There is something about the reporting of this story that makes me think that it is only the police, door staff and ambulance crews who understand exactly what goes on when drunks get violent.

In my view it didn't look much like an epileptic fit to me. It does look very much like a violent drunk struggling for position - I've been restraining people doing exactly the same thing.

But of course, she's a woman and 'non-white', so the usual suspects start making comments that it is a racist attack, and one person compares it to the beating of Rodney King. I'm guessing these people have never seen women 'kicking off' in the centre of town after too much to drink. Just another way some people's perception of reality differs greatly from mine.

Feel free to discuss while I sleep between shifts (as opposed to sleeping on shift, which is tricky and rarely successful).

It has been in the news recently that the BBC has hold of documents showing a large increase in the number of 999 ambulance calls. This is the reason why my phone hardly stopped ringing yesterday as various BBC radio stations wanted interviews. (I had to turn two of them down because I was going to be spending a rare evening with Laura).

One of the reasons given for the increase in calls was the recent British Heart Foundation urging people to call for ambulances if they get chest pain. In my own experience there hasn't been a huge increase in calls due to this, I suspect that the LAS has the official figures, but in my area people don't need any encouragement to call us out.

When I started working for the ambulance service we would get around 2,500 calls across London each day - now it isn't unusual to get 4000+. While a government spokesperson says that there are more ambulance staff than in the past (which is true), it doesn't follow that there are more ambulances. Ambulances which were covered by staff on overtime now staffed by reliefs.

I don't think that there has been an increase in the actual number of ambulances in the last fifteen years; yet we have increasing call numbers and our ever expanding role.

I would say that there are a number of reason why there is an increase in calls.

• The lack of GP services 'Out of hours', since GPs were allowed to stop covering out of hour services the quality of primary care during the hours of darkness have plummeted. Due to decreased GP cover we are going to more and more 'primary care' situations, jobs that would normally be under a GP remit.
• The increasing 'I have the right' brigade - people who know that they have a 'right' to an ambulance as a free taxi to hospital. All thanks to the 'Patient's Charter'
• People want healthcare when they want, rather than when it is available. Waiting for an appointment to have your foot wart removed is such a chore, you want it off now? Call an ambulance to take you to hospital.
• A general lack of education - a simple chest infection in an otherwise healthy person isn't going to kill you; but some people do believe that a cough is something life-threatening.
• A lack of magic cures - I've lost count of the number of people I've been to recently who have seen their GP for a chest infection, have taken two of the prescribed antibiotics and yet they aren't feeling better. Then they call an ambulance. Here is a hint - there is a reason why there are 28 tablets in the pack...
• Increased population, more and more people are living in smaller places, buildings are being thrown up all over London, yet there isn't a corresponding increase in healthcare provision. And the government is closing two A&E departments in our area, because, you know, they are full all the time.
• 24 hour licensing, I know it's an unpopular view in some circles, but we are going to more drunks, and alcohol related calls than ever before.

One of the problems is that we are trying to solve all these problems by throwing ambulances at them. We are covering for reduced GPs by implementing ECPs (Emergency Care Practitioners, GPs on the cheap). Who is going to want to get an appointment for a GP when you can dial 999 and have someone turn up at your door when you want. We aren't refusing ambulances to people who don't need them, partly for fear of being sued or making a mistake. As a whole, health education in this country is dreadful - barely going beyond 'safe sex' and 'stop smoking' messages. Drunks in the street are going to a nice friendly A&E department rather than a less comfortable police cell where they are charged with an offence.

Part of it is that we are mollycoddling people for fear of being sued, and having bad press. If the ambulance service continue this way then I can't see things getting any better. Because of the lack of funding from the government we are having to change the way we work in order to meet those useless targets; this will lead to problems with patient and crew safety - but that is a post for another day.

Without a sea change in society as a whole and in the funding and measurement of targets in the ambulance service, despite the LAS' best intentions, things aren't going to get any better.

The BBC news forum has some hilarious comments (and it does point out some of the weird ideas that people have about the ambulance service).

As I type this there is an *awful* segment on blogging on the BBC breakfast news.

Expletive Deleted.

Isn't it nice to be valued by the government? Pay rises below the rate of inflation which are also staggered which effectively means that my standard of living is set to go down.

Crap conditions, increasing demands, moronic running of the NHS and increased expectations with no increase of resources. Lies from the government who took money away from the ambulance service that made it's (worthless) targets. A screwing over of our new members of staff giving them barely liveable wages for years. An expectation to work harder, an expectation to increase our scope of practice and all this leading to increased danger to staff.

