The other night I had my favourite type of job, the type of job that meant I wasn't upset to be late leaving work.

People who are diabetic sometimes have very low blood sugar - this makes them confused, agitated and sleepy, this can lead to unconsciousness and even death. Their blood sugar can become low for any number of reasons, most often they have done more exercise than normal, and not eaten enough to raise their blood sugar.

The treatment for this condition is to either give them sugar, or an injection that 'frees up' some sugar that is stored as fat in their body.

Our patient last night normally controls her diabetes very well; so much so that her family had never seen her with a dangerously low blood sugar (the medical term for this is hypoglycemia). They called us because she was acting confused, and was unable to speak properly or stand upright. We arrived, and found out she was a diabetic, checking her blood sugar we got a reading of 1.6mmols (the normal range for a diabetic is around 4.5-12.0mmols), this is very low and explained why she was slipping out of consciousness.
The family were understandably upset, as they had never seen this before, they saw her slipping into a coma in front of our eyes - so we explained what was going on as I prepared the injection that would raise her blood sugar. I gave the injection (this injection is called Glucagon) and waited for it to take effect, all the time reassuring the relatives.

Within 10 minutes she was up and talking, we then gave her some sugar jelly which raises the blood sugar some more. Soon she had made a full recovery, with her blood sugar reading 5.6mmols. We gave her some carbohydrates (for 'slow-burn' energy) and left her in the care of her exceptionally happy family.

The reason why this is such an enjoyable type of job is that we are actually saving a life (for a change) with the treatment that we can give, and that the recovery is normally rapid, and always impressive. From unconsciousness to 100% fitness in the space of about 15 minutes really impresses onlookers, and it does our ego good to be praised every so often.

We got called to a pub (which is always promising), to a 24 year old female who was having 'difficulty breathing'. When we turned up at the pub, we were met by a man who, after letting us know he was a 'first aider', told us that she was fitting, and that she had stopped breathing - but that mouth to mouth resuscitation had 'brought her back'.
Entering the pub we found the woman thrashing around on the floor. She wasn't having a fit, it was more like a temper tantrum. Throwing himself on top of her was her husband, who was reluctant to let us approach her. People in the pub told us that they had both been drinking heavily.

We near enough had to force the man off of his wife so we could examine her properly - and it soon became apparent that she was just very, very drunk. Out of the corner of my eye I saw sudden movement and ducked quickly as the husband threw his wife's shoe at a man standing behind me. We decided that loading her onto the ambulance would be the best thing to do. The husband demanded to be let in, but we told him that we needed room to properly examine his wife. He banged on our windows twice, but then left, apparently running up the road - possibly due to him throwing a pint glass at another of the pubs customers. (This was very unwise of him, because half of Newham police force were 200 yards up the road dealing with an armed incident).

By this time a second crew had turned up, as someone had called 999 and told our control that the woman had stopped breathing. We stood them down, although on reflection they could have been of help keeping the woman on the trolley because the woman was still throwing herself around, refusing to lay still, and generally making life difficult - we managed to get a blood sugar, pulse and blood pressure (all of which were normal) but she refused to stay on the trolley, wouldn't sit on a chair and so we let her lay on the floor.

At times like these, I think I'd give my eye-teeth to be able to put people like her in a four point restraint - but it's something we are not allowed do.

Then while I was driving to hospital, she made an attempt to leap out the back of the ambulance, and it was only the rugby skills of my crewmate that prevented her escaping under he wheels of a following car. The rugby tackle was all the more impressive given that my crewmate is five foot nothing tall.

We finally managed to get the patient to hospital, where she threw her vomit bowl (with vomit) over the floor and tried to hit a nurse - luckily I was standing behind her, and grabbed her before she could damage any of the staff, or even a patient.

To cut a long story short, the nurses let her phone her sister to come and pick her up, and then kicked her out the department.

Two things about this job that bring a smile to my face; one - one of her shoes is still laying in the gutter, where we picked her up from, and two - Her husband got out of prison today, and given his attitude and behaviour, he'll soon be back inside.

So, it's not just weekend nights we get the violent drunks, it's every damn night...

It just goes to show that some people can survive a hell of a lot, being shot, falling 5 floors and nearly being cremated. Value judgments about whether he should have lived or not are welcome.

Once again, from the unsurpassed Boing Boing

The London ambulance service is normally pretty good for supporting their staff through some tough times, but at the end of the day it comes down to the management on the ground, tonight was a case in point.

A crew had to deal with one of the worst jobs you can get - I won't give any details, but I suspect it will be on the news tomorrow. Just imagine the most heart-wrenching thing you can.

One half of the crew is fairly new staff, he's a good bloke who knows his stuff, but this job was so outside the normal, it had obviously shaken him up (and I would suggest that anyone not at least a little shaken up by this job is someone who has lost all sense of humanity). The hospital involved offered a chance for a 'debrief', which is when they sit around a pot of tea and discuss the job, dealing with the feelings that everyone has. Not many hospitals do this, and I'm very happy that they included the ambulance crew in this session.

A Station Manager was working, and his advice was to 'return to base for two hours and have a cup of tea', which isn't helpful at all.

Every other crew rallied around and made sure that the crew involved was alright, and a Duty Officer was called - he spoke to the crew and stood them down for the rest of the night - doing something that the Station Officer should have done hours earlier.

The reason why we are stood down is because after dealing with such a ghastly job if your next call is to someone with bellyache for seven days, there is a strong likelihood that you will say something to the patient that you will regret. I know I've done it when I worked in hospital, and luckily gotten away with it.

So, there is support, it just depends on who is on duty that shift.

The thing I like least about doing seven 18:00-01:00 shifts is that I start losing touch with friends, at least in part due to no-one being on IRC when I'm at home.

Then there is the cycling home at 01:30, where I would be really tired and ready for bed before leaving work, the cycle home wakes me up. Not good when you want to go straight to bed so you can get up early in the morning.

Still, what other job lets you deal with calls similar to those I had tonight - An RTA at less than 10 mph, with very minor cosmetic damage to the car; and yet the driver is clutching his neck as if it is about to fall off...

At least the lazy git I was working with wasn't any trouble, he didn't decide to run off and hide so I couldn't call up ready. So I suppose you could call it a good night. I might be working with him tomorrow...

So 'Good Night' to you all

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