Just a quick 'thank you' for everyone who sent me a 'Happy birthday' and/or sympathy for the thumb. The thumb is now much better, and the birthday went well because my brother bought me loads of stuff from my Amazon wish list.

Presents are good. A rich brother is also good. Together they are perfect.

Thanks Brett

Now can I get the same response for single, non-smoking females who want to date a shift-worker?

I've mentioned before how the ambulance service and the A&E department is often seen as a "safety net" by other healthcare providers. Both yesterday and today we had perfect examples of this.

Yesterday we were called by a 70 year old man with a urinary catheter which had blocked. This is a fairly simple thing to solve as it just needs a flush of water up the catheter to clear the blockage. It's a five minute job that we, as ambulance crews, aren't allowed to do - however it is the sort of job that District nurses are supposed to do.

So why hadn't a district nurse been to see the patient, so that she could flush the catheter and prevent the patient from having to attend A&E? Why was the patient, who had phoned up the nurse himself, and told her exactly what he needed doing, forced to call an ambulance?

Because the nurse didn't have any water to actually flush the catheter.

It's a bit like if I turned up to someone having an asthma attack, and didn't have any oxygen to give them.

So the district nurse told the patient to dial 999 for an ambulance. We arrived and found him with a bladder so full it was causing him severe pain. We took him into Newham hospital, who, within minutes had cleared his catheter, and eased his pain - then they gave him a 'takeaway' bottle of water so that the district nurse wouldn't have an excuse the next time she needed to visit him.

Today, we were called to a patient who needed his anti-Parkinsons disease medication. He had a carer, who was supposed to visit him once a day to clean, and arrange his medication. But for the last two days, because the 'carer' couldn't get in touch with the patient's GP, had just left him without his medication. We turned up, not knowing what we could do to help. The flat in which the patient was living is brand new, and yet was already very untidy. The patient told me that he was lucky if the carer spent longer than 5 minutes with him (the carer is contracted to work with him for an hour a day).

This poor man was left, alone and shaking, with a carer who seemed to think that if he ignored this 'problem' it would soon go away.

So we did the only thing that we could - we took him to hospital, so that they could sort out his medication for him. Meanwhile I filled in an 'LA260' which is a 'vulnerable adults' form, and allows the LAS to bring situations of abuse, and potential abuse to the attention of the local social services. They now have the name of the care agency, and this problem can solved before it repeats itself in a months time.

Hopefully someone will get a bollocking, and our patient will get a carer that actually cares for him.

It often feels that we, and the local A&E departments, are left to do the jobs that other people should be doing, but because we are there, these other agencies don't seem to care about doing a competent job. I'm aware that there are probably loads of health visitors/social workers/district nurse/CPN's and GPs who do actually give a damn about their patients - it's just that we never seem to meet them.

I went to visit our patient from the last post, this morning I'd put my hand in my pocket and found that I had £2:66 of his money that had spilled out of his pocket during our struggle and I'd put it in my fleece for safe keeping - given the saga of the job, I'd forgotten to hand it in when we reached the hospital. I thought it would be best if I returned it to him, so I had a chat with the lovely receptionists at the hospital, and they told me what ward he was on. I went to the ward to find him sitting there, seemingly none the worse for wear. He did have a bit of a black eye (not my fault - honest), and when I spoke to him he told me that the doctors suspected that he had fainted, and when he had hit his head had suffered a form of concussion. His CT scan and blood tests were all normal, although I suspect that they will be running EEGs and other more detailed tests a little later. He told me that he was feeling pretty much normal, and I suspect that they are keeping him in hospital to continue to run their tests.

He was very grateful to see me, and we had a little chat - I offered him his money back, but he refused and suggested that I get myself a pint with it.

It's the first time I've actively gone to look for a patient after bringing them into hospital - and it is a weird experience going to a ward when I'm not expected to transfer that patient to another hospital. Yet another new thing I've done because of writing this blog.

I should be working today, but (and I want loads of sympathy here folks) I'm off sick with a work related injury. Thankfully it's nothing too serious, certainly nothing as serious as last time.

On Thursday we got called to a big conference centre in town for a (possibly) suspended/dead/fitting male - so we rushed over there and were met by their security who had rather cleverly staked out both entrances to this place so that they could lead us to the patient. Parking up we had to climb a couple of flights of stairs carrying nearly all the equipment from the ambulance. Our first response bag, oxygen and associated kit, defibrillator, suction and carry chair are quite heavy, and as were were in a rush to get up the stairs we were a bit out of breath when we reached the patient.

