A little while ago it seemed that every other shift I would be working with HEMS. Either RTAs, people falling through their ceilings or babies getting scalded.

The Doctor on HEMS at the time was a very nice Doctor, and after one job which we transported to the Royal London by road - she offered us the opportunity to visit the HEMS flightdeck.

While I was up there, I took this jerky smartphone video of the helicopter and the surrounding view.

I don't often get the chance to take videos or pictures of the jobs I go on (it often doesn't seem right, and I'm normally a bit busy) but in this case it seemed like the right thing to do. As you can see, the view is lovely - and were it not so overcast I imagine that on a quiet day you could get quite a suntan up there.

(If you are quick, you can just see the back of my old crewmates head as he disappears behind the helicopter).

So far the calls that I have gone to on the RRU have been the normal run-of-the-mill things that I go to when I'm working on an ambulance. I've had a couple of Diarrhoea & Vomiting (but then recently everyone has had at least a couple of Diarrhoea & Vomiting). I've had people who get confused between their abdomen and their chest - so I've been going to people with constipation who have described their pain as 'Chest pain', thus making it a high priority call. I've also been going to all manner of illness typified by 'difficulty in breathing', in which there is no difficulty at all, more like a blocked nose.

Add to this the normal 'hot children', and you can see I've been on fairly familiar ground.

There have been one or two jobs of interest - one was a gentleman who was having an Anterior Myocardial Infarction (heart attack) while he was sitting in front of me. Thankfully the ambulance was pretty close behind me, so I had just enough time to get a history and start giving some oxygen before they turned up. They did a 12 lead ECG on the back of the ambulance and this confirmed the MI.

I went to a job the night before last that was a nightmare in an organisational way, still at least it wasn't a medical emergency.

I got sent to 124 Berry Road (not the real address) for a 'Severe difficulty in breathing', but when I turned up there was another RRU outside the address knocking on the door. I checked with the other RRU, and he was having trouble getting anyone to open the door - but didn't need my help, so I started to head back to the station.

Then I got a call on the phone that the patient had given the wrong address, and was in fact at number 128, so I headed back to make sure the other RRU knew.

As I pulled up outside the new address a woman came out of number 130, and beckoned me inside - thinking that there was still a communication failure I entered, and looked for the other RRU.

Except he wasn't there - he was in number 128 with his patient, and I had stumbled across a completely different case. This patient had stomach pains and diarrhoea.

Eventually everyone who needed an ambulance got one - but it just goes to show how confusing it is when neighbours call ambulances independently of each other at 3am in the morning.

Neither of the patients actually warranted an ambulance, but neither drove, and they didn't think to call a minicab

I've also been climbing over 7ft gates to get to heroin users who had painful injection sites.

I love my job.

I now have three days off before beginning a set of four day shifts (06:30 ? 18:30). I shall be spending part of it in "World of Warcraft".

European servers, 'Earthen Ring' Realm, with a character rather imaginatively called 'Reynolds'.

It turns out that Newham General Hospital had at least 70 people through their doors concerning the food poisoning epidemic. Some patients also had gone to King George's hospital or to Whipps Cross hospital, which, if you add in the number of people who are suffering in silence at home makes a lot of rather sick people

The kebab place has duly been closed and the various public/environmental health bodies are looking closely at the situation. I have heard an unconfirmed rumour that the cause of the sickness was due to Salmonella

At least one person is very ill, and at least eight people were admitted to Newham hospital. This has stretched the resources in the area to near breaking point, Newham hospital and King George's hospital were both closed on Sunday night because the A&Es were full, and there were no beds left in the hospital. It got so bad that Newham hospital declared an internal "major incident" a wise choice I think, as it means that the resources needed to deal with the situation are pointed in the right direction.

Unfortunately, with our local hospitals closed, patients have needed to go further to get to a hospital. Some are quite happy, such as those who get taken to the Royal London (remember, in most people's eyes the Royal London is the hospital to go to. Meanwhile others have been less happy (such as those who have been taken to Whipps Cross

It is my belief that a terrorist network doesn't need bombs to bring London to it's knees, it just needs to spread a little Salmonella around, and then watch the NHS collapse

My first shift 'on the car' went fairly well - there are lots of things that are different between the car and working on a truck that I think you may be interested reading about, which means I'll have a series of postings about RU work to write about when I next get some days off.

