On the way back from London I met Lee*. 

Lee thought that it was ‘cool’ to…

     …Get drunk on Strongbow and White Lightning.

     …Overdose on Heroin.

      …Fixate on Kurt Cobain.

     …and stick silly, and unattractive, amounts of metal through his face.

In fact Lee actually wanted to die young.  Preferably of a heroin overdose.

I spent a very enjoyable tube journey telling him exactly what us LAS do to twits like him.

I even demonstrated a proper sternal rub.  He couldn’t stand five seconds of it…

With idiot kids like him, is it any wonder we are fighting a losing battle?

Well, at least he and his friends, did entertain me on the tube back from the centre of town.

And he did promise to phone me when he was drunk…

I suspect he might reconsider if he reads the rest of this blog….

 

*Lee is his real name – I wasn’t on duty, so who cares about confidentiality and anonymity.

Not in the pub at all. Honest.

It started off as “hit with a broomstick”, but ended up resembling a cross between a riot and a carnival.

A small road, perhaps 20 households, down on the isle of dogs.  A family feud had finally spilled over into violence, one woman had been hit with a plastic broom, another had hurt her leg, a 10 year old had brandished a knife.

One of the injured parties had knocked on every front door in sight looking for witnesses, so there were around 50 people (mainly children) milling around.  It was a beautiful day, and people were enjoying the spectacle in the afternoon sun.  Children were running around, ice creams were being sold, and teenagers were staring at the scene, smoking and snogging and getting in the way.

The police had come in a van, and no-one was listening to what they said.  They couldn’t arrest the 10 year old, there were no witnesses, the child was under age, and yes, if he had stabbed someone then they could arrest him.

There were half a dozen languages being spoken, and people were angry that the police and I aren’t fluent in Urdu, Hindi, Somali, Turkish and Twi.  they didn’t realise that running up to a policeman, waving their hands around and shouting what sounded to me like gibberish, when there is someone who can translate standing next to you isn’t the best way to go about things.

“She hit me”, “All three of them hit me”, “I was kicked”, “I have a broken leg” (No…you don’t), “My mum is going to have a heart attack”, “I want them arrested”, “I want this written down”, “It’s been going on for ages, why haven’t you done something?”, “Why are we waiting so long for the ambulance?”, “What are you going to do about them?”, “My mother has fainted”, “My leg is still broken”.

I suggested that the police get the riot squad down.  A good idea, but they were all on day release having a picnic.

The police were starting to lose their temper, no-one was listening, no-one cared for what the police could or couldn’t do, they just wanted the attackers punished, locked up, or evicted.

People started to filter away when they realised that no-one was going to get handcuffed and thrown in the police van.

I finally managed to get to one of the ‘patients’.  Her family were pouring water over her head.  There is a ‘section of the community that believes that water being poured over the afflicted area will help, so I get sent to people with difficulty in breathing who are being soaked with flannels, and chest pains that are dripping wet.

I’m used to strange beliefs, my mother thinks inanimate objects have feelings…

The water was running clear from her head, no blood.  No loss of consciousness either.  Looking at the ‘broomstick’, a light plastic pole, I’d be surprised if it even left a bruise.

The ambulances came, crews looking confused as I gave them the shortest version of the respective stories I could come up with.

The other ‘patient’ was complaining of a broken leg.  She was still convinced she had a broken leg as she climbed up the steps into the ambulance.

Two patients, two different hospitals (we like to keep people separated in cases like this), and half a dozen police officers.

Slowly the street returned to normal and I settled down next to the Thames to do double the normal paperwork.

“No obvious serious injury”.

Fuck.

Stupid, stupid, stupid judges.You have just made any form of information transfer potentially illegal.

Just wait for some other countries to take advantage and economically crush the US tech business.

If not the next war, but the war after it will be fought because the US doesn’t like their enemy’s ‘lapse’ copyright laws.

Now watch the entertainment companies persuade British companies that the American route is the way to go.

Other things that could be rendered illegal?  TCP/IP, Video recorders, Camcorders, Tape recorders, Ethernet, WiFi, Pen and paper…

Lets see how many lawsuits the RIAA throws around.

See you all in the dark ages.

Got interviewed by the BBC today (Health online website).  At the end of the phonecall I was asked if I had a photo of myself I could send.

Well bugger me if I don’t look like a complete pillock in all the photographs of me I own.

And everything on Flickr that is tagged with my name has me looking drunk.

Perhaps I should get a cool photographer to take some portrait shots?  After all, I’ll need one for the back cover of my first book.