The first thing that we saw (and were very happy about) was that the patient hadn't suspended, and was instead thrashing around on the floor with some security guards and the centre's medic sitting on top of him. Approaching closer we saw that he wasn't fitting, but was instead very combative, trying to fight off the people who were holding him down in a very confused nature. Aha! we thought, 'he's post-ictal'.

During the post-ictal phase of a seizure, the fitting has stopped, but the patient is often disorientated, sleepy or aggressive. In this case it appeared that the patient was both confused and aggressive - he wasn't responding to anyone trying to talk to him to calm him down, and he could only make guttural sounds. Normally these episodes last less than half an hour, so we stay with the patient until we can get them into the ambulance.

Sometimes the aggression can come from physically being held down, the patient is confused and frightened, and all they can feel is people holding them down - so they struggle. I suggested that the security guards let him go, which only resulted in the patient trying to stand up, only to fall over again (don't worry, we caught him) and unfortunately the centre medic got a head butt for his trouble. I managed to get a blood glucose reading, which was normal, and a work colleague phoned the patients mother, so I could get a bit of history. The patient is normally fit and healthy, not diagnosed with epilepsy, but has had two fits in the past two years. All during this phone conversation the mother could hear her son shouting in the background. He had never been violent before.

We resigned ourselves to a bit of a wait, so we managed to get him over to a leather couch, and held him down there - after ten minutes there was no change in the patients condition, normally they get a bit tired or they start to have a change in their condition. So we started to think about other ways in which we could help the patient at the scene. We couldn't get him to the ambulance while he was so combative, and so we thought he might need some form of sedation. I ran back to the ambulance and asked control to get us a BASICS doctor, or at least someone who could give some form of sedation.

Instead after about 10-15 minutes we got the Physician Response Unit, which is a new service where a doctor from the Royal London Hospital covers medical emergency calls, it's a bit like HEMS only without the helicopter, and instead of going to Trauma, they instead deal with medical emergencies.

The doctor (who is a very nice man) and paramedic crew with him took one look at the patient, listened to the patient's history and decided that sedation was a very good idea.

Cut forward 40 minutes worth of trying to sedate the patient with increasing amounts of medication. For the medically trained out there, the patient needed 10mg Haloperidol and 17mg of Midazolam. At one point the doctor was thinking about knocking the patient completely out and intubating him (something that has it's own risks). But luckily the patient was sedated enough for us to get him out of the conference centre, and into out ambulance, where we 'blued' him into Newham hospital just in time for him to wake up (the sedation lasting only around 15 minutes) where the doctors there did paralyse and intubate him.

We have few ideas why the patient was so violent and so deeply confused - it's something that will be investigated in hospital. We were considering epilepsy, head trauma (from when his head hit the floor), meningitis (so antibiotics were given on scene) or some form of brain insult. I'm asking my crewmate to find out what happened to the patient.

The reason why I am off sick? Well after holding the patient down for an hour and ten minutes, I managed to sprain my thumb. As I can't be considered safe to carry a patient downstairs, I'm taking today off (plus two days of leave) so that my thumb can heal and I can get back to saving lives picking up drunks again on Monday. Oh, and it's my birthday tomorrow - 33 is such a young age don't you think?

This is very interesting, it's a way to embed large videos, photos and pretty much everything else via a blog post.

All I need to do is work out something I can use it for, perhaps a video of driving to a job, complete with maniac idiots walking out in front of me?

Go have a look at some of the other things Downhill Battle do - they are good guys (and gals).

Sometimes a day can just drag along. Today due to rather unusual circumstances , the day really dragged. Here is the time-line of today

