First off, apologies for the lack of blogging, but I've been working a 60 hour week, coupled with a two day conference and other stuff (including being contacted a lot about Nightjack - about which I appeared on Channel 4 news, but which I, myself, missed.)

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I was woken from my sleep by a text message from a friend telling me that I was in the News of the World. As far as I know the publishers hadn't planned anything with them so it was a bit of a surprise.

He sent me this picture of the article.

I was somewhat perturbed. Actually I was flaming furious. You see, despite the mistakes, it also implies other things.

For comparison you can read the original post here.

Firstly, I didn't say anything, I wrote it. Over three years ago. Hardly news. I'm also not based at the Royal London hospital - we have these things we call ambulance stations. And they get the name of the book wrong. So far not exactly quality reporting.

(And why I do have more than one blog, I think they are mixing up 'blogs' and 'posts', which while annoying is perhaps a little petty to bring up)

The ambulance arrived and took the baby to hospital (sorry 'brain bug tot'), the baby didn't travel in the neighbour's car at all.

The implication is that the baby definitely had meningitis (which it didn't) where in the actual article I try to show that it isn't meningitis. Also things have changed for the better and FRUs are waiting on scene for long times a lot less often than when I did it.

I would guess that the News of the World got hold of a copy of my book - reached page four (where this story is printed) and got no further because they smelled something they could get outraged about. Rather than, say, doing some work and seeing how busy the ambulances were that day (three years ago).

While I've never expected quality journalism from the redtops, it still surprised me how easily they twisted the facts to say what they wanted to say, while getting even the basics wrong.

The sad thing is that this sort of coverage will probably make my bosses look a little less favourably upon me, even though I had nothing to do with the paper printing it, or with putting their own spin on things.

Notes on the Nightjack verdict, written in haste, in anger, and unedited (because I'm knackered and I have no time to do it justice. My apologies - I think I made more sense when speaking to a Guardian journalist about it)

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When I started writing this blog I made some effort at remaining anonymous, it wasn't a big effort mind you, but it involved writing under a pseudonym and not shouting about it in the messroom. When my real name was found out I discovered that I was very lucky, that the communications department of the LAS didn't want to come gunning for my job.

There are laws that protect you should you wish to 'whistleblow', if someone is doing something illegal or immoral then you can be protected if you brig it to someone else's attention. Of course, in the real world, that 'protection' is only as good as the lawyers you can hire to fight for those protections.

A lot of what bloggers bring to light is the chronic state of the their day to day life - a classic example would be police bloggers letting us know about how much administration that they must fill in whenever they make an arrest. Part of what I write about is to highlight the flaws in the governmental running of the NHS. Other bloggers do this more than me.

What bloggers do is humanise and explain their section of the world - public sector bodies do well to have bloggers writing within them, after all these are the people who care about what they do, about what improvements should be made and about where the faults come from. They highlight these things in the hopes that, in bringing this information into the public consciousness, they can effect a change that they would otherwise be powerless to bring about.

Anonymity provides a protection against vindictiveness from management who would rather do nothing than repeat the party-line, or lie, that everything is perfect, there is no cause for concern. Having seen management do, essentially illegal things, in order to persecute and victimise staff - anonymity is a way of protecting your mortgage payments.

It is not just for bloggers this protection of anonymity - consider a support forum for people with mental health problems, anonymity allows these user to perhaps be more open, more honest and more themselves then they would do were they forced to reveal their own identities. It is the nature of the internet that our identities are fluid.

Perhaps that can be the Times next 'scoop', tracking down the people behind anonymous forums in the cause of 'public interest'.

Journalists work to protect their sources, some ending up in prison over their refusal to breach the privacy of their sources. This is right and proper.

So - when Judge Eady told the Times that they could breach the privacy of the police blogger Nightjack, it has lead to a very real fear of what this means for the rest of us.

The thought that Nightjack breached laws on writing about criminal cases (when the details are all in the public domain post-trial) seems petty, and if he did indeed compromise trials then why is his force only giving him a written warning rather than prosecuting him?

I won't dwell on the 'public interest' of unveiling bloggers, they have done it before in utterly despicable ways and for some reason it seems to be their 'cause' - were I vindictive I'd be looking into their expense accounts right now for some justified retribution. Or googlebombing them as a bunch of tossers.

Instead I'm mindful that a lot of exceptionally interesting, thought-provoking blogs might now come to an end. What is to stop companies and public bodies from hunting down people who may have been negative about them. What blogger, with bills to pay and mouths to feed, is now going to take the chance of lifting the lid on mismanagement, badly though policies or idiotic governmental decrees when there is the very real chance that their identities can be revealed for nothing more than a lurid headline on someone's chip wrapper.

Why should bloggers put their careers at risk, over subjects that they are evangelical about, when the simpler, safer option is to fall back into the horde of people who grumble under their breath yet risk nothing to change things for the better. The world can then continue with less public scrutiny because people are scared to speak out.

If it is so important to know a bloggers name so as to better judge them as a source, then I think that it is time to do away with the journalistic practice of protecting sources. After all, without producing the source, the journalist could be (gasp) making up lies. I think we should also know, for definite, what enticements a journalist has had to write a piece for a paper - that 'holiday in France' piece, was it 'bought' by the holiday company that receives the good review?

(The answer is that this does go on - I've seen it with my own eyes)

I wonder if Judge Eady reads blogs, or even has any idea what a blog is. I wonder if he has any idea of what a door he has opened for witch hunts and the reduction of our knowledge of public services to bitesized PR fluff. I wonder if he realises that anonymity is one of the strengths of the internet, not a weakness.