In different topic, tomorrow I shall be at the NMK seminar – if you are there, feel free to wave at me.  I’m still tryng to work out why I’m going, I suppose that it seemed like a good idea at the time.

So…

“Da Boss”, Peter Bradley CBE, Chief Executive of the London Ambulance Service also moonlights as the governments ambulance advisor.  As part of this new role he has created a report on the future of the ambulance service.  This report will be published on Thursday, although a couple of his ideas have already been released to the public (the use of ECPs and the changing balance of vehicles).

ECPs are ‘Emergency Care Practitioners’, paramedics specially trained in treating minor injuries.

Mr Bradley is strangely respected by the road crews of the LAS – and I say ‘strangely’ because we tend to be dismissive of anyone who works in an office.  Middle management tends to be disliked by everyone, and upper management is seen as having lost touch with the job as it is today.  But Mr Bradley commands a great deal of respect amongst the troops.  From people who have spoken to him I hear that he is indeed a fair, and forward thinking boss, something that I think we need.

Once I get my hands on the report I’ll do a full breakdown of it, but until then, here are my thoughts on what the media has been reporting.

First off, there is no way the ambulance service can continue in the current way of working.  The number of people using the service are rising, and while the ambulance service was originally for emergency calls, our area of expertise has had to be expanded in order to fulfil the wishes of our clients.

In plain language, we deal with a lot more ‘crap’ jobs.  Because of all these crap jobs, we soon won’t be able to cope.

We have tried to educate the public about the correct use of ambulances, and the NHS has provided other sources of patient information and treatment, like pushing for pharmacists to provide more advice, the creation of NHS Direct, and more ‘Walk-in centres’.  Unfortunately, this hasn’t helped much, and the change in the working hours of GPs has only increased the workload for ambulance services countrywide.

In other words, no matter how many times we tell people we aren’t a taxi service, and give them other ways to get treatment, they still want a ride to A&E in a big white taxi.  GPs refusing to work during the hours of darkness (or hours when the golf course is open) hasn’t helped us much either.

So, the ambulance service needs to think smarter, rather than throw resources at the problem.

We surrender.  The public are too daft to be told.

The plan is simple, we bring treatment to the patient, rather than bringing the patient to the treatment.  A&Es are busy places, and there are a lot of patients who can safely and effectively be treated at home.  Other patients will be advised of other, more appropriate, avenues of treatment.

Taking everyone to A&E only increases hospital waiting times, which are no good for anyone (let alone government targets), so why can’t we treat things like minor wounds at home?  We should also be able to tell people with a runny nose that they need tissues, not an A&E department. (We do at the moment, but the service doesn’t currently support us doing this).

The ambulance personnel that will undertake these roles will have to have extra training.

Here is the problem, it’s all good until someone gets left at home and then dies.  Training will have to be pretty intense, and that will cost money, and take time – there will also have to be some serious support for people acting in this extended role.  When every job could ‘go bent’, I imagine the stress will be pretty big.

The salaries of those trained will have to increase.

Because a majority of calls to ambulance services are not life-threatening emergencies (my opinion only), the balance of solo responders (like myself) will increase, while the number of ‘proper’ double crewed ambulances will drop.  Of course, if these extended role practitioners feel the need for a patient to go to hospital, if appropriate they may transport the patient themselves.  (This is why all new ‘Rapid Response Units’ are going to be people carriers).

This is really brave.  With enough ECPs I think that this will work.  But I wouldn’t like to work in the PR department the first time the Daily Mail has the headline “Ambulance chiefs send car to dying wife”.  Also with more people turning up alone to calls, I suspect that there will be more and more risk of ambulance personnel being assaulted.

The plan is to send these rapid responders to more calls, so as to filter out and treat those people who do not warrent an ambulance.  Then ‘proper’ ambulances will be reserved for the most serious cases.

My personal opinion of what I’ve heard?  I think it’s a bold, yet very clever idea – and I hope that it will work.  I think that success will depend on the details, like what the training is like, and I hope that the government doesn’t water down the ideas.  We will also need some serious thought going into treatment guidelines and protocols in order to protect the registration of paramedics.

At the end of the day – we are cheaper than GPs, we work 24/7, unlike district nurses, community psychiatric nurses and GPs.  It is up to the ambulance service to pick up the shortfall in care that this leads to, and ‘Da Boss’ is thinking ‘outside the box’ to solve this situation.

I’ll write more once I’ve read the report.

One of these is a London Ambulance.  One is Thunderbird 4.

So, I was at the RRU meeting yesterday, where we talked about response times, the future of the ambulance service and the new piece of equipment us RRU people are getting.

