Here is a fragment of an e-mail I received the other day. It makes me more than happy to have released the book under a CC license.

I'm an occasional reader of your blog and have just
downloaded the CC version of your book (I would've
bought the book itself but I'm in Nigeria at the
moment and Amazon refuse to deliver here - can't think
why!).

How superb is that?

I'm feeling better now, thanks for all your kind words. For some reason I got a load of 'flu-like' symptoms for 48 hours, aching joints, lack of sleep, headache the whole nine yards. Maybe it was some nasty mouth bacteria that got into my tooth-hole. The worst thing was that I had to cancel a day with Laura. Something that made me feel even more wretched.

There is a secret(ish) forum for as ambulance staff, one of the people there posted this, while slightly tongue in cheek I thought that it would be shamefully wasted if it stayed on the forum. I reproduce it here for your reading pleasure. Send happy thoughts and wishes of quiet nightshifts to 'The Saint' who originally wrote this.

Would all helpful passers by please note:

If you really must ring for an ambulance for someone you see collapsed/dead/fitting/sat in a shop doorway, please ring then, and not three hours later, by which time – not surprisingly – the deceased has got up and left.

Two adult males sitting outside South Kensington tube station, sharing a bottle of Diamond White cider are NOT collapsed – they are having breakfast/dinner/lunch/a party. Singing, talking, vomiting and belching are all indications that the said males are alive.

Someone who is sitting in a shop doorway when it’s pissing with rain is SHELTERING, not collapsed.

Just because someone with crutches is sitting down, they are not necessarily in need of medical intervention. Having hospital crutches is a clue. They have already been to hospital, and have been discharged.

If you really feel you just have to interfere in the life of a person happily sitting there drinking himself into alcoholic oblivion, when you ask him if he needs an ambulance, please take it as a massive clue when he says “Faaaaaaaaarrrrrrkkkkkk Ovvvvvvvvvvv!!!!!” This is his little way of saying “Thank you for your concern, but I’m fine.”

When someone tells you they are fine, and they do not want an ambulance, please, please, please believe them. They are NOT lying – they know what they are doing.

Someone who is staggering between point A and point B CAN walk. The helpful clue is the movement of the legs and feet. If someone tells you that they cannot walk, but their legs are moving, THEY ARE LYING. Don’t believe them.

Green stuff coming from a drunks’ nose is NOT a reason for an emergency ambulance – it is actually a reason for an emergency hankie. Green stuff emanating from the patient’s nose is very rarely Cerebro-Spinal Fluid, despite what you might have learnt from Casualty, ER and Holby City. It is SNOT.

If you see a pair of legs under a car, and the legs are surrounded by mechanic’s tools, the person under the car has NOT been run over – he is more than likely to be FIXING it. Other clues are the radio playing nearby, and the deceased singing along to the music.

Talking of cars, if you happen to see several cars colliding with each other, and you can’t get through to the ambulance service, have a look around you. Yes, the other twenty people with phones stuck to their ears are ALL calling the ambulance service. That’s why you can’t get through. And please tell us the right location – saying you are on Greenford Broadway when you are on Southall Broadway is less than helpful. And please don’t insist you are right and the other twenty callers are wrong – it is highly unlikely.

Oh – and – please do not call the ambulance service if you see 200 people fighting on Fulham Broadway on Friday night. We are not remotely interested, and will not become interested until the police arrive. The police have guns, batons and CS gas, and can deal with a large fight a lot better than two female LAS personnel who are five feet nothing and jointly weigh 12 stone, and are only armed with rubber gloves and a frothy cappuccino from the Wild Bean Cafe. Please ring the police first – we’ll pop along a bit later. Honestly. We will.

Finally – the dictionary meaning of the phrase “passer by” is “A person who happens to be walking past someone or something.” It does not say “A person who stops and interferes. Don't do it Mate - it's not worth it!!

(I'm horribly ill at the moment, so this is also a cheating way of posting without much work on my part).

This is my tooth after being torn from my jaw by my Finnish dentist. I bravely laughed at the huge pair of pliers she used. Born from my head amidst a lot of tugging and a rather horrible splintering noise coming from my jaw. If you look closely you can see a bit of jawbone still attached. At one point the dental nurse whispered a quiet, "Wow".

Afterwards she asked me to blow out my nose while she held it shut - I think it was to make sure that she hadn't tunnelled through my head. with her accent, my ears and her facemask I was convinced she was telling me that she was going to, "break my nose".

I considered this a little harsh.

I'm now left with a huge, slimy, blood oozing hole in my mouth. The local anaesthetic is starting to wear off.

I must have some painkillers around here somewhere...

The dentist did look a bit strangely at me when I asked if I could keep the tooth - I thought it best that I didn't mention I was going to put a photo of it up on the internet.

I'm sitting in my dentist's office, waiting to have one of my teeth pulled out.

This is something that is planned and I'm, rather strangely, looking forward to it.