And as for the Times - I wouldn't wipe my arse on it.

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I am exceptionally busy this week, with a 60 hour work week, two days of conference and numerous other things dotted around the place. I barely have time to sleep, let alone eat or write.

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Photograph by Robotson licensed under a CC license.

I thought I would wait until I saw what was in the public domain before commenting on this story, some friends of mine had attended this call and had told me about it.

A police patrol car which hit and killed a teenager in east London while answering a 999 call had not been sounding its siren, police said.

Khaleel Rehman, 16, from East Ham, was knocked off his bicycle on a pedestrian crossing in Ron Leighton Way, East Ham, in the early hours of Saturday.

|t is a terrible, tragic, incident and my sympathies go out to all those involved. Whatever I write here is not designed to deflect or apportion blame to anyone involved, but just to provide some information that the media might not be aware of.

The main concern is that sirens were not being used by the police car. According to earlier BBC reports the accident occurred around half past midnight. At these times of the night we do not routinely use sirens - in most cases the blue lights of a vehicle are easier to see than trying to place where the sound of a siren comes from. We are also aware that people are trying to sleep - and so running around with sirens blaring at all times of the night would result in a large number of complaints to the emergency services.

Imagine also if you live near an ambulance station, or one of the popular junctions.

The choice is simple - do you run the sirens all the time in the unproved theory that it will stop an accident, or do you let the driver use their judgement as to when they are needed?

When I'm driving around at night I often see bicycle riders, and it seems that for many of them the standard dress, as it were, is that of dark clothes and no lights or reflectors on their bike. On more than one occasion I have had the urge to pull up alongside such a cyclist and remind them that what they are doing is likely to have them end up in the back of my ambulance.

Obviously I don't know if Mr Rahman had a light and reflectors, that will be something for the IPCC to investigate.

I'd would also like to point out how surprised the police are when they hear how little blue-light driving training us ambulance people receive, I believe that the police training is both longer and much stricter than ours.

I suspect that the IPCC investigation will take some time although police cars have comprehensive 'black box' recorders, so the facts should be simple to find out. If the driver was driving dangerously, then I would hope that they suffer the same sanctions as any member the public. If they are found not responsible for the accident then I hope that they can put these terrible events behind them.

I suspect that the media would only report on one of those two outcomes.

A controversial database which holds the details of every child in England has now become available for childcare professionals to access.

ContactPoint was a response to Lord Laming's report following the death of Victoria Climbie, who was abused by her great aunt and the aunt's boyfriend.

But the system, costing £224m, was delayed twice amid data security fears.

The government says it will enable more co-ordinated services for children and ensure none slips through the net.

But in 2007, a report into the project by auditors Deloitte and Touche said it could never be totally secure.

Last summer ministers delayed the database, admitting there were some "issues" identified in testing.

It says 390,000 people will have access to the database, but will have gone through stringent security training.

And it is a certainty that not one of those 390,000 people will be able to be blackmailed or bribed in order to give up a child's details.

Ahem.

I would suggest that giving over a third of a million people 'stringent' security training will be rather harder to do than the government thinks it will be.

Much like getting children used to handing over their fingerprints to borrow library books it seems that we are educating tomorrows generation to be content that the government has all their details.

Some quick comments to two pieces of ambulance news.

A chief constable has said he fears an injured person will die in the back of a police car heading for hospital due to poor ambulance response times.

Mick Giannasi of Gwent Police, was commenting after it emerged 92 people had to be taken to hospital by his officers over six months.

In December 2008 alone, police cars were used as a last resort 41 times because ambulances were not available.

I'd like to see the LAS figures on the number of calls that come to us from the police, normally assaults, that have 'no units to send'. The police are just as busy and stretched as us, and often our jobs overlap - it's just a matter of numbers that we sometimes end up doing each other's work. To be honest, given the exceedingly minor injuries that a lot of 'assaults' cause, it would seem a waste to have an ambulance pick up someone with a few scratches, of course using a police car in such a case, while quicker, is still not an ideal use of resources.

But picture the uproar from the headline 'Assault victim told to make own way to hospital'. Even if such an assault is a scratch the bad PR isn't worth it - which is one reason why we take everyone to hospital.

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A Derbyshire man is angry his 98-year-old mother had to wait several hours for an ambulance, on two occasions, after injuring herself in falls.

Brian Beardsley said his mother Agnes had lengthy waits for an ambulance called by a doctor at her Ilkeston care home on 4 March and 27 April.

Mr Beardsley says the waits were not acceptable for a 98-year-old.

East Midlands Ambulance Service officials apologised for the delay but said they had to prioritise 999 calls.

Mrs Beardsley, who has a history of falling, suffered head injuries during three falls in one day at the Victoria Care Home on 27 April.

Paramedics were on hand in minutes for two but for the third she had a lengthy wait.

Sadly the number of ambulances available are not infinite, and so all calls have to be prioritised - in this case the patient had been seen by a doctor who said that a four hour wait was acceptable, and she had to wait twenty minutes longer than that. I'm trying my hardest to see how this is 'news'. Note that when a doctor hadn't been out to see her first that 'Paramedics were on hand in minutes'. The flip side of the story is of course 'My husband died of a heart attack while ambulance crews dealt with a minor injury already seen by a doctor'.

It's lovely to be hated so much.

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).