10:00 Turn up for work, brew a cup of tea
10:01 First job of the day, taking someone from Newham hospital to Barts.
10:02 Cut finger on my locker door, try to stop bleeding, look for plaster.
10:23 Give up search for a plaster - there are none on the station - leave for Newham hospital.
10:26 Arrive at Newham hospital, ask for plaster, they also don't have a plaster so I now have a huge dressing on my finger.
10:28 Meet with patient, pleasant woman - meet nurse who will be accompanying patient, barely understand nurse due to her inability to speak English.
10:30 Get patient's notes and read them, they make more sense.
10:32 Ask Nurse in charge why this patient (who is having cardiac monitoring and a blood transfusion) is going to an outpatient department. Get told that the patient 'just is'.
10:54 After packaging the patient on a stretcher, loading them on the back of the ambulance, we set of for Barts hospital.
10:55 Nurse escort tells me that she gets travel sick.
10:55:20secs Give nurse a vomit bag.
11:37 Arrive at Barts hospital
11:38 Enter Outpatients department, Reception seem rather surprised to see patient on stretcher appear in front of them.
11:40 Problem is referred to the sister in charge, she also looks befuddled.
12:00 We wait while sister in charge phones around the hospital trying to work out why this patient is in her outpatient department.
12:30 Still waiting...We let Control know why we are waiting - there is no stretcher/bed to put the patient on.
13:00 Still waiting
13:30 Still waiting - we let Control know that we still have the patient on out stretcher while they work out what they are going to do with our patient.
14:00 Still waiting
14:30 Still waiting - we let Control know that we haven't gone to sleep, we are told by sister in charge that patient will be admitted soon.
14:45 We place patient on an examination bed so that we can go back to answering emergency calls, patient will hopefully be in a hospital bed soon. We leave the nurse escort with the patient.
14:48 We are finally available for another job.
14:49 We realise we have nearly no fuel, and no fuel card to pay for fuel. We decide to return to station to borrow a fuel card off an unused ambulance
15:20 We arrive back on station to look for fuel card (and have a cup of tea).
15:30 We leave to get fuel. Take infusion pump back to hospital - the ward seem surprised that the patient has been admitted to Barts.
15:48 We have fuel, we are now ready for another job.
16:00 We get a call, out of area, Maternataxi
16:09 Arrive at Maternataxi, contractions (genuinely) every two minutes, previous baby born in 3 hours, drive rather quickly toward her booked hospital
16:12 Patient's waters break - start swimming in back of ambulance.
16:20 Arrive at hospital
16:24 Throw patient at midwife, run back to ambulance.
16:30 Tell control that we need to return to station to mop out the back of the ambulance.
17:20 Get back to station, mop out.
17:45 Crew to relieve us are already on station, await ambulance to dry out
18:00 Leave for home.
18:37 Get home, collapse into sofa, start writing this post.

-Fin-

This is how you get to work an eight hour shift, yet only do two jobs...

In unrelated news, I had a rather nice time at the London Blogger Meetup, people there included 'Stroppycow', Andrew and Mark, all of which blog for different reasons. After only two pints of John Smiths, I managed to get on a train travelling in the wrong direction... The next meetup will be merged with that of the Funjunkie Christmas meetup, which I am rather looking forward to...

Tonight I'm being sent across London to work at Camden ambulance station. For a grand total of four hours...

Last night was also fairly easy, with one laughable job. I'd just like to say, before telling you about this call, that I have nothing against people who are pregnant, pregnancy is fine, women are fine, it's just...well...sometimes it makes me cringe that the normal processes of pregnancy lead to us being called out as an emergency vehicle.

The patient was a 30 year old female who is 8 weeks pregnant. She has been suffering from normal 'morning sickness', so she went to the GP on Monday, then to the A&E walk in centre on Thursday where they prescribed her a medicine to stop her vomiting. Last night she wanted us called because while the medication was working, but she still felt nauseous - and couldn't actually vomit.

So she her husband called us as a 999 emergency call, and asked to be taken to a hospital out of our area because "she had a bad experience at Newham hospital". She couldn't speak any English, and the husband didn't have the worlds best grasp of the language either - so I suppose that it may just have been that the patient didn't understand what was happening to her, perhaps she needed a translator service so that the information she was being given wasn't translated by her husband who, to be honest, wasn't the brightest bulb in the box. Or perhaps this young pair were just rather stupid...

What makes things worse is that they had a much nicer flat than me.

Tonight, for some reason the traffic in the area was bleedin' awful (note the technical turn of phrase) - it took me 35 minutes to get out of the street from my flats, and my normal 15 minutes commute turned into 2 hours. It was like this across the whole of the area, which unsurprisingly has a big knock-on effect for the ambulance service.

Imagine, everyone coming in to work is stuck in traffic (and talking to our resource centre there apparently wasn't a single ambulance which wasn't affected by someone being late) - this obviously manages to reduce the number of ambulances on the road.

I would imagine the same is true for other essential workers, police, firefighters, nurses and more.

So the next time you are in a traffic queue, and you feel like cutting in front of someone because your journey home is more important than anything else, consider this - they may just be the person who will be cutting you out of the wreckage of your car later when you decide to drive down the wrong side of the road again.

The actual shift was quite pleasant - we did a handful of jobs one of which was a drunk! One of our regular callers had fallen over in the street after having a little too much of the funny juice.

Our last job was the only job of note. We got called to a 33 year old male who had 'difficulty in breathing'. When we got to the patient it transpired that he had was 'feeling funny'. Could this be because of a lowered blood sugar, a head injury or the patient being septic? Could it be an undiagnosed mental illness, an aura preceding an epileptic fit or a brain tumour? Or, more realistically, could it even have been because he had been smoking marijuana all evening? As I was driving I never got the chance to point out that this was the entire point of smoking the stuff, but we took him to hospital as it managed to finish our shift off nicely. You can see the Mensa members we find ourselves meeting on this job...