After posting such a nice post about the lovely people in Newham it was perhaps obvious that when I got into work last night I’d hear about some not so nice people.  Such is karma…

Some of my station workmates were parked at the hospital on Wednesday night booking a patient in.  Someone broke into their ambulance and stole the sat-nav monitor (which won't work as all the actual electronics of it are buried deep in the motor itself).

They also stole a drugs pack with little else in it besides some paracetamol and some vials of adrenaline.  So keep your eyes open for someone with a fast heart rate running around Newham with sachets of Calpol in their pockets.

What this means is that we will have one less ambulance on the road while it is getting fixed (the whole dashboard was pulled up).

Also that night there was a strange man walking around the station at 3am. He stole some cigarettes and when challenged replied, "You're open 24 hours ain't you".  He then acted threatening towards one of our female crews before leaving.

Shame I wasn't there...

Once more it’s the complete disregard that some people treat us underpaid, overworked ambulance staff who do our job because deep down inside we want to help folk.  I wonder if they care that they are robbing the community of an ambulance.

I suspect that they don’t.

I had an interesting job yesterday, but for various legal reasons I’ll have to wait a bit before posting about it.  You’ll see why when I do post about it.

One of the things that the newspapers seem to like to do is to stir up trouble between different racial groups, one need look no further than the amount of press given to the Forest Gate demonstration last week – less than 100 people turned up, and yet it was ‘important’ news.

Actually living and working in Newham gives you a much better picture of how people get along, and it has nothing to do with mainstream media’s attempts to split us apart on behalf of various vested interest groups.

I was sent to a ‘little old lady’ who had fallen over earlier in the day, she had been found by her next door neighbour who looked after her.

My little old lady was White British, while the family who looked in after her were Bangladeshi Muslim.

For a number of years they had helped her and her husband, checking in with them to make sure that everything was alright, the son of the neighbours would help out around the house,

When my patients husband had died, the family only stepped up the amount of help they gave her.

So it was the neighbours son who had found her and called us.  It took us some time to deal with the patient – she had an obviously broken hip and we needed to give her a large amount of painkillers before we could move her.  During this time the Bangladeshi mother and son stood watching, making sure that she was alright.  The mother spoke no English, but even I could recognise her prayers.

As we loaded the patient into the ambulance both the mother and father were praying, and it brought a smile to my face when their son shouted at then, “Will you both stop that, we aren’t in the village anymore”.

When the patient’s real son turned up he appeared more concerned about the inconvenience that his mothers fall was causing him.  The neighbour’s son was more concerned with her health.

 

This is what I see – I see communities working together and looking after each other, not because of government sponsored ‘multi-racial community days’ but because, quite simply, we all live together.  The only thing is that you don’t hear about these small acts of humanity when so-called ‘community leaders’ are shouting about perceived unfairness.

NeeNaw lets us know how busy it was the other day – although the call rate by midnight was closer 5,700 than 5,000.

so why is it that I dislike football so much?

Despite being an atheist, I still feel uncomfortable walking in my boots into a Mosque – especially while the prayers are still going on.  At least the people who ask me to remove my boots are understanding about why I can’t do as they ask.

I like East London, with the mix of cultures and languages it’s like living in the ‘cantina’ scene out of Star Wars.

You’ve got to be careful in this job, because the thought that will keep you lying awake at night covered in a thin film of sweat is simply this,

“Any action, inaction or wrong action tomorrow at work may well mean I kill someone”.

I suspect doctors have this a lot worse than us ambulance people.

Least fun thing yesterday - looking after a 72 year old man. His wife of 50+ years had died in his arms and there was nothing we could do for her.

Second least fun thing yesterday – Trying to hold the leg of a five year old boy still while he waved it around.  I was feeling the broken ends of his leg grinding together.

It's not all drug-addled prostitutes in this part of the world.

I've just been cheered up out of a funky mood by watching some youngsters practicing Capoeira dancing in a bandstand. They have these little bongos to provide the music.

The sun is out and, yes, I still love London.
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Sent from a mobile phone, you know the rest.
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Ten karma points if you can tell where I've been today...



Of course this only works if the picture comes through as well - lets see if Flickr works right...



UPDATE: It's St Leonards church in Shoreditch. Yes, I was picking up one of the drunks who likes to drink in churchyards.

