The health secretary admitted there would be difficult decisions to be taken on staffing, because "some parts of the NHS in England have taken on too many doctors and nurses".

Good grief, Hewitt is bonkers.

I'm beginning to think that 'Care in the Community' for our mentally ill has gone a bit too far when one of them has become Secretary for Health.

NHSBlogDoc is as incredulous as I am.

I'm watching the TV and a politician has just referred to people who 'binge drink' as 'people who drink to get drunk', a phrase I first used on this blog a year ago. Maybe someone in government is reading this site?

I've written before about how I am a different person when I'm wearing a uniform, how I am more confident, more proactive and sometimes a bit more 'shouty'. The reverse is also true and I think that this is, in some way, due to the way that people treat me when I'm wearing the uniform.

People see me in uniform and permit me to direct them, advise them and do things physically to them. Without the uniform I can't do this.

It all became obvious on the way home from the centre of London one night. I was using the tube and, on coming up an escalator while changing between lines, came across a man who had collapsed.

There were two members of the public with him, a station officer and a station cleaner. As I approached I saw that he was pale and sweaty, he triggered that bit of my brain that says 'this person is properly ill'.

I tried to walk past, I really did. I think I got two steps beyond him before turning around and returning.

"Hi there, I work for London Ambulance, can I help?"

He'd apparently became dizzy and then had collapsed, a little chat with him revealed a significant history of internal bleeding in the past. Feeling for his pulse I couldn't find a pulse in his wrist, this meant that he had a very low blood pressure, this would explain his paleness and sweatiness.

I asked the Station officer if he'd called an ambulance, and he mumbled something in the affirmative. I tried to take control of the situation, but it all came out a bit vague and quiet. I put the cleaning bucket under his feet to try and raise his blood pressure a little and awaited the ambulance.

All the time this was going on I was feeling rather vulnerable, unlike when I am 'on the job', I could also tell that the people I was with weren't taking me as seriously as I would had I been wearing a uniform.

The ambulance crew arrived and I handed the patient over to them. They didn't seem impressed, again probably because I wasn't wearing my uniform.

As I walked away I felt rather bad, If I had turned up in a FRU car, then the job would have felt very different, but without my uniform I wasn't as confident.

It's funny what a green shirt can do for your confidence.

I had a job that required me to undertake an extended role.

The call came down as 'Patient's own hospital bed broken, patient stuck', rather predictably I had visions of some little old lady folded in two by an electric bed.

The 'patient', as it were was sitting in their chair, he husband was running around flapping and the domestic carer was looking confused.

The bed was a type that I had never seen before, it had a hydraulic ram underneath it which tipped the mattress on end by 90 degrees, I suppose so the patient sort of 'slides' into an upright position.

The bed was stuck in this upright position - if the sheets had been black it would have looked like the Monolith from 2001.

After some fiddling around (a technical term) I managed to get it into the horizontal position and checked that it would raise and lower as designed. I'm grateful for my various experiences fixing broken things.

So ten minutes later, after pointing out the rather large print on his bed's instruction folder (Which said 'Emergency out of hours technician ring 0800 xxxx'), and we left another satisfied customer.

I decided to have a joke with Control.

"Control, The patient's bed is fixed, I'll do my paperwork for this job then I'll be ready for any blocked gutters or windows that need fixing".

Funny how people panic and call us...

I have a problem with knees, partly it's because I'm slightly squeamish about them, partly because when they break or dislocate it is incredibly painful for the patient.

Our woman had slipped on a wet floor, she had landed on her knees and, after we drove across most of our patch to get to her, we found her laying on the floor.

Upstairs.

In a narrow corridor.

She wasn't a 'small' person either.

My physical examination led me to believe that she had broken or dislocated her knee - it was a bit tricky to examine her in the enclosed space she found herself, her weight didn't help either.

The patient was lovely, she understood why she had waited so long for an ambulance. She'd also taken some painkillers before we arrived, something that is an absolute rarity. She was nice to talk to and when I explained that we would take things slowly for her benefit she understood.

First thing that I did was to give her some of our painkiller gas entonox. Then I slipped a splint around her injured knee, this combination seemed to help the pain a lot. She proved to be a good patient by immediately understanding my instructions on how to take the entonox - another rarity in our area.

