Just a few bits of info.

1) I'm looking forward to a drink tonight, although given the fact thatyesterday I was staggering home after two weak ales, my first alcoholic drink in ages - if you want decent conversation, you better turn up early... Because the few photos of me floating around apparently look nothing like real life, I shall be wearing a '404 /shirt/tie/ not found' t-shirt, with a red shirt over it. If you are the first person there you will also probably see me fiddling with a bit of technology.

2) They are knocking down my dump of a tower block (Yay!), there was a meeting last night, which told us that because "security and safety" are too much of a problem, and it would cost £10 million to makes the flats up to the governments 'basic standard' we are all going to get decanted to other properties.
Considering the safety/security problems are caused mainly by the residents, I suspect the council wants to disperse people. Also Barking town centre is undergoing "regeneration", and as my block is on prime land, I'm sure they don't want the likes of us spoiling their plans...
Good news is that I will get a lump sum of £3,500 for having to move, which will pay of half of one of my credit cards.

3) It is my workmates funeral tomorrow, the family want a service funeral, so we are all turning up in uniform, unfortunately that uniform means long-sleeved shirts, of which, I have precisely none. (It's easier to wash body fluids from bare arms than have to launder a shirt). I'm not the only person with this problem, so people who have long sleeved shirts are lending them to those who don't have any.

4) While I wanted to do something interesting on my days off, I have instead been undertaking the epic "Cleaning the flat" which is taking much longer than I thought - but it does look very nice now. All set for it to be bulldozed in the new year I suppose.

5) My brother has bought me a nice new shiny laptop, I have to pay him back at £50 a month, but at least he isn't charging me interest. Thanks Bruv!

First off, the first "Grand Rounds" are at Blogborygmi - quite a few top-rate medical articles there, go and have a look.

As I promised yesterday, I'll explain what the LAS Major Incident policy and procedure is, and why you won't get me running towards two collapsed people.

First off, lets define a "Major Incident" is, from the little book I was given, "Any occurrence which presents a serious threat to the health of the community, disruption to the service, or causes (or is likely to cause) such numbers or types of casualties as to require special arrangements to be implemented by the health service", basically this means anything that has, or will cause, a large number of casualties. Anyone in the emergency services can declare a Major Incident, and to be honest its the one thing that makes me a little nervous, because you never know what you are going to see on scene until you get there.

The Potters Bar train crash was phoned into the Ambulance Service as a "Chest Pain"...

If I'm first on scene at a Major incident, then if I am the attendant I need to run around the scene to do a quick bit of reconnaissance, I'm not there to treat anyone. I then get back in the ambulance and radio in a "CHALET" report. This is...

C - Casualties (number and severity).
H - Hazards on the scene.
A - Access, meeting points, vehicle parking area.
L - Location, the map reference and best directions to get to the parking area.
E - Emergency services required.
T - Type of incident.

I'm then to work out the ambulance parking points, loading area and casualty clearing areas. Well, I say "I", but I'm hoping that an officer turns up to do all that. When a fair ride collapsed in Alexandra palace and a Major Incident was declared officers outnumbered road-crews.

There is a big part in the LESLP (London Emergency Services Liaison Panel) booklet about how to set up a well run Major incident scene. Its a good site, run by the people who tell us what to do in a Major Incident, and you can even download the manual that we use. (Large .PDF)

Part of the LAS responsibility is for the first people on scene to do a Triage Sieve, this is essentially deciding who is most 'deserving' of our immediate treatment. This is only done when there are more casualties than there are rescuers. We do this so that we don't 'waste our time' dealing with someone who will probably die, to the detriment of being able to save other people.

We use a flowchart to decide which category patients fit into.



You start at the top left of the card and work your way through it for each patient. For example, if someone isn't breathing, and by opening their airway (tilting their head back) their breathing doesn't start then they are a 'Dead'. In a normal situation we would try to resuscitate a patient in this condition, but with a large number of casualties 'Dead stays Dead'.

We have on our ambulances a number of tags that you tie to the patient as you walk along making these snap decisions, it's something I hope I never have to do - walk amongst the wounded, ignoring their calls for help just tying tags on people...

'Immediates' get seen to as quickly as possible, as there is a chance we may save their lives, they are also normally the ones who get first transport to hospital. Then come the 'Urgent' patients, while the 'Delayed' can wait until last, and/or can make their own way to hospital.

It is important that we don't overload the local hospitals, so the two nearest hospitals are normally nominated as the 'receiving' hospitals with other nearby hospitals marked as 'overflow'. The 'receiving' hospital(s) tries to clear it's A&E department as quickly as possible and closes to normal 'walking wounded' patients.