You know you've been doing this job for a long time when someone mentions that your patient is a heroin-smoking, weed-puffing drug addict who funds her habit with prostitution - and you don't blink an eye.

Maybe it's because I'm used to working in Hackney?

Like all the prostitutes I've met, I wouldn't touch them with a 10 foot pole. Heaven knows the sort of people who are so starved of sex that they would consider paying good money to have sex with them...

However there is one advantage of working in this area - I keep bumping into a very pretty paramedic...

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Sent from a mobile phone, sitting on Standby outside Victoria park.
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Aparrently there are near riots in the Canary wharf area.
Today I have been working alone on the FRU car.

I've just spent an hour and twenty minutes sitting on scene with an 86 year old woman waiting for a 'real' ambulance to take her to hospital.

Why so long?

Because all the ambulances were dealing with (presumably) drunken rioting idiots...

(It's also typical that the one time I work outside of my normal area we get the 'fun' of rioting...)
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Sent from a mobile phone, probably from the cab of an ambulance.
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So yesterday we nearly had an accident in the ambulance.  first off, let me tell you that I’m doing occasional video captures of our drives through town – it’s part of a little project I’m working on entitled something like “I can’t believe you did that when there was an ambulance with flashing blue lights and loud sirens bearing down on you”.

It may need a shorter title.

We were racing on blue lights, as I wasn’t driving I was using my digital camera in video mode to see if I could catch anyone doing something humourously dodgy.

Then, from in front of a bus…

 …well – see for yourself… 

The reason there isn’t any sound is that I don’t really need you all to hear me shouting, “FFFFFUUUUUUUUCCCCKKKKK!!!!!”

As my camera isn’t really a video camera, I’ve blown up one of the frames to let you see what I thought we were going to hit.

 

I have no idea how we didn’t hit him, or his dog – but I’m bloody grateful we didn’t.

UPDATE: Due to some of the comments, I thought I'd clarify.
We didn't hit a person because (although it looks fast on my crappy camera with limited frame rate) as we approached the zebra we were aware of the hazard and therefore going at a speed that allowed us to stop before our wheels even touched the zebra.

If we couldn't have stopped before crossing the crossing, then it would have been dangerous driving.

It's why I had to provide a freeze frame, because the child is spotted and the vehicle brought to a halt within such a short period of time.

The dog running was travelling faster than a human, and yet we still stopped in time.

Recall also that I am sitting in the passenger seat, and therefore have a poorer view than my driver. It's why I swore, and the driver didn't, because they saw the child and took the correct action.

So my point is - even though it looks like we are going fast, we drive so that we can stop given the hazards of the road - those hazards include kids on scooters (and their dogs) dashing out in front of us despite the lights and sirens.

It's my fault I didn't make this clear in the initial text of the article - I'd just like to blame 28 hours awake (which is why my crewmate was driving in the first place...)

I've just discovered a new phrase that the police use - 'TACAU', which means 'Treat All Calls As Urgent'. It's used to 'flag' an address so that if there is a 999 call from it they run there as quickly as possible.

In this instance it was because a young man decided to beat his mother-in-law over the head with a broom before threatening to kill other members of the household.

Everyone was rightly concerned that he might return to the house to make good on his threats, which is why the policeman in attendance flagged the address.

The mother-in-law had such a swollen cheek her face was twice the normal size.

Back when I was an A&E nurse I would have put her somewhere quiet so that she could try and relax, especially because she couldn't speak English and her relatives were still at the house dealing with the police.
Unfortunately the nurse in charge was a little less sympathetic and put her out into the waiting room. So I ended up leaving her looking upset and confused, surrounded by people she couldn't understand. While it might have been the 'clinically correct' thing to do, I wouldn't have thought it was the right thing to do...

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In totally unconnected news, there seems to be an awful lot of people frequenting the local mosques today - something to do with a demonstration in Forest Gate perhaps?


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Sent from a mobile phone, probably from the cab of an ambulance.
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I am currently feeling like death warmed up - and it's all my own fault.

Here is the thing... I've just finished a week off work. Convinced I would be coming back to a series of nightshifts, I spent the last few days off gradually retuning my bodyclock to 'night'.

Then I looked at my duty rota, and found out that I'm actually working 12 hour dayshifts.