While others were dealing with stabbings and shootings (at least two in the area last night) I, who is supposed to go to the most serious calls, had two patients who actually needed hospital treatment, a crying baby, and 5 cases of 'D&V' (Diarrhea and vomiting). I was not alone in dealing with this sudden increase of D&V, Newham hospital was very busy with an epidemic of similar illness, and it seemed that crews were persuading a lot of them to stay at home and nurse themselves..

If you live in the area I work then I'd stay away from the Kebab shops in Romford road (Manor park end) if I were you, as at least twelve cases were tied to one kebab shop, with perhaps as many as twenty seven people eventually falling ill with the same symptoms after eating from the same shop.

Now...can I name the shop involved? Legally and ethically, am I on firm ground?

Maybe I should study journalism at night school...

The other cases were all fairly simple, although at one job I had to wait over an hour for an ambulance to turn up - I was stuck in a house where the only person who spoke any English was a 4 year old child. Not normally a problem, but there was some uncomfortable silences. Still, the family understood that we were really busy and were all very nice - offering cups of tea and little snacks, which is something no-one has ever done for me while working on an ambulance.

I may have something more interesting tomorrow, but for the first night it was really pleasant to be eased into this entirely new way of working.

Now to sleep...

So after some time (arranging things with work, battering my computer into submission and have a day of doing nothing except "chilling out") I think I an finally reveal the 'big secret' that I have been using to keep you coming back to read this blog...

I'm still in the London Ambulance Service, and I've not been promoted - however the vehicle that I drive, and the role that I play will change.

I'm no longer going to be driving one of these... Or even one of these...








But one of these...

For the foreseeable future I am going to be on the Rapid Response Unit.

The role of the RRU is to get to emergency calls within eight minutes, thereby pleasing the government, and by extension, pleasing management.

I am to get to calls as quickly as possible, get a history off a patient and start treatment until an ambulance can arrive - I then leave the patient in the care of the ambulance crew and drive off looking for another emergency call. When I don't have a call to go on, I am to spend at least some time driving around the area in the hopes that I will be closer than an ambulance when a call does come in.

This means I have even more autonomy than working on an ambulance, because I am working on my own - there is no crewmate to bounce ideas off. There is also a better chance of things going horribly wrong - imagine having to deal with a cardiac arrest on your own, with distraught relatives knowing that there isn't going to be an ambulance for 30 minutes...

Still - it should be fun, especially considering that I'm starting this new rota with a Friday, Saturday, Sunday night.

Today was typical, in that the jobs we did veered from interesting to dull, and from heartwarming to heartbreaking.

As an example of how one job can be different from another, we found ourselves attending an elderly man who was looked after by his daughter and son-in-law. They lived in Portugal, but when he had became ill they had moved back to England to look after him. The house was spotlessly clean, as was our patient, there was real love in the house, and they obviously cared deeply for him. He was generally a bit poorly after a fall earlier in the day, so we took him to hospital for a check-up. Straight after that job, we ended up going to a pair of alcoholics living in squalor, where one of the pair had fallen over while drunk and had cut their ear. The patient later said that his partner had punched him, and that is why he had a cut ear, that and she had also kicked him in the stomach.

This is the fun bit of this job, we go from loving families to quarrelling drunken couples.

We had a bit of a 'trauma' with a victim of a hit and run. The patient was crossing the road, when he got hit by a car, bounced up onto the bonnet and ended up in the middle of the road. Luckily he wasn't hurt in a life threatening way, but he did have a broken arm (for the medics in the audience, or those who can use Google, the patient had a simple transverse fracture of the mid-shaft humerus). He didn't have any other injuries - which in my book makes him rather lucky, especially considering the speed that cars can get up to down that particular road.

What was particularly interesting was that, although the man was laying in the middle of the very busy road, only a bus, and one bystander had stopped, the bystander was making sure that he didn't get hit by any other cars. People were so unbothered that at one point I had buses rushing past my head as I treated him. You'd think people might slow their driving a little when swerving around an ambulance parked in the middle of the road with all it's lights flashing...

But not around here they don't.

We also went to a 'Fire job', where a mother had left a 7 year old, a 5 year old and a 2 year old locked alone in a house while she popped out for some fruit. A small fire had started, and the children had only been saved when a neighbour walked past and saw the kids crying at the window, and the orange flicker of flames in the background. He broke the window and saved the children. The mother was, perhaps unsurprisingly, distraught. A moment of carelessness nearly cost her children their lives. The quick thinking of the neighbour had meant that the children were completely unharmed, so I hope he gets a nice write up in the local papers.