The staircase that we needed to get her down was steep and narrow, there was no way we could use our carry chair. She would have to be strapped to our scoop and carried down the stairs that way. But we would need help.

I'm 6'1", my crewmate is 5' 1 1/2", not the best combination of sizes for getting a large woman downstairs on a scoop (although my crewmate would like you to all note that she (believes) is the strongest one out of the both of us). So we called Control for assistance, namely another crew or an FRU person. We were assured that one would be on their way.

While we were waiting we placed her on the scoop and started the long process of strapping her to it so that, when we tilted it by 80 degrees to get her out of the house, she wouldn't slid out of the scoop like someone being buried at sea.

After some time one of our Emergency Care Practitioners arrived and he gave us some much needed help in man-handling the patient down the stairs and into the ambulance. We took the patient to hospital where x-rays showed a dislocated knee.

This is what I like about my job - This job wasn't about saving someone's life, it was about causing them as little pain as possible while solving the puzzle of how to get the patient out of the house all while keeping them as calm and happy as possible. It's not a 'buzz', but it is the satisfaction of a tricky job well done.

As you may know (if you have ever read this site before), I enjoy a little game called 'World of Warcraft'. For those that don't know about computer games, you take control of a little person, team up with other people and delve into dungeons to kill evil monsters in a fantasy setting¹.

One of the essential things that you need to do before your character enters these large dungeons is to make sure that you are carrying a stock of 'health potions', magical drinks that heal the damage that you character may have taken in the aforementioned fighting of monsters.

I can remember to stock up on these life-saving potions, and this is just a computer game².

So, to translate this into a real world situation if I needed a 'potion' to survive, I'd be damn sure to carry it around with me.

Why then do I find myself going to asthmatics, many of whom are old enough to know better, who let their life-saving inhalers run out? If I were asthmatic I'd make sure that I always had at least two inhalers at all times. Or is there some bizarre flaw in the way these medicines are allocated.

I'm sure that if I were like my last patient (unable to sleep without at least one 'blast' on my inhaler) I'd have one tied around my neck. I could maybe understand it if my patient were a teenager, but this patient is a full grown man.

Oh well, just another mystery for me to ponder.

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¹For those who play, yes I know this is hugely simplistic

²I'm addicted but I can still call it 'just' a game

It is 3am, it is cold and dark and damp. I am tired and fed-up and sad.

My heart is being broken by a deeply demented 65 year old woman who can only whimper and cry for no obvious reason. She can hardly talk due to the dementia, crying quietly to herself is now a large part of her life.

She is clean and well looked after by her daughter who, a couple of months ago, suddenly had her mother-as-a-child, in addition to her own children, to look after.

It's jobs like that which slowly destroy your soul.

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

Blah...blah, ORCON...blah...lack of patient care...blah...blah...stupid government target...blah...blah...no rhyme or reason...blah...blah...

You have heard me ranting about ORCON many times in the past, about how it causes a reduction in patient care, how it isn't a good reflection on an ambulance service and how there seems to be no evidence as to why eight minutes is so important. Whenever I've asked about the magical eight minute figure no-one has been able to give me a straight answer.

The (excellent) Magwitch has taken on this mystery that no ambulance person has been able to answer and has detailed his findings here. It's a superb read and I suggest you all take a look at it, and the comments, and decide for yourself why the reasons for this target seem to be hidden.

I think some further investigation is needed. Anyone an expert on the British Library?

There is a road on our patch that I'd never been to before, there are only thirty or so houses in it. However, in the past two weeks I've been there on four occasions.

Last night I was there because someone had slipped and fallen on the floor. Last week I was there for an ill child, but it was the first two times I went there that will stick in my mind. They were both on the same day.

It was the first call of the evening, a 'difficulty in breathing' for an elderly woman. We entered the house to be surrounded by a large number of relatives, this isn't unusual it was an Indian family and they tend to be large. The patient herself was a very frail and bedbound elderly woman, she had had many strokes in the past and was dependant on her family for her care.. It didn't need the FRU paramedic to tell us that she was extremely unwell. The patient was unresponsive and had laboured breathing. She had a sheen of sweat on her, a sign that her body was struggling and she was completely unresponsive.