The planners have thought long and hard about every major incident they can imagine, we have hundreds of contingency plans, training is ongoing, and every hospital in London has a decontamination unit. When I was working in hospital, I got training on how to use the NBC suits - and I'll tell you this, they are not the cheap and nasty ones...

If/when/should terrorists do something spectacularly nasty, I would like to think that we are as well prepared as we can be, but every incident is different in a million ways.

Why won't you catch me running towards two collapsed people? We use STEP 1,2,3 which means if there is one person on scene collapsed we proceed as normal, if it is two people then we proceed with care, if there are three people collapsed, then we hold back and get the chemical team in to have a look.

So...I saw the BBC's programme 'Dirty War' last night along with the after programme live audience discussion, and I must say I wasn't very impressed.
The programme itself was poorly written, not knowing whether to deal with the 'detection' of the bomb, the capturing of the terrorist cell or with the emergency planning around the event itself. It would have been better if they had focused on how, with their 'extensive' research, the emergency services would/would not cope with such an event. I'm not even going to start talking about the firefighter who removed his protective clothing to continue fighting a fire in a part of London that would be a 'no-go' area for the next 50 years...

The programme started with an exercise set in an office block, and here the makers were clearly referencing the Bank exercise that ran last year. It was during this exercise that the limitations of the protective suits, and the communication gear became apparent. Hopefully these problems will have been solved before we need to do this for real.

I did notice that the terrorists decided to irradiate East London, which is a bit of an 'own goal' as most of East London is Muslim in population, rendering Brick Lane uninhabitable would be a bit stupid...It's called Banglatown for a reason you know. I also found it amusing that they would blow up a bomb in my 'patch', if that day were anything like previous major incidents that I should have been involved in - I'd be sitting in the pub/someones party getting quietly drunk, and therefore being in no fit state to work.

There was a minor mention of the ease of gaining radioactive materials, for example in America 840 radioactive sources have been lost since 1997. Caesium has been offered for sale in Thailand, Bangladesh and Chechnya. All the usual suspects have shown serious interest in a 'Dirty bomb'.

There then followed a live discussion panel, which reminded me (as if I needed it) that the public are often really rather dense. Kudos to the representative from the Muslim Council of Britain for congratulating the programme makers for a balanced drama (although he couldn't see any Muslim victims of the bomb, which given the area it was detonated in, was laughable). Some of the callers however still moaned that the BBC was stirring up Islamaphobia. "Why couldn't it be unnamed terrorists" asked one caller, well I'm sorry to sayit but most of the terrorists in today's world (with a few exceptions) are indeed extremist Islamics. Then a member of the audience wanted to shout up a 'class war' point that it would be only the politicians who would be safe, which is a reasonable point - but not one that needed quite as much shouting and ranting.
Then discussion turned to the 'Preparing For Emergencies' booklet, which over half the audience said they had received and were critical of. However when asked how many had actually read it, a lot of hands went down...
One of the main complaints was that the booklet was 'patronising', well I'm sorry, but dealing when with the geniuses of the general public, I'd say it had to be written simply so people could understand it.
There then followed a lot of repeating the same questions, followed by repeating of the same answers and from then on I sat there grinding my teeth in despair at the great British public.

So at the end of the evening, very little was shown about terrorist threats or what to do in the event of a dirty bomb and nothing new was known about the governments response to such an event. I would suggest that most people went away from the programme more frightened than before, and with very little to reassure them.

My next large post will be about what the LAS (and by extension, myself) will be doing in the event of a Major Incident.

For those that are interested, on Thursday (30th) I shall be having a drink in the "Bell, Book and Candle" pub in Ludgate Hill (near St Paul's Cathedral). Everyone who reads this is invited along. I shall be in the pub from about 6pm.

Lets call it a very small blogmeet.

First off, thanks for all the suggestions on what to do with my time off, none of them were rude, and some of them I'll take up. I've replied to some of your comments over there - when I could think of something amusing to write in reply. Also thanks to those that sent private emails, I'll get around to replying to them as soon as I can.

This is post number two from the "your vote" post I ran a while ago...

