

“Unfortunately, our sinking feeling (along with the sinking City) was correct. Just as dusk set in, a Gretna Sheriff showed up, jumped out of his patrol vehicle, aimed his gun at our faces, screaming, "Get off the fucking freeway". A helicopter arrived and used the wind from its blades to blow away our flimsy structures. As we retreated, the sheriff loaded up his truck with our food and water.”

“In the pandemonium of having our camp raided and destroyed, we scattered once again. Reduced to a small group of 8 people, in the dark, we sought refuge in an abandoned school bus, under the freeway on Cilo Street. We were hiding from possible criminal elements but equally and definitely, we were hiding from the police and sheriffs with their martial law, curfew and shoot-to-kill policies.”

This is a post that has been a long time coming, if only because I can't really think of a way to make it in the slightest bit interesting.

Agenda For Change.

The short (and therefore hopefully less boring) version is this.

The government want to standardise pay for the whole of the NHS, so they are splitting different wages into 'bands', from band 1 the lowest, to band 9, the highest. Within each pay band is a range of potential wages, so, for eaxample, pay band 4 starts at £16,004 and then increases in 6 increments to £19,284.

Band 5 starts at £18,698 and then increases in 8 increments to £24,198.

Are you with me so far?

To decide what banding each profession in the health service starts at a group is convened, and they "job match". So if for example you "Supervise fellow workers", or "At risk of potentially serious physical abuse", then you score some points and can be put into a higher band.

This is the problem that we in the ambulance service have - because of the things we are expected to do in our daily work, the government would have to pay us a lot of money.

So it has taken two years for them to try and work out how much to pay us.

They still haven't decided.

But today (actually I as was writing this) they published their findings.

Paramedics will be paid in band 5 (to be reviewed in 12 months).

They still haven't decided on EMTs (which is yours truly).

The bulletin that we have just recieved states that 'experienced' EMTs will be paid in Band 5, while less experienced ones will be paid less.

This is, frankly, a load of bollocks.

The reasoning behind the different increments within the band is that this is to represent increasing experience. The banding is supposed to represent what our job is.

EMTs all do the same work, so why I should I find myself working with someone who does all the same things that I do, has the same skills and has exactly the same job description, and yet gets paid a differing amount.

(But we won't know for sure for another two weeks...)

I can see a few things happening.

First, the Unions have all signed up for this, and so the general feeling from the crews on the road is that we have been sold down the river, this means that morale, which is poor at best, is going to plummet.

Secondly, I imagine that our ORCON percentage (our main benchmark of performance) is going to also take a nosedive.

Thirdly, it's going to cause friction between EMTs, paramedics and Team Leaders (who are on Band 6 despite hardly touching a patient). Especially when you consider that Paramedics are going to be paid their new, higher rate much earlier than any change in EMT wages. Add in the time that it will take for them to decide which EMTs are better than other EMTs and there will be a huge disparity in pay for quite some time.

My next post (assuming a Major Incident doesn't happen beforehand) will be about how the LAS could have lessened this problem.

Just to remind everyone (because at the moment I am incredibly angry, and this may explain any typos) is that the thoughts and views expressed here are mine alone - they do not reflect on my employer, or anyone else in the service.

Apparently an ambulance has crashed into a car in Enfield. The crew are alright, but we don't know how the people in the car are. If I find out more I'll let you know (or point to the story on a news site).

The first rule of Book Club is not to talk about Book Club.

Person #207 to use this ‘joke’ according to Google.

Some time ago I was asked by the strangely named, but very lovely, Giskin Day to come and have a chat with her medical humanities book club about Safelight by Shannon Burke.  So I read it yesterday (and finished it in the bath today) and found myself in West London in University College London with a glass of wine and some depressingly young looking medical students.

Everyone was really nice, even though I wasn’t too impressed with the book itself.  Partly technical – Eyes ‘bulging out’ after hanging for three weeks in a fly filled room when there wouldn’t be any eyes left.  And partly because of the style of the writing – lots of short vignettes written in a very detached way, nothing flowing very well, and one of the cheesiest end lines of any book I’ve read.

And I know I’m not a great writer myself, glass houses, stones, and all that notwithstanding.

So I had a nice little chat, and discovered that the department has a blog!  It’s an interesting one, I’d describe it as the ‘Boing Boing’ of medical humanities.

Go there now, and look at the comic a post or two down, for UK readers it’ll ring a few bells.

Asked what advice to give to the medical students, my reply was to find a good nurse, and listen to them, as they are the ones who have been working the job day in and day out for years.

One of them mentioned that the vignettes in the book are a bit like blog posts, and was I going to write a book?  I did a bit of hand waving on the subject…maybe if some publishing houses started knocking on my door I’d do it, otherwise it’s a lot of work for something that no one would want to publish.

So, this week I’ve spoken at OpenTech, been on the BBC website, and been a guest at a Book Club.  On Friday it all settles back to normal when I start the first of four nightshifts, and it’ll give my ego a chance to deflate as I wade through the vomit and blood of East London.

Joy.

Although there is the Great Britain Beer Festival coming up soon, and I do have that Wednesday off…

UPDATE: Actually I was at Imperial College London not UCL. At least I didn't confuse it with UCLH.