It soon became obvious that the patient had pneumonia and wasn't shifting enough air to keep alive. We loaded her and one of her relatives onto our ambulance and 'blued' her into hospital. The relative seemed resigned to our patient dying, we couldn't disagree with them.

---

By the time we took our next patient into the same hospital, all the relatives had arrived. They had spoken with the doctors and it was decided that it was in the best interests of the patient to not pursue any active treatment, and instead to let her die. The relatives had asked if they could take her home, and the hospital was in the process of arranging transport for her.

It must have been a hard decision to make - having seen many, many futile attempts to save someone's life, it always seems to involve pain and suffering as needles are pushed through skin, drugs with nasty side effects are given and breathing tubes are inserted. It was brave of the patient's relatives to make that choice that this moment was the end of their loved one's life and that it should be as undistressing for the patient as possible.

---

It was less than an hour later that we were called back to the same address, the job was given as 'patient deceased'.

What had happened was that the hospital transport had taken the patient home and, before they left, the patient died. They then advised the relatives to call for an ambulance.

So we arrived and everyone decided that it was for the best not to resuscitate her. We offered our sympathies and arranged for a GP to come out to certify the death.

The family were lovely, they offered us tea and thanked both us and the hospital for what we had done. We hadn't saved her life, but we had allowed her to die with some dignity at home, rather than being treated futilely on a hospital trolley.

When I went back to the same address a couple of days later (for the sick child), I saw the funeral notice on their front door. Last night when I went back to the same street for the woman who'd fallen over, one of the family came out and thanked us again.

Four times to one small street, and with a family and a 'job' that I'll remember for a very long time.

Is it wrong to want to punch a patient before he tells you to fuck off and he's going kill you? Even though you have personally been extremely nice to them.

This is our first job.

It's going to be a long night...

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

Lots of anger tonight.

The local A&E departments are full, the nurses in charge are doing juggling acts in order to try and get patients in a position to be examined by the doctors. Waiting rooms are full and in at least one case there are no beds left in the hospital while plenty of patients needing admitting.

I explained to one patient we brought in that this is why she had to go to the waiting room - there just wasn't room for her and her two-day old headache to lay on a trolley...

"Fucking hospital, always some excuse!".

It took some restraint on my part to not shout at her to open her eyes and take a look at the crowded department she was standing in, to look at the staff charging around doing a dozen things at once, and to consider that this headache perhaps wasn't the highest priority illness that night.

The expectation of patients is much higher than that which can be provided. Even when it is obvious that the department is being overloaded, the desire to get their 'serious' problem cured immediately leads to anger.

Patient tempers were flaring, likewise the doctors and nurses were run ragged. Multitasking is an important nursing skill, especially when, not only do you have to do all your normal nursing duties, but you have to run crowd control on angry relatives and the normal cast of drunks.

I'm writing this post in the middle of my shift and it wouldn't surprise me if there is violence in the department before the sun comes up.

So please explain to me why those complete *expletive deleted* morons in the Ministry of Health are going to be closing two of our local A&E departments? When the current A&E capacity isn't enough, and there is a year on year increase in attendance, shouldn't these people be supporting the A&E departments rather than cutting capacity even more?

Sorry, I forgot - we are supposed to be more 'efficient', people are going to be treated in the community (by ambulance staff at some point in the indeterminate future), they won't need to go to hospital. Remember that 60% of our calls don't need an ambulance. But, and it's a big but, they might need an ambulance, x-rays, blood tests and the like to come to the conclusion that they didn't actually need that ambulance.

Of course, people will still want to go to hospital, and we are unable to refuse. Then when they get there and see queues running out the door they'll complain and make life awful for the folks who work there.

This overloading of A&E departments is one of the things that led me to leave nursing - and I haven't haven't missed the hassle, nor the inability to properly care for terminally ill patients because there were no pillows or blankets in the hospital.

It's sad, but one of my favourite nurses is in the process of moving career because she's getting fed up of trying to bail out a sinking ship. I suppose that this is a governmental success, less departments and less nurses means fewer wages which saves money.

I don't know what they plan to do with the patients though.

This was written when most newspapers had the death of a race horse as the front page news.