We were (as ever) running to a call on the other side of our 'patch' when suddenly my crewmate told me to pull over and stop (I was driving). Wondered what had happened, he leapt out of the ambulance and I saw that he was heading towards a bus that I'd just overtaken. Leaning out of the window was the driver, blood gushing out of his nose looking very sorry for himself.
Apparently a car had pulled up to the drivers window, and accused him of cutting him up, the other driver had then said "I'm a bus driver as well", and then punched the bus driver on the nose before driving off. We soon managed to stop the bleeding, and the bus managers came down to investigate, along with the police. Luckily our patient had managed to get the number plate of the man who had hit him, and I can only imagine that if what he said is true, there will soon be one out of work bus driver.
Violence against transport staff has gotten silly, did you know that they carry DNA swab kits for collecting DNA evidence from people who spit at them?

That same night we went to a youngster who had been hit by a car while trying to cross the areas busiest 'A' road (the notorious A13, the fourth most dangerous road in London). This youngster was wearing black trousers, black trainers and a black hoodie and baseball cap (hoodie pulled up), he was also black himself, the only thing that could have been more dangerous would have been if he was wearing sunglasses. Luckily he wasn't badly hurt, and as one of the police that attended commented, "Nice camouflage".

Anyone remember "Be Safe, Be Seen"?

From today I have over a week off work, what I would normally do is sit around on my backside 'relaxing', only to be completely surprised by the bucket of cold water to the face that is a sudden return to work.
There are a couple of things that I will definitely be doing, I will certainly be giving my flat its long overdue 'Spring Clean', as I think the approaching Autumn is giving me a less than subtle hint that it really should be done. Likewise I'll be blogging all those other things that I gave you the chance to vote for a couple of days ago.

Another thing that I should be doing, is working on a few projects that I have been thinking about, the "Rough Lives Through A Rough Lens" (Pictures on my mobile phone of drunks I've picked up), 'You Have Cost Us' business cards (Cards I want printed that explain exactly how they have misused the ambulance service, to be slipped into the pockets of drunks), and a redesign of the website.

I keep thinking about doing things, joining a gym, learning a totally new skill and reading a few of those books that I have sitting around the flat. I thought that my recent health-scare would have given me a new-found lust for life, but instead I have settled into the same old patterns. The recent loss of a workmate has again made me think that I'm wasting the life I have. I have good health, I'm still fairly young, and yet outside of work I feel that haven't done as much 'living' as I should.

Perhaps it's just jealousy of the lifestyles of other bloggers?

So are there any suggestions as to what I can do/see in and around London. I feel that I should be doing something. Any hints on how to give my life outside of work a kick up the arse?

The London Ambulance service doesn't just deal with emergency calls to people's houses, we also do hospital transfers, patients who go from hospital to hospital because the original hospital hasn't the expertise to deal with that person's medical problems. An example of this would be the transfer I recently did from Newham to the Royal London because Newham's CT scanner is broken, and the patient needed an emergency scan.

One of the regular places that we find ourselves transferring people to is St Joseph's Hospice, or as we call it "Holy Joe's". Sometimes we will be picking up patients from one of the nearby hospitals, sometimes from the patients own home. It's one of those jobs most of us don't mind doing. The patients are, by definition of needing hospice treatment, actually sick - and we aren't so hard hearted that we would begrudge an ambulance to someone who is ill. Then there is Holy Joe's itself...

Holy Joe's is a religious place, it used to be run by nuns, but now they are a bit few and far between. To be honest I saw my first nun there yesterday, and she was picking her nose... But, you walk into the place, and it just seems nice, it is clean, the staff are all friendly, the patients all seem happy and there is a really good social atmosphere there. I don't know if it is because of it's ties to the religious orders (I hate all religions, but the best nursing homes always seem to have nuns running the place), but the hospice just seems to exude calm.

My crew-mate and I had just transfered a terminally ill patient into Holy Joe's and were having a cup of tea in their tea bar (hot drinks are free to the LAS, another reason to love Holy Joe's), sitting in this clean comfortable area, we were watching the patients chat with relatives, staff and other patients, giving the place a real friendly atmosphere quite unlike anywhere in the NHS. It is very rare to see a doctor sitting down with a patient, chatting about nothing in particular, and having a cup of tea together. We both agreed that this has got to be one of the better places to see out the end of your days, and that it is a real shame that there aren't more places like this.

It is a shame that in this increasingly 'technical/evidence based/audit/professional development/governmental targets' style of health service, we seem to have forgotten that sometimes we simply, and honestly, need to care.

Many thanks for all the condolences in comments and sent privately in respect of our colleague who died on Tuesday, they are all appreciated. His family has decided to have a Service funeral, which has pleased a lot of the staff here, because it lets them do 'something' to help out the family, even if only as part of a parade of remembrance.