It's enough to make me want to strike, and I'm hardly militant. Makes me feel so happy to go to work this weekend and pick up drunks all night while the MPs sleep safely in their beds. Makes me want to punch someone... preferably someone in Westminster.

All I want is the same value money I had last year - now it's worth less.

Which is how I feel.

(And breaking news is that London Underground workers are getting a 4% pay rise. Maybe striking does work)

*This is all assuming that ambulance pay is in the same general area as other public service workers, something that I see no reason to be otherwise*

For those in the UK Panorama tonight has a programme on violent patients in the NHS (BBC One 20:30).

Us ambulance crews are verbally and physically abused on an almost daily basis – it has gotten that we tend to ignore the verbal abuse that we get.  It’s only with the increasingly common physical assaults that we fill in the required forms.

Let me give you an example from my last night shift, a not unusual job.

We were called to ‘woman collapsed in the street’ at gone midnight.  We arrived to discover our ‘patient’ lying under a bus stop with what appeared to be her worldly possessions in a plastic bag.  There was no-one else around except for the minicab driver who had called us from hi office that she had ‘collapsed’ in front of.  While my nose can no longer detect alcohol my crewmate for the shift was able to tell me that the patient smelt as if she had been dunked in a brewery sewer.

A quick check in her bag revealed nothing obviously medically wrong with her (medicalert bracelets or ‘I am an epileptic’ cards).  It did however reveal that the woman had been released from custody earlier in the day.

I tried to wake her, but she screwed her eyes tight and refused to talk to us.  The problem is that we can’t leave her on the street; someone else would call us and we would be back and forth all night.  Likewise if she froze to death we would be to blame and, if she were stabbed later in the night we’d also probably be to blame.  The police also wouldn’t be interested, they have stopped taking people who are drunk, one too many deaths in custody is to blame for this.  So, as she refused to go home or to her hostel, the only place that we could take her was to hospital. 

I was in a good mood, so I explained all this to her, that we couldn’t leave her here, and that if she didn’t come with us the police would probably be called and that they might take a dim view of her drunkenness (a bit of a bluff, but it sometimes works).

So she started to swear at us, she threatened to hit me and she was generally rather rude…

Again, this is all water off a ducks back to me.  At one point she tried to kick me, but I’m an old hand at drunks in the street and by the cunning tactic of stepping out the way managed to avoid a scuffed shin.

Eventually we managed to hoik her up and into the back of the ambulance where, after a bit more swearing, she settled down.

She did give me a dirty look at the end of the journey though.

I would say that I get a patient who is verbally abusive at least once or twice in a shift.  I don’t mind violence from people who are medically unwell (e.g. diabetics with low blood sugars, post seizure epileptics).  But can I really count ‘drunk’ as a medical problem?

I also count myself lucky that I work where I do – unlike the hospitals where people become frustrated by long waiting times and percieved injustice I’m often seen as a friendly stranger who makes everything better.

For further stories of assaults you can look here, here, here and here. Unfortunately these won’t be the last.

You know that you have arrived when you start getting press releases. Especially when they are actually things that you care about...

DRINKERS are being encouraged to cut their booze consumption during Alcohol-Free Week.

The week will be launched Wednesday 21 February 2007 to coincide with the season of Lent when, traditionally, observers abstain from some indulgence such as drinking alcohol.

During Alcohol-Free Week people are being encouraged to give up alcohol for one day, a weekend or for a full week.

The event is sponsored by The Alcohol-Free Shop and is supported by the NHS Drinking Responsibly Project, the national charity FAS Aware that highlights the dangers of alcohol in pregnancy, Manchester City Council, and Manchester Drug and Alcohol Strategy Team.

A new website to promote the campaign www.alcoholfreeweek.co.uk has been set up where visitors can find information about the health impact of excess alcohol consumption and enter a competition to win a supply of alcohol-free beer. The web site also has links to support groups for those worried about their own or someone else's drinking.

In its first year, Alcohol-Free Week has been adopted by Manchester City Council as part of its 100 Day Challenge to tackle anti-social behaviour. It is intended to make Alcohol-Free Week an annual event involving health organisations and local authorities across the UK.

John Risby, who launched The Alcohol-Free Shop in May 2006, said: "A lot of people make new year's resolutions to reduce their alcohol intake, lose weight and improve their fitness but after a few weeks, often their good intentions fail. Lent is a good time to give it another go.