The final job of the day was to a 'nursing' home - the patient had apparently developed a bony lump under her hip. The staff thought that she may have broken her hip - but as the patient is bed-bound, and no-one admitted dropping her it would be a very suspicious fracture. I had a look at the supposed 'fracture' and couldn't see anything unusual, the patient was just extremely frail. The patient was suffering from dementia, and when I examined her properly, was also rather dehydrated. So we took her into hospital - along with a 'carer' from the home. All throughout the transport the patient was scared, so I did my best to look after her, hold her hand, talk to her - that sort of thing. During this the 'carer' stared out the window of the ambulance and didn't say a word apart from worrying that she would have trouble being relieved when her shift was finished.

When we left the patient at the hospital I told the 'carer' (can you see why I put 'carer' in quotes?) that her job now was to "hold her hand, talk to her and reassure her because she would be scared in this unusual place. In fact it gives you a chance to do that caring thing that you don't have time to do normally".

I think she knew I was a bit angry at her - but she did as I said, so maybe she got the point.

Another 12 hour shift tomorrow - then (hopefully) I'll have a day or two off, when I can sleep and perhaps manage to fix my laptop.

If the above post doesn't make any sense then tough, I'm knackered and all the Red Bull in the world can't make me into a Hemingway.

Todays functioning is brought to you by...



CAFFEINE.

Actually, the majority of the NHS is fueled by caffeine and chocolate. This is why there are no old ambulance crews.

Lack of sleep is not a good thing, especially when you are trying to (*cough*) save lives. Therefore insomnia caused by worrying about a potentially corrupt 'SVCHOST.EXE' file may impact how I deal with people.

So it's a good job I was driving today. It's also a good job that no idiot decided to pick today to leap out in front of the big yellow truck with blue flashy lights that was making loud warbling sounds.

However, things that will cheer me up include finally getting a CTU (from TV's '24') ringtone working on my phone.

I also found out that the world is indeed a small place because I read about a R&B star on Warren Ellis' site, who decided to pluck out an eye, only to then turn around in my chair and chat with the crew who took him to hospital.

I could give you the inside gossip, but it'd be breaching patient confidentiality, a big No-no. But I can tell you that no-one around here knew who he was. All the other information/pictures are in the public domain.

However my day was made so much better because my 'secret plan' has unfolded, and I will start my new role on Monday.

But for now, the ability to form coherent sentences is leaving me. I must sleep - I have another 12 hour shift tomorrow.

For the first time today, the people of East London have decided that they don't need an ambulance, so I can quickly write an entry while supping a cup of tea.

I turned up to work today, only to find a poster in our station telling us that if we manage to reach 90% of priority calls within 8 minutes, then two Team leaders will come and wash the cars of those on duty on that day.

This leads to two questions - first, just how desperate are management to get our response rates up, and secondly, shouldn't Team Leaders have better things to do with their time than washing our cars?

Although I do admire their attempt to 'think outside the box'

The eight minute respone time is the main gauge of our success dictated to us via the government, this is called the ORCON time. As far as anyone knows, the eight minutes has no obvious basis in clinical practice - the best guess anyone can come up with is that the government considered it a good time because that is how long they have to vote when the Division Bell rings.

At the moment the complex is reaching around 68% of all these calls within 8 minutes - the only problem is that it is supposed to be 75%. This is considered Not Good, and so there is a rush to try and get that percentage up. As part of that plan we have these incentives, and a number of Rapid Response Cars have been funded across the area. The RRU's are supposed to get to a job in under 8 minutes - then if the patient is seriously ill provide immediate treatment, if the patient isn't ill, then there is little for the RRU to do.

If we get 75% or more, then we get more funding, if we get less... Well we get less funding.

Today I can tell you that the ORCON percentage is probably below the required 75%, because throughout the day our Dispatchers have been putting out general broadcasts for ambulances - so there have been more jobs than there are free ambulances.

This is the problem - we, as ambulance crews, don't hang about and dawdle to our emergency calls, we genuinely try to get to these calls as quickly as possible. But given traffic conditions, the size of our area, the actual lack of ambulances (and the staff to crew them), there is little we can do to improve the times.

I mean, if we drove any faster, we'd probably have half the fleet off the road being repaired after crashing into other road users.