I'm not working for the next couple of days, so I'll spread these subjects out over the next few posts.

(It'll give me something to do in between wallpapering my new place).

The RRU cars are all getting a new piece of equipment, a propaq monitoring device.

They measure blood pressure, oxygen saturation, pulse, respiration, ECG, and end-tidal CO2.

They weigh a lot. They also come in their own shoulder-strap bag.

At the moment we can measure blood pressure, oxygen saturation, pulse, respiration and ECG. We can't measure end-tidal CO2, but it is incredibly rare that we would need to. Ambulances, as opposed to RRUs can monitor end-tidal CO2.

The equipment we are using at the moment is lightweight, and fits in one hand (or our primary response pack).

Cost per unit for the Propaq? £9,000 each. (That is a discount because we are buying in bulk)

Cost for the kit we are using now? £320 (roughly).

Number of RRUs in service? 60.

Total cost for this new equipment that we really don't need? £540,000

Yes. Over half a million pounds for a bit of kit that is heavier, more fragile, more expensive to replace and does essentially what we can do right now.

I suspect that there is someone high up in management who. much like the Blair government, thinks that throwing I.T. at things will make life better.

I think I'll stick to manual blood pressure measurement, and an oxygen monitor that is the size of a box of matches.

Oh, and some bright spark has made them cut off the carrying handle, so that it wouldn't be so heavy...

I’ve just come from a management meeting about changes and suggestions for the Rapid Response Car.  Given that I now want to stab things, I think I’ll wait until tomorrow before letting you know what was discussed…It is, in part about this report.

Loads of people have asked me about the recent UK news items about the response times of various ambulances.  Essentially the BBC investigation suggests that ambulances that should respond to “Category A” (high priority) calls within 8 minutes, are only doing so because trusts fiddle the numbers.

Note: I am not a Dispatcher, and have only spent a few hours up there – if anyone in Control wants to correct anything I write below, just let me know.

I’ve mentioned this before, but for any new readers…

“Cat A” calls are the highest priority calls, and from the time of activation we have 8 minutes to get to the patient.  There is absolutely no medical reason why it is 8 minutes, and although it is often mentioned as he maximum time that someone can survive with a stopped heart, the actual number is actually closer to 6 minutes.

The story is that different ambulance trusts start the clock a different times, so that they have more time to get to a call.  You can read more about it here, and listen (for the next couple of days) to a radio discussion about it here (MP3).

What has amazed many in the ambulance services is that the Staffordshire trust is being held up as the ‘golden child’, when it has been widely believed that they fiddle the figures more than anyone else…  (Just a rumour, I’m not suggesting that it’s true, please don’t sue/sack me)

The government, whose bright idea this is, tells us that the clock should start when the calltaker has,

a) The name of the patient (or caller).

b) The complaint or injury (enough detail to know how serious it is)

c) The location the ambulance needs to go to.

Rather reasonable I think.

The problem is that some trusts have been starting the clock later (apparently).

There is a crazy idea that the London Ambulance Service has a delay of minutes when dealing with calls.  Well I can only see the times when the phone is picked up, and when the clock starts.  The times are often around a minute apart.  Sometimes it is longer, and that is because of the problems that the LAS has due to the size and makeup of our patient population.  One of our calltakers has posted a comment, and it’s pretty much as I expected. 

The problems are…

a) Only 1 in 6 callers has English as a primary language.

b) People dial 999 shout “I want an ambulance” down the phone and hang up.

c) People with mental health problems will ring up for a chat, and calltakers can’t hang up the phone on them.

d) People don’t know the address that they want the ambulance sent to.  Our computer mapping system isn’t brilliant and pretty much requires a postcode.

e) People who keep talking, but don’t answer the questions the calltaker asks.

When I spent a couple of hours up there once, none of the calls I listened to were easy to understand…

Do I think that we ‘fiddle’ the numbers?  Well – back in the good old days before we had the computer dispatch and all the times were taken from your paperwork, then we could use the ‘magic pen’ to knock a minute or two off the times.  Now we can’t fiddle the times, as they are all collected, to the nearest second, by the computer system.

Does getting to 75% of all calls within 8 minutes help patient outcome?  Well no, except in a very few cases.  Remember, if I get to a dead body in 7 minutes that is a ‘success’, while If I get to someone and save their life in 9 minutes, then its a ‘failure’.

Do Trusts ‘fiddle’ the numbers?  Possibly.  Do they wait four or five minutes before starting the clock?  Probably not, and almost certainly not in London.