"Alcohol-Free Week is intended to encourage people to become more conscious of their own drinking and the impact it may be having on their health and the well being of those close to them.

"Health experts say that even moderate drinkers should have one or two alcohol- free days a week. We're hoping that, during Alcohol-free Week, people will avoid alcohol on at least one day and that avoiding alcohol at least some of the time will become a lifestyle choice."

Liz Burns from the NHS Drinking Responsibly project said, "We know that people want reliable information and environments that support responsible drinking.

"There is more to drinking responsibly than just soft drinks, so whether you own a pub or off-licence or you're in your own home, stock up on a range of quality alcohol-free drinks to help pace your drinks or for that alcohol free day.

"Unless our drinking habits change, liver disease may overtake coronary heart disease as the major cause of early death in the next decade".

Councillor Pat Karney, who heads Manchester City Council's Social Strategy Committee, said: "Like a lot of people I have enjoyed drinking so it's not a question of moralising or being judgmental. It's good from time to time for everybody to check their alcohol intake to see if there are any problems. This week provides a great opportunity to do that."

Once more a shortage of ambulances makes the news...

A man stabbed outside a pub was taken to hospital in a fire engine because the area's three ambulances were busy...

...An ambulance service spokesman said: "The three vehicles on duty in the Maesteg area were already committed.
"The nearest available ambulance was at the Royal Glamorgan Hospital and this was dispatched but was stood down when police responders informed control that they would convey the patient in a fire brigade vehicle

Full article here.

What strikes me as amusing is that I heard of a fire engine bringing a traffic accident in my local hospital only a few days ago - once more because of a lack of ambulances, and this is in London, not Maesteg. Once more the demand for ambulances far outstrips the actual number of ambulances we have available.

At the moment the London Ambulance Service is at 'level 3' in our 5 point scale of how busy we are. So, despite not having the money for it (thanks to the government taking a large chunk of our budget away from us to pay another hospital trusts bills), we are having to pay people for overtime in order to keep the service running to the standard that the government and the public expect.

It's long been known that the ambulance service runs on it's overtime, and our ORCON times have been dropping through the floor because until now we haven't had the funds to pay for overtime (due to the aforementioned government taking money away from us). Now it is reaching a crisis it seems that we have found the money for overtime somewhere - I suspect by 'robbing Peter to pay Paul'.

It's a simple formula, 'Too many calls (often for rubbish) + not enough ambulances + high expectations from the public of the service we provide + demoralised staff = long waiting times for ambulances, delays getting to genuine life-threatening calls and an unhappy public/government'.

Large swathes of the population expect an ambulance for every cough, cold and sniffle - the government is unwilling to pay for this expectation and so the ambulance service gets squeezed from both sides.

In April we tell the government if we have made our targets. I hope that we don't make them this year. If we make the targets after the government has cut our budget, then what incentive do they have for giving us our pre-cut budget back?

If we make our targets, then we will have made a rod for our own backs.

UPDATE: Edited to correct my mistake - we are actually at level 3, not level 4 as originally written.

To be honest, today I'm kind of ashamed to be English.

So overnight and this morning it snowed, the snow lay and as I write this we have about two inches of it all on the streets.

(Rather amusingly, as I don't watch the weather reports I only found out it was going to snow because of my Twitter cloud).

I'd planned to visit my mum, so I had a careful drive to her house - my car felt as if it had power steering and as I opened the front door I was greeted by my brother.

I may have mentioned before how my brother is a teacher, he'd gone to school and had been sent home. Apparently half the teachers hadn't turned up to work and a similar number of children were absent. A cleaner had slipped over in the hall (and then a trampoline had fell on her) breaking her leg. The headmaster then decided to send everyone home.

Cue much phoning of parents and writing of letters. Now the streets of Dagenham are more dangerous than normal, not because of of the snow, but because there are gangs of teenage thugs roaming the place.

So everything shuts down - snow is headline news (although as I'm writing this the BBC is showing pictures of puppies in the snow. No dumbing down there...) Why is it I can remember winters like this, but without all the fuss that this current fall is making.

Ernest Shackleton nailed planks from his ship to his feet to trek across hundreds of miles of frozen tundra, but a bit of snow and everything grinds to a halt. That is why today I'm ashamed to be English.

I *am* however looking to racing around icy streets in a big, heavy yellow van tomorrow (although I'm not looking forward to getting up at 5am to do it).