It looks like the Tamils are at it again, a Sri Lankan was shot in the throat while driving on the A13. The bullet lodged in his throat, but it looks like he is going to be alright.
What this probably means for the rest of us however, is that the Sri Lankans will spend the next couple of nights chopping each other up with knives, machetes and swords.
The last time they decided to get violent on each other I attended a multiple assault, and looked after a chap who had gotten his knee opened up by a sword - this was after driving along a road full of cars with smashed windscreens. I would imagine that some police leave will be cancelled tomorrow, and certain areas of Newham will be watched very closely.

This also means that there is someone roaming around Newham with a gun, and they are not afraid to use it.

Deep Joy.

Well...no sooner do I say I'm not working with the same lazy git from yesterday - than Resources phones me up and tells me I'm working with him again. However...I'm attending today, so I can control a bit better when we call up ready for another job. Lets see if he makes good on his promise to hide from me at hospital, so I can't 'green up'.

...Someone else takes over. A fairly new blog, but so far very well written, very enlightening and I hope that Zinnia keeps writing. I sometimes have to deal with the first hour of grief, what do you say to the surviving partner of a 60 year marriage when he wakes up to find his wife dead in the bed next to him? Zinnia deals with them further along the path of grief, and can help the survivors to move on.

Go, read the blog now, that's an order!

I've mentioned before (ad nauseum) that we need to reach 75% of Emergency "Cat 'A'" calls within eight minutes.

A new Station officer moved into ********* station (they know who they are...) - He told them in his opening speech, that he didn't think that any of them were special, that there would be no 'family friendly' rotas, that there would be no 'special leave' (which is leave you get on short notice if, for example your house floods, or your child gets ill and you can't get a carer) and he told them that if they didn't like it, they should go to work on a building site.

The amount of patients reached in those magic eight minutes went from 75% of all calls to 17%.

The crews weren't on a go slow, they still got there in the same amount of time, they still looked after the patients to the best of their ability - just that they recorded on their paperwork that every time took nine minutes. (The 17% would be the calls that legally need accurate time-keeping, like cardiac arrests, police jobs and the like.

New Station officer got called up in front of the bosses, and has now been moved to an office job, far away from the station in question.

It is so much more civilised than going on strike.

From October the first this year, local NHS organisations will have responsibility for managing how ambulance services respond to Category 'C' calls. These are the calls that are for cut fingers, simple bee stings, grazed knees and splinters in the hand. Ambulance service chiefs nationwide welcomed the changes, because they think it will mean more ambulances for actual emergency calls, which means that response times should go down. This will make the chiefs happy, because it makes the government happy.

But I have bad news for them - The London Ambulance Service was selected to trial this idea, so we instituted a 'No Send' policy. This meant that the call takers in Control could redirect crap calls to NHS Direct or the patients own GP. This was going to reduce our workload, increase response times and generally make life a lot better for all concerned (including the A&E departments who would have less crap brought to them by ambulance).

We have approximately 3300 calls a day across London. Our 'No send' policy filtered out, on average, 30 of those calls.

That is 0.9% lowering of our workload.

The reasons for this are many, primarily we are scared of getting sued - if someone phones up and asks for an ambulance, we refuse and they drop dead later in the day (from something completely unrelated) then the lawsuits, suspensions and bad press will be massive.
Then there are the callers who know how to work the system. When you call up 999 and ask for an ambulance, the call-taker asks a number of questions about the patient - one of these being 'Are they having difficulty breathing?'. If they answer yes to this question an ambulance gets sent as a Category 'A' emergency call. This is fine until you realise that most people will answer yes to this question in order to get an ambulance. Sometimes they will just agree with everything the call-taker asks, and other times if the patient is crying (because, for example their boyfriend left them), then they will think that this is 'difficulty in breathing'.

Sometimes a cough, that the patient has had for a week, equates to' difficulty in breathing', in the callers mind.

This is without getting into the thorny subject of people who call for an ambulance that can't speak English.

I think I've mentioned before that I spent a shift up in Control, listening to calls being taken. I couldn't do their job - at least I can see the idiots and decide there is nothing wrong with them, call-takers just have some nutter shouting down the phone at them in barely decipherable gibberish.

So, in closing, congratulations for extending the 'No send' policy across the country - but don't expect it to do wonders for your numbers.