Because of this almighty bugger-up, by the end of my shift I'll have had one hours sleep in twenty-eight hours.

Today's work will be brought to the people of Newham by the power of Red Bull.

Still - hopefully it'll be a peaceful day....

News Statement

5 June 2006

Response to London Assembly 7 July Review Committee report

To be attributed to Chief Executive Peter Bradley:

"The events of 7 July were unprecedented and the courageous actions of our staff and their colleagues from other agencies undoubtedly saved lives.

"We have acknowledged we faced difficulties with communications that day, but this did not prevent us treating and transporting more than 400 patients to hospital from all the sites within three hours; this is a testament to the way everyone involved handled what was a tremendously challenging situation.

"We have been honest about the fact that there were a number of lessons to learn, and indeed the Committee has previously praised us for the amount of information we have made available.

"While the committee’s findings broadly reflect those of our own debriefs, we will study the recommendations closely to ensure they are fully addressed in our ongoing work to further improve our ability to manage future incidents."

Ends

Notes to editors:

Our full response provided to the Assembly in March can be found on our website – www.londonambulance.nhs.uk

Improvements to our major incident planning since 7 July

Since the events of 7 July, we have made a number of improvements to the way we will respond to major incidents. These include:

1. • Issuing radio pagers to managers for use in major incidents
2. • Developing a pre-determined response for any future major incidents, including sending 20 ambulances and six managers to the scene as soon as a major incident is declared
3. • Reconfiguring our new incident control room, with an improved ability to manage multiple simultaneous major incidents
4. • Successfully lobbying to be brought forward in the rollout of the new national digital radio system for ambulance services. This will be introduced next summer and will be fully operational in early 2008. Ahead of this we will also be receiving an interim allocation of 200 digital radio handsets. The first of these will be arriving next month and will be issued to operational managers.

1. • Reviewing levels of equipment carried on our emergency support vehicles, as well as now carrying additional supplies on 25 training officer vehicles.

Our response to specific issues within the London Assembly’s report:

Communications/mobile phone issues

We have been open about the fact that we were over-reliant on mobile phones. We have now issued all our managers with radio pagers, which are more resilient in a major incident.

Technically our radios worked, though we have admitted that the volume of traffic on our radio system made it difficult for managers to get through and speak to the control room. We have made changes to our internal procedures to address these problems, and have reconfigured our major incident control room so we can deal more effectively with a number of simultaneous incidents. The Service has also been brought forward in the roll-out programme for a new national digital radio system for ambulance services, and this should be fully operational early in 2008.

To clarify, it was our managers who had difficulty in communicating with our central control room that day; once at scene our ambulance crews come under the direct control of local management teams and do not need to contact our control room for instructions, either by mobile phone or radio.

Use of hospitals

On 7 July, we initially put all the hospitals in London on standby, letting them know that a major incident had occurred and that we might need their assistance. We then confirmed with seven hospitals that we would be bringing patients into them.

Distribution of patients to these hospitals was generally good, with the exception of the Royal London Hospital which received three busloads of patients with minor injuries from two of the scenes. Faced with communication problems, our operational managers on the ground quite rightly took the decision to use the buses based on information they were receiving from ambulance crews and their local knowledge of hospitals in the area.

There is no doubt, however, that if communications had been better, we would have achieved a better distribution of patients with minor injuries by spreading the load across three or more hospitals.

Delay in additional ambulances being sent to Russell Square

We got to all the scenes very quickly and gave priority to those people who were most seriously injured, treating and taking them to hospital as quickly as possible.

We experienced delays in getting a second wave of ambulances to Russell Square; our communication problems made it difficult for our managers to request further resources, and it is also evident that ambulance crews who were on their way to Russell Square instead became involved with the rescue operation at the bus bombing in nearby Tavistock Square. Once it became apparent that this was happening, staff were redeployed to Russell Square.

The delays in sending the second wave of ambulances meant that it took us longer to get the less seriously injured patients to hospital, but we still managed to treat over 400 patients and take them from the sites within three hours.

Availability of medical equipment

Given the nature of the incidents and the large number of casualties involved, it was inevitable that medical supplies were going to be used up quickly. We accept that there were delays in getting further equipment to some of the scenes, but we worked hard do address this and were able to move all patients to hospital within three hours.

We have since reviewed levels of equipment carried on our emergency support vehicles, and we also now carry additional supplies on 25 of our training officer vehicles.