...and no, I don't have a fetish for dentists.

-=-=-=-=-
Sent from a mobile phone, probably from the cab of an ambulance from a dentist's office.
-=-=-=-=-

9010 is our code for 'Assist only, not transported'.

It's a grey, horrible day. There is a constant drizzle of rain and when I got in my car to come to work it was so humid everything I touched was sticky.

Our first call of the day was to an elderly female who was believed to have had a CVA, a CVA is another word for a stoke. It's never a nice job, so my heart sank*

We arrived to find the patient sitting in her living room chair, also present were her friends (who have a front door key) and a carer who was preparing breakfast. The patient was *lovely*, she was sorry to have called us out and was, as is common with our older patients, worried that she was wasting our time.

She hadn't had a stroke, instead she had been unable to get out of bed, and so had crawled onto her landing on hands and knees in order to get some help. Her bed had recently been changed after being discharged from hospital a week ago and the rails that she used to get out of bed had been left leaning against the wall.

So my crewmate and I fitted her bedrails. Then we made sure that she could get into and out of bed. I then checked her physically to make sure that she wasn't hurt in any way. We then had a nice little chat, flirted with each other a bit and then, because the patient didn't want to go back to hospital, left her with her carer.

Throughout this call the patient was really worried that she was wasting our time. Personally I think it has the chance of being our most worthwhile call all day - we turned up, fixed her bed (even though that isn't our job) therefore providing her with some more independence. We left her at home feeling happy and more confident about moving around the house. This wasn't a job where we save someone's life - but it was still hugely satisfying to help her out, even if it meant using common sense rather than following any protocol.

*This is also the day that 36% of the world think that torture is acceptable, that America decide that they will annex space and Blair demands more power for control orders and right minded people watch the funeral of 'habeus corpus'...

Birmingham University medical school has banned full face veils in clinical areas. It just interests me how such things spread, not that I wish to turn this blog into 'veil-watch'. As an update to the post about headscarfs being made part of a school uniform, it appears that this was misreported (although the cynic in me considers that they have decided to quickly change the policy after the media attention). Check the comments of that post for more details.

(Via Warren Ellis)

Oh yes, the Wordpress question doesn't mean that I'm moving this site to Wordpress - I'm a Huge fan of Blogware and my hosting company. I'm just interested in starting up another blog for non-ambulance stuff.

There are days when you wake up in a foul mood, I'm sure that everyone can relate to this. For no good reason you just want to growl at everything. Us ambulance people get those days as well.

The trick is to try and hide your general grumpiness with the world, given some of our calls this can be a bit tricky.

It is particulary difficult when your first job is to transfer a maternity patient from one hospital to the other and the midwives in the sending department treat you rudely. I wouldn't treat a taxi driver the way we were treated that day.

We were called over with a dismissive wave of the hand. The handover of the patient consisted of a doctor referal letter being thrown at us and the midwife who accompanied us hardly spoke a word to me or the patient.

Add in a rude relative and the job was a bundle of joy.

It wasn't helped by the midwife spending forty minutes at the receiving hospital photocopying the patient notes.

I very nearly said something I would have regretted.

Still, it all became better after I had a full fry-up breakfast.

It's not good to want to do painful things to other healthcare professionals, but us ambulance folk are only human too.

-=-=-=-=-
Sent from a mobile phone, probably from the cab of an ambulance.
-=-=-=-=-

It seems that the discussion on the wearing of a veil can go the other way. A UK school has made the hijab part of the school uniform, even though 10% of the children there are not of the Islamic faith.

Countdown until the tabloids catch wind of this, 3...2...1...

(Thanks to It's Your Time You're Wasting, Not Mine)

My crewmate (permanent crewmate mind you) called me ‘Tom’ yesterday.  She has never called me this before.

She normally calls me ‘Harry’, because she is rather obviously mad and thinks that I look like ‘Harry Potter’.

I call her Moomin, partly because she wants to live in Finland and partly because she is short and looks like one of them.

We don’t have nicknames for our regular patients, except perhaps for, ‘Oh it’s that bloody man again!’

Now for a request…

Has anyone any experience in hosting for Wordpress?  I’m looking for somewhere, preferably in the UK who will host a Wordpress blog.  It doesn’t have to be the world’s cheapest (although that would be good), but somewhere which has a pretty good record of treating it’s customers right.

Thanks in advance.

I don’t often do reviews, mainly because I don’t read them and am therefore uncertain about the format.  But this was too good an opportunity to miss.  Also I may have sold any reputation I have down the river and have agreed to do a bit of PR for the company promoting it – no money has changed hands.

‘Saved’ – Sunday at 9pm on the Hallmark channel.

Although this will perhaps be old news for any readers from the Americas, there is a new ‘Paramedic Drama’ TV show called ‘Saved’.  It’s on the Hallmark channel in the UK and last night I saw the pilot for it.  I made a few notes…

Like all TV medical dramas it was full of the interesting (but rare) jobs that we go to – I believe that somewhere out in TV writer-land there is a list of things that *must* happen in a medical drama. 