Thanks to *anon* who pointed this out to me - I'd forgotten all about it

Back to work with the rather enjoyable 18:00 to 01:00 shift, where you tend to get lots of drunks, and very few serious cases that require me to do some actual work.
However, you do occasionally come across a job that is tricky, not because I worry about the patients illness, but instead for reasons that to the non-ambulance person are hard to understand.
Our first job of the day was one of those very jobs. The call we were given was 13 year old female with a dislocated knee. Nice and easy I hear you say, but lots of minor problems can build up to make a job less than ideal.
We arrived on scene and found a patient who had a rather obvious dislocated knee - just imagine your kneecap shifted two inches to the left, so much so that it casts a shadow on the rest of your leg. Simple enough to deal with - if you are feeling brave you can slide it back into place yourself, or go the more recommended route which is to take them into hospital and let the doctors fiddle with it.
Then the problems started piling up - To start with there were no adults present, just another (unrelated) teenager, neither the patient or this other teenager were what exactly call brain surgeons. We aren't supposed to deal with children without an adult present, but what else can you do in those circumstances? Her father had been called, but he was travelling from another hospital where he had been undergoing outpatient treatment. So we had to decide if it was 'safe' for us to take the patient to hospital - we use something called 'Gillick competency', but it's always a bit of a gamble on our part.
The patient had fell from her bunkbed - so her friends (who had run off) had lifted her back onto the top bunk. She was screaming in pain (which is fair enough I suppose), and wouldn't let us near her. This little problem was solved by giving her a lot of Entonox, known to some people as 'laughing gas'. After enough of this stuff she started laughing and we essentially 'grabbed' her off the bed.
Now she refused to sit in the carry chair, but because we were upstairs she needed to go in it. After a lot of persuasion, and a lot of her screaming very close to our ears, we managed to get her to sit down - this had the rather excellent side effect of popping the kneecap back in place.
This would normally mean that the amount of pain goes down by a lot - but this girl has a touch of 'hospital phobia', so she continued screaming.
While screaming she was also arguing with the teenager who was with her, telling him that he needed to come to hospital with her - but he was refusing because "How am I gonna get back home?". I must admit I really wanted to tell him to walk it, because the hospital was only about 1000 yards away. But despite her pleading with him, he wasn't for budging - he set his burberry baseball cap square on his head and refused. I don't think she is going to be too happy at him next time she sees him.
Once that arguement had run it's course (and my crewmate and I managed to stop laughing), we had to get the patient downstairs - this was made more difficult by a sideboard that was in the upper hallway bay the stairs. To counter this problem, we had to lift her completely over the bannister - luckily she was a lightweight, and my crewmate and I are both strapping, good looking *cough* men.
We saw her later in hospital, having a plaster cast put on her leg, so that the kneecap wouldn't slip out of place. She was much happier and surrounded by her parents. She even managed to give us a smile - which, in the end, made the job worthwhile.

So this is what we occasionally have to deal with, not so much the life threatening stuff, but more the 'silly little things' that can make an 'easy' job, much trickier.

For those of you who don't read the comments that people leave, Emchi found this story which shows that unlike my previous post, some people do make an effort to turn their lives around.

Came across this story about a 480 pound (34st) woman who died after the "patient extrication from Hell". To think I moan about having to carry a 17 stone patient down a couple of flights of stairs...

It's one of those jobs where you would turn up, take a look at the situation, get back in the vehicle and radio Control with your resignation letter.

Who is too blame? Well, my opinion is that the patient committed suicide by overeating. Where were the social services? Where were the psychiatric services? Where was the GP? More importantly, where were the relatives?

from the ever excellent Boing Boing

My first day back after my holiday, and the Resource Centre thought that I was still on leave - Oh well...never mind. I decided to stay on and work though, partly because the manning at the moment is awful. We are missing three ambulances today, and about five tomorrow - I dread to think what it will be like on Sunday. This time it is due to an actual lack of staff rather than the lack of vehicles as recently reported.

I checked my mail slot to find out that the coroner is investigating the death of the young diabetic that I attended to some time ago (and wrote about here). Essentailly I have to write a statement about what happened, including the traffic situation and access to the house (both of which influenced the job to a major degree). Rather thankfully at the bottom of the request letter is the note "No complaint has been made". I might end up having to give my statement in Coroners Court, and given the problems we had with this job, I may well end up being asked questions by the coroner themselves. I'm not too worried as I can justify everything I did on that job.

On a lighter not, the first job of the day was one of our regular drunks, who was discovered laying in the street by two police officers. As they can't take people who are 'properly' drunk into custody anymore, we end up getting called to them. It was so lovely to return to work and have this smelly, incontinent drunk welcome me back.

(Sarcasm? Moi?)

Currently I'm sitting on station awaitng yet another chance to save a life...

