The daughter of a 77-year-old man who died two days after falling over said she may sue an ambulance trust.
Henry Purnell, of Great Yarmouth, had been drinking heavily before he fell.
He suffered a fractured skull and died in hospital from severe brain injuries two days later. An inquest jury has returned a verdict of accidental death.

No comment, or blogging today, as I'm off doing something wonderful - more on which later...

You know, I've been trying to think of a way to write about this for quite some time now (and the related subject of planning around it), but each time I've thought about how to write it I've always been scared that I'd come across as racist.

So here we go, lets give it a try and just write my impressions without putting any value judgements on it.

In my area we have a large amount of immigrants. For reasons that I presume are cultural many of these groups tend to start having children earlier than your 'native white' woman. They also tend towards having lots of children.

I tend to take more immigrant birthing women to hospital than 'native white' women. Is this just because 'native white' women tend to be financially better off and therefore own a car or have other transport?

Recently I've been finding that, on taking birthing women to hospital, they tend not to have any empty beds.

It doesn't end there.

Having lots of children places a strain on the ambulance service, the A&E departments and GP surgeries. When an infection starts spreading through the schools we get lots of calls to sick children.

If there are a lot of children in a house then all the children tend to get sick.

People who do not oppose immigration, and I count myself as a moderate member of this group, would say that if there are more people in the country then there are more people to work in the medical services industry.

Except that it doesn't work like that, I can count on the fingers of one hand the number of, for want of a better phrase, 'minority ethnic*' ambulance people. For some reason it's less of an issue for nursing staff and GPs.

(Heh, maybe 'minority ethnic' people aren't as daft as folk would make them out to be - what sane person would want my job?)

This lack of 'minority ethnic' ambulance people is at least partly because the government doesn't give us enough money to hire more people. I don't think that the LAS recruited anyone for an eighteen month period recently.

But there is no simple solution, can you really tell people to stop having quite so many children? The majority of the people I go to aren't that rich (otherwise they wouldn't live where they do), so taxation isn't the answer. Where does the money come from?**

So we muddle along. Myself? I can see us ambulance people delivering more babies at home as birthing mothers get turned away from midwife units (the second child I ever delivered was born at home because of this).

A while ago I took two 'native white' women to the midwives, both in labour, one after another. Both shared the same first name. Both were on a Methadone program. I mention this à propos of nothing.

Oh well, so it goes.

UPDATE:Just watching the local news, apparently in my area three out of every four births is to an immigrant mother, which reflects my experience.

*Because, if you are born in England you are a native Englander. But I understand that it's not as simple as that.

**The first person to comment, "By not fighting unwanted, improper and pointless wars" wins a cookie for stating the obvious.

Imagine being called to the third pub of the shift, like the other calls the patient is 'collapsed'. You arrive and the person is stinking drunk.

He's able to answer questions, an examination shows nothing serious. You tell him that you'll take him to hospital.

He refuses.

He becomes aggressive, swearing at you, flailing around to push you away.

You can't 'kidnap' him, even if you could there is no way to safely force him into your ambulance.

So you leave him with his friends, or the police arrest him. Then you spend the rest of the night worrying that there was something wrong with him and that you'll end up standing in a coroner's court.

That nightmare has just happened to an ambulance crew.

I have a problem with the sub-headline 'Paramedic refused to treat him'. It looks to me that they tried to treat him but that he refused.

99.99% of these jobs would turn out fine, the patient would sober up in the police cells, or back at home - unfortunately there is always the slight chance that alcohol is masking something more serious.

Obviously the report can't tell us everything that happened that night, and I wasn't there and anything I write about this situation is supposition. However I do have experience with calls very much like this one - a lot of experience.

I can see how the crew made the decisions that they did. I've made similar decisions myself.

Take for instance the report of being unconscious for ten minutes. Daily I come across people who don't know what 'unconscious' means, for some people sitting on the floor means 'unconscious'. For others groaning in pain is 'unconsciousness' and for some being dizzy means that they are 'unconscious'.

If the witnesses to an event have all been drinking and aren't medically trained, then you often take what they say with a pinch of salt.

If you are unconscious for ten minutes there is a good chance of you occluding your airway and dying, someone sitting there chatting to you is unlikely to have been unconscious. I'm not saying it never happens, it's just unlikely.

So I can't blame the crew for taking the history with a pinch of salt.

But in any case, they tried to take the patient to hospital (where he would probably be sat out in the waiting room to sober up where the headline would then be 'Nurses sat patient in waiting room to die'). It was only when the patient because abusive and aggressive that they stopped trying to get him into the ambulance.

So at what level of aggressiveness do you stop trying to force someone into your ambulance? When they tell you to 'fuck off'? When they threaten to hit you? When they take a swing at you? When they push you away? When they connect with a punch? When they connect with a second punch?

At what point do our bosses, and the courts, or the press, want us to ignore being abused?

When can we kidnap people? What powers should we have to force people to submit to treatment and transport? If someone doesn't want to go to hospital and they seem to understand what is happening then we have no power to drag them to hospital.

So it's not as if the crew didn't try to take him to hospital.

The question comes down to asking if the head injury this person suffered is what caused the aggression. Unfortunately we don't have portable CT scanners and the skill to read recent onset cerebral bleeds.

Also injuries of this sort after a fall of this type are very rare - I can't count the number of 'drunk - head injuries' that I've gone to (and yes, I try to take them all to hospital), but I can't remember any that went on to die.

So, it's not incompetence, it's not a lack of care, it's not a "oh, he's just another drunk, lets leave him". It's a combination of it being illegal to take someone to hospital who doesn't want to go, of not wanting to have a fight in the back of an ambulance, and of the unlikely odds of this being something serious.

So, based on the reporting, I look at what this crew did and I think that I probably wouldn't have done anything different.

Honestly, what would I do? Take him to hospital in police cuffs for apparently only a graze to the head?

What would you do, without the benefit of 20/20 hindsight?

I have sympathy for the patient, his friends and his relatives. I also have sympathy for the ambulance crew, no-one wants their patients to die.

But that is the risk we take whenever we don't take someone to hospital.