You must have,

• A fat guy having a heart attack.
• A cardiac arrest (which is saved).
• A case of child abuse.
• A baby being delivered.
• A car crash.
• A dead child.
• A mad homeless person, and…
• A newbie.

‘Saved’ ticked all of those particular boxes, but didn’t feel cheap for it.  In an hour long show (especially a pilot) you need to make things as interesting as possible.  The plot is fairly typical, the ‘hero’ has personal and family problems with a complicated love life, another is separated from his wife and child.  Once more drama needs these tropes to make you feel for the characters.  No-one in a drama has a happy marriage, just like no-one in Eastenders has a life free of pain.

But before you think I am being harsh, I’d like to let you know that I really enjoyed it.

I understand that there are differences in the way that American ambulance staff differ from us in the UK, but there were some universal truths that I can’t ever remember seeing in a TV drama before.  For example, on their way to hospital after dealing with a trauma the attendant was chatting quite happily while doing a medical procedure – now, realistically the driver would have pulled over, but it was the dialogue that I quite liked, they were both calm (no ‘If I don’t make this he’s gonna die’ histrionics) the driver was congratulating his mate on not getting them beaten up moments earlier.

The dialogue was similar to the way we talk in real life (although not always in front of the patient), the way of talking that may seem cruel and uncaring, but it is that level of disconnection which gets us through the shift.

There was the same superstition about uttering the ‘Q word’ in relation to a shift, I imagine that their medical consultant threw that idea into the writing pot.  It’s funny that they have the same belief in America.  We also shudder if someone says that the shift will be ‘quiet’ – it’s a terrible curse.

At one point the ambulance was stolen – the reaction was pretty much what ours would be, a moment of ‘oh sh*t!’ followed by laughter as the police followed it down the road.

The attitude to the patients was also similar to a lot of what happens on the road, telling the heart attack that he wasn’t going to die, and that he was safe now is the sort of thing that we all say in order to relax our patients.  I’m also glad that I’m not the only one who mentions to patients that he doesn’t like doctors either…

It’s also nice to see someone who wears gloves less than I do – I’m not a big fan of wearing them, but, unlike the protagonist, I do wear them if I’m delivering a baby as it gets bloody mucky.

I liked the reaction to being told that a patient of theirs had died – a little sad, but not broken up about it – and then back on the road for the next call.

Can I just say though, sex in the back of an ambulance?  Ewww.  Reember, we know the sorts of people who we regularly pick up…

Finally, I can’t tell you how much I love the photo montages of the patient’s backgrounds that are shown as our heroes arrive on scene – they condense a lot of information into a short space of time and avoid the ‘Casualty’ trap where half the programme is set-up for the emergency.

(As an example, I saw Casualty this week, the first part of the programme showed a woman with two children next to a canal – I was guessing that one of them would drown.  I was wrong, one child smothered the other, but it had distracted me.  The ‘Saved’ approach is much better at compressing a patient history into a few seconds).

So I’ve got to say that I enjoyed the pilot and I’ll be watching again next week to see if they can keep the same standard of realistic bits mixed with the trauma cases we get once in a blue moon.

Oh yes, the American site for the programme has two blogs!

“Male, 40 years old – fitting”.

It was a park, it was midday.  I didn’t really need to see the update that said,

“Patient with two males, both appear drunk”.

I think that it is a law of the universe that your middle-aged, middle of the day, middle of the park fitter will be an alcoholic.  That or they are an epileptic alcoholic.

As we approached the scene my crewmate asked where I thought it would be.

“Well, the drunks tend to hide down by that end, it’s close to the off license”.

I was right.  Our patient looked familiar, but after a while they all look familiar.  I did recognise his two friends, one had been picked up two days ago, the other was another of our regular callers.

“He’s had another fit”, said the slightly more sober one, “He’s had three today”.

“Yeah”, said the other taking a swig from a big bottle of cheap cider, “He’s epileptic but he doesn’t take his tablets”.

Our patient had the same ground in grime that you get from sitting on a park bench drinking all day, then falling over and going to sleep in the bushes before heading home at some point in the early hours.  A simple job to load him up onto the stretcher, check him out and give him some oxygen and pop him into hospital.

My crewmate and I were inspecting him in the ambulance when I felt an urge to pass wind.

It was perfect timing, I could blame it on the semi-conscious patient.

My crewmate groaned, “I think he’s pooed himself”.

I told her the truth.

Honest.

By the time we reached the hospital the patient was a lot more awake, so we spoke to the handover nurse, put him on a trolley and went outside to clean up, finish off the paperwork and *ahem* air out the back of the ambulance.

I think it was thirty seconds before we saw him walking out the department.

Probably towards the nearest off-license.