The call was for an assault in the street. A nice simple job for a pleasant afternoon in Newham.
We arrived and found six police officers around a Russian man and his girlfriend. There was a lot of shouting and screaming on the behalf of the man, mainly because he'd had his front two teeth knocked out.

Suddenly one of the police turned to me and said, "Quick, we are moving to another area".

"Why is that", I asked.

He pointed to a house window across the road, "Because there is a man there with a gun".

Thirty seconds later my ambulance, my patient, my crewmate and most importantly *myself* were 200 yards down the road behind some houses and a very solid brick wall.

Policemen with big guns appeared from nowhere and they laid plans about what to do about the situation.

To cut a long story short, the police negotiated the release of a child from the house and after around seven hours the siege was ended peacefully.

My patient managed to smoke all of one policeman's cigarettes.

---

Now to reply to two comments that initially don't seem related.

'Let's hope they don't gun down an innocent brown-skinned young man this time.'

A somewhat snide remark. The police don't go around looking to shoot people, despite what the media may lead you to believe. Whenever I've been involved with armed police I've been impressed by the pure professionalism that they show. They are anything but looking for brown-skinned people to shoot.

People who make such pronouncements don't understand how confused a scene can get, with differing intelligence, hearsay, rumour and lines of communication suffering from Chinese whispers.

The second comment is this...

Well now some ten hours after your post, and I can't find anything on the Beeb web site. I'm keeping the conspiracy theories at bay by acknowledging that I'm probably not looking for the right thing...

Related to the above comment, this is an example of how the media works. The operation went off without a hitch - no one was shot, there were no interesting pictures of irate kidnappers. The only injury was someone who had been punched in the mouth.

In 2002 the armed police were called out 2,490 times in London alone.

How many times was this reported in the media?

It's only a story if someone gets shot.

This is why the public have an imbalanced view that the police enjoy shooting people. You never hear of all the lives that have been saved because of their attendance.


The reason why blogs such as mine are so popular is because they tell you the stories that aren't interesting enough for mainstream media to dedicate time to. We humanise the jobs that are often just 'nameless men in uniforms'. Perhaps we need an armed police blog...

So - I'm number one on Meet The Author. Number two is someone who I included in my link.

Dear reader - you are a force to be reckoned with. For one thing you are making my ego explode.

No wonder I keep getting people trying to buy advertising space on my blog for £40-50.

Dhaarling, I don't get out of bed for less than £100...

...So... there is an armed siege currently underway in my patch. I've been involved in it and once more I'm not sure what would be the right thing to report about it. Lets just say that I was there and it went from a nice easy 'assault' job into a rapid dash for cover...

Something a bit different on a Sunday afternoon. I wonder how the local and national news will cover it. Even for Newham it's a bit out of the usual.

I've got to give the armed police their due - they turned up very quickly once the call went out.

After four attempts to write something a year on from 7/7 Diamond Geezer and Inspector Sands write what I feel.

There wasn't a blog post yesterday as I spent all day working at both of my 'two jobs'. In the afternoon I was racing around East London rushing genuinely ill people into hospital. In the morning I was doing a bit of publicity for my book.

Now - given how us ambulance people make fun of each other, I'm writing about this only because you, dear reader, deserve a good laugh. I fully expect to get ridiculed at work. Can you see the trauma I put myself through for you?

The plan was simple, there is a company that make short 'talk to camera' videos of authors talking about their books. These videos then get posted on the internet, get linked to from Amazon, get sent out to independant bookshops and find their way onto touchscreens in Tescos. It's all good publicity, and I am a whore for publicity these days. They are called 'Meet The Author'.

So I found myself in my publishers office having to talk about my book in an unscripted fashion for around one or two minutes. In one take. While everyone in the office watched.

Well, after four or five attempts This is what we got. Please do not mock the video virgin.

Many thanks to John the camera guy who made the whole process much less painful than I thought it would be. After the first take where I stated my name, the title of the book, whimpered the word 'ambulance' and froze, he took his time to get me warmed up to the idea of talking on camera.

So, when you view the video I want you to remember that I had to talk off the top of my head into an unblinking camera lense.

One thing though - I do seem to be channelling Norman Lovett (without the jokes).


Of course, when I got home the first thing that I did was take a look and see how other authors did, and there are a lot of authors there and a lot of big names. I'm heartened to se that some of them look more frightened than I...

...although if I'd done my research I took could have had a 'stunt lime'.

I have a bit of luck, a brand new shiny relief has drawn the short straw of working with me for four days. This means that I know who I'm working with for this period of time which makes me a more relaxed ambulance person.

She asks that she be described here as 'sexy, smart, kind-hearted and with a nice bum', or something like that. I was too busy laughing at her after the first few words.

She is actually a very nice person and I think she'll fit in well with the rest of our complex. I'm enjoying working with her.

...except...

Last night, with one exception, all our patient's were so ill we had to 'blue' them into the resuscitation room at the hospital. 'Bluing' in a ptient means that we find ourselves racing to hospital on blue lights and sirens because we are concerned about the well-being of our patients.

Our first call was a 'classic'. A frail, demented 90+ year old female in a nursing home who had become 'semi-conscious'. We arrived at the home to find that the FRU had arrived before us. He shouted out the window at us that the patient 'wasn't well'.

Breathing at sixty times a minute, she barely flinched as we lifted her across onto our trolley bed. She looked so unwell I connected her to our defib machine 'just in case'.

As is usual with these cases the nurses at the nursing home couldn't give us too many details on the patient, they had no idea how long that she had been ill for and had to be persuaded to call for the next of kin.

Our next job was for a man who had collapsed and was having a seizure in the street. He had a cycle of coming out of a seizure then having another one. This continued in the ambulance