Was the radio piece biased?  Oh yes…

Maybe more later, check on the comments – but I desperately need some sleep.

A couple of people have asked me to comment on the whole "delayed times" for activating ambulances that is in the news here in sunny England.

I'll write a proper piece on it when I get home, and can give it some proper thought.

If there is anyone in Control/CAC who wants to let me know their opinion, then feel free to drop me a line in the comments, or via email.

Confidentiality will be observed.

Well Stroppycow was closest in answering how I got a small bruise on my left knee. The small grey thing that you can see in the photo is the control unit for the sat-nav system. It's placed just where I brace my knee when I go around a corner a bit fast, so that I don't slide all around the seat.

Thanks to those of you who suggested that I might have gotten it because of having wild (and weird) sex with nurses. Sorry to disappoint, but even if I were having sex, sex with me tends not to leave bruising... Just satisfaction.

(Well I'm normally satisfied...)

I do get an injury from carrying my huge and heavy response bag, but it tends to be bruising on the shoulder from where the strap rubs, or wrenching of the odd muscle from catching it on someones radiator.

I think that when the fitters are done checking my tyre changing work, I'll see if I can head down to the computer people to get the handset moved.

This time it isn't my fault. I was a slow leak, rather than me mounting the kerb a bit too vigorously.

I heard a "flapflapflap" sound coming from the car, but I thought that I needed something to eat first. So I pulled up outside McDonalds and two community police officers pointed out the flat tyre.

The plan is that we are supposed to wait around until the RAC come out and change the tyre. Unfortunately they would be between 3 and 4 hours in coming.

So I got my hands dirty and changed the tyre myself. If you were in the Stratford area this morning you may have seen me scrabbling around on the floor trying to work out how to use the car jack.

I changed the tyre, but I don't trust my hand tightened nuts to hold together when I screech round corners. So I am now sitting on station while our fitters change and check the tyre.

For some reason the phrase "I need to get my hand tightened nuts checked" made the women in Control laugh.

I have a bruise.

It is on the outer edge of my left knee.

I have gotten it via work-related activities.

It is about half an inch large.

I don't think that it will heal while I am in my current role.

Put your guesses as to what it is/how I got it in the comments box, I'll let you know in my next post.

I went to a sick kid in a local school today (not particularly ill, easy job, nothing of note). When I was walking out there was a display on the wall that gave definitions of different belief systems. For example there was Nilhilism, Materialism and Animist. However I did find it worrying that they defined Fascism as "A far right wing government that is sexist or racist".

Tut-tut.

Still it doesn't surprise me, my brother is forced to teach falsehoods purely because it is in the National Curriculum.

"Male, cut to arm, threatening to slice up neighbour, known psychiatric patient, wants London Fire Brigade for fun"

That is how the job came down the computer terminal to me. Now, normally I'm not too bothered about going into potentially dangerous situations (I can run really fast if someone is chasing me), but this job rang warning bells.

1) He has a cut to his arm, did he do it himself? If he did do it himself, then he'll probably still have the knife.

2) Why does he want to 'slice up' his neighbour? Is he angry with them? Neighbour arguments tend to be rather nasty.

3) What is his psychiatric history? Does he have a history of violence? Does he have a pathological hatred of the colour green? (Our uniforms are green...)

So I decided that for this job I would wait for the police to arrive.

So I'm sitting in my car around the corner, there is an ambulance with me, and we are waiting for the police to come and protect us.

So my mind starts to wander. How bad is the cut to his arm? He could be laying on the floor bleeding to death if an artery has been cut. What about the neighbour? In the time I'm waiting, has he stabbed them? When I finally go around there, will I come across a bloodbath?

I consider having a look myself, I have a stabproof vest, but my arms, legs and head are still vulnerable to having 8 inches of sharp metal shoved into them. If I did go around and get stabbed there are two things that would happen,

(a) I wouldn't get any attention until after the police turned up.

(b) I also wouldn't get any sympathy from work as they've already told me not to go near the place.

So we sit there, members of the public stare at us, and I try to chill out by listening to the latest Coldplay album (verdict: rather good actually).

Why haven't the fire service turned up yet? He did ask for them, and I'm sure they, like us, can't refuse a call.

They never turned up though.

The police turn up, we go around to the address, and the patient is as nice as they come. He'd been (allegedly) pushed over by the neighbour, and had a graze to his arm.

So while I could have completed the job in minutes, to do so safely took a lot longer.

This is the sort of thing we have to think about as we go to each and every job. And that's just sad.


With the exception of the slashing job yesterday, all these 'Knife Time' posts took place during one day.