I would suggest that a lot of the people who read this website are doctors and nurses of one persuasion or another. I also guess that many of these readers have some experience of A&E departments (and I'm glancing sideways
at 're-minisce' here, for he signed up for a double sentence in one of those windowless boxes of suffering).

So as an EMT I wish to apologise.

I'm sorry that throughout the shift I will continue to bring fresh meat to the grinder, that is I will be forced to transport patients from 'outside' into your department, where they will need to be looked after and assessed by your own good selves.

I'm sorry that I have to sometimes bring their relatives who will harass you about waiting times, the pain their relative is in and about why you are drinking that cup of coffee while their dearly beloved is 'at death's door'. I'm also sorry that sometimes I couldn't bring the only relative who can translate the patients' moaning and groaning into English, thus making assessment a thousand times easier.

I'm sorry for the dross that I bring to you - the cut fingers, the bellyaches and the spotty backs. I'm sorry that the Primary Health-care workers (the GP's) are often so useless as to be a liability. I'm sorry that you have to cope with the fallout that because there are so few good GPs you have to become the first point of call for coughs, colds and diarrhoea

I'm sorry that the schools don't teach basic health and first aid to their students, preferring to waste time on the history of glaciers or the solving of quadratic equations. This means that the population wouldn't know the difference between a minor cut and an arterial spurt if it jumped up and hit them over the head with a hammer, nor which of these two warrants a trip to the local Emergency Department.

I'm sorry that our communities where our Elders teach our Youngsters and the Youngster listen no longer exists - thus resulting an influx of first time mothers who think that when a baby vomits it is a precursor of death.

I'm sorry that the protocols and guidelines that we adhere to don't allow us to leave patients at home. In England at least we have to transport to hospital. The government thinks that we cannot tell the difference between serious cases and the aforementioned cut finger.

I'm sorry that the police cannot look after drunks on a Friday night, they worry that they will choke to death in the cells, and so we get called - and we have nowhere else to bring them except your department. Sorry.

I'm sorry that I bring in those serious cases five minutes before your shift finishes. If it's any consolation it's probably five minutes to the end of our shift that people decide to have their heart attacks, their amputations and their dissecting aortic aneurysms. Like you this means we get off late as well.

I'm sorry, but it's not my fault.

Previously posted on The Lingual Nerve

Blimey, who turned up the thermostat and humidity in England while I was gone?

I spent a whole week without internet access, stuck in the middle of nowhere. It was so far from anywhere of any interest that I wouldn't have been surprised to trip over a blonde farm-boy with a lightsaber looking to get out of his humdrum existence. One internet café seen, if only in passing, very few English newspapers, and a TV whose only English channel was some 24 hour business channel. I managed to finish reading some books that I had been putting off for a quiet moment - and this holiday was one very long quiet moment.

It felt as if I had travelled back in time to the 1980's, there was pitiful mobile/GPRS coverage - so much so that I could only get a signal at sunset - and that was everywhere I went on the island. The music that was being piped out of shops and coaches was of the Phil Collins/Chris Rea/80's soft rock movement.

But the thing that made me think I was in the 80's was the design of the advertisements. Billboards with the faces of people who look rather uncannily like a (pre-capture) Saddam Hussein, pictures of bad drawings of buildings. Big red stars with whatever the Spanish equivalent of "Sale!" or "50%! Off! Now!". It is a sad state of affairs when you start looking for more and more tacky advertisements for entertainment and for some form of cultural "zero-point".

Some things that I did learn on holiday, taking a laptop is well worth its weight, especially when said laptop is loaded with films. Seeing a 'Marineland' show taught me that Dolphins and sea-lions are smarter than me, because I can't balance a ball on my nose, and that although being a dolphin trainer must be one of the best jobs in the world, they still have to rake the dolphin shit from the bottom of the pool.
Also after a trip to 'Green Planet' zoo, I've discovered that Raccoons are the cutest animals in existence - can we have some released into the wilds of England please...

To get vaguely on-topic, Spanish ambulances are tiny, I couldn't stand up in one...

I was exceptionally happy to fly back into England, catch the last train home and in a fit of rather sad geek-dom, post that I had returned. What can I say - I was itching to get my keyboard under my fingers. For the rest of today (after unpacking my bags) I shall be catching up on all those links on the left of the screen. Understand my journey - click on them all yourself and spread the love of a visit.

I'm back from holiday - it is currently 01:20am on Tuesday,this means I haven't slept in 38 hours - and the first thing I do when getting home is boot up the computer and post about how I'm back.

Tomorrow/Later Today I shall be catching up on what has happened in the world during the last week, sending off an article for Lingual Nerve and posting (and moaning) about my holiday.

Then hopefully it will be normal service resumed when I moan about everything