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Thanks to the folks in the communication department for getting back to me and letting me post this up on here.  As I got it off our internal network, I thought it best to ask permission first.

As always, the thoughts on this blog are my own, and have nothing to do with my employer, the London Ambulance Service.  I do not represent them in any official capacity and the views here are how I see things and I may have incorrect information.  Also while I’ve read the report, my sinuses are blocked and my head feels like it’s going to explode.

The report on the 7/7 bombings makes interesting reading and despite what some of the media may have you believe it is not ‘slamming’ the response of the emergency services.  (I could mention all the ways in which ‘The Sun’ report is inaccurate, but I can’t be bothered wasting my breath).

Personally I agree with a lot of what it suggests.  In the whole I think that it is a reasonably balanced report and that a lot of the changes it suggests are reasonable ones.

However there are a few points that I believe are misinformed.

The people making up the review take on the role of ‘informed layperson’ – looking at the backgrounds of the people involved in the review, one is a barrister specialising in employment law, one has a degree in economics, one is a solicitor, one a business trainer and one has a BA in politics and economics (and incidentally studied where I trained to be a teacher).

My concerns about the report is that I believe none of them have any experience in emergency situations.  It is very easy to look back and criticise the actions on the day – but the ‘fog of war’ is a very serious obstacle.  Much like you, dear reader, perhaps had little idea of what ambulance work was like until you read this blog – I think that some of the reports recommendations show a lack of understanding of what a major incident is really like.

The main finding and recommendation of the report is that the communication network was inadequate, and that more should be done to improve communication between staff on the ground and Gold Control, who’s job it is to coordinate our response.  Eighteen years after the Kings Cross fire and the emergency services still needed to rely on ‘runners’ for communication as the radios we have don’t work underground.  With this I recommendation I agree completely, our communication needs to be upgraded – unfortunately, from what I hear the TETRA airwave system that we will be getting in the start of 2008 is not going to solve many problems.  It simply isn’t as good a system as people would have you believe.  (But this is a topic for another post).

There are some recommendations which are a little strange, such as allowing medical staff who are untrained in pre-hospital care to start setting up field hospitals and the like.  While medical knowledge is incredibly useful, it’s also very useful to not have people who may be unaware of all the dangers on scene wandering around explosion sites in nothing more than theatre scrubs.

I understand the urge to help, I would have done the same when I was working in A&E and I don’t want you to think that I’m degrading the work that these volunteers did on the day – but the risk of creating more casualties is just too high.

One thing that the report does is to record the accounts of members of the public caught up in the explosions – unfortunately the report does not mention that in such times of trauma the brain can easily become mistaken with what is happening.    Perception of time can become altered – two minutes can easily feel like ten.  Also there can be a misperception of what the first ambulance on scene does – on arrival the driver should stay in the ambulance and provide communication with Control, while the attendant makes a survey of the scene in order to report on what additional resources are needed.  The first ambulance on scene does not treat any patients until the scene management is taken over by an officer.  Add in that the first person needs to be sure that the track current is off, and then needs to walk fifteen minutes to get to the train – spend a couple of minutes assessing what has happened and then walk another fifteen minutes to get back to the ambulance, and it is unsurprising that a lot of the injured felt that the ambulances took a long time to arrive.

While the evidence from the public should be gathered, I think that by publishing emotive eyewitness reports on what they believed happened is a poor idea.  In some places the report reads more like a disaster movie rather than a report on how to better improve our response.

Some mention is made of the lack of equipment, unfortunately in the first response to a major incident you are going to get ambulances, and not the ‘bigfoot’ support vehicles – we can only carry a limited amount of equipment in an ambulance, and to be honest it’s not unusual to only need to use an oxygen mask or two in the course of a normal twelve hour shift – so while we are equipped to deal with a patient or two, we simply do not have enough room in our ambulances to stock for major incidents.

As I said at the start – the report makes a number of excellent points, and at no time does it criticise the actions of those ‘on the ground’ who did an excellent job under difficult circumstances.

I know that the LAS has already made improvements, such as reinstating the ‘obsolete’ paging technology for it’s managers – something that came in extremely useful two weeks later with the failed second attacks.  I do have the LAS’ news release concerning this report sitting on my computer, I just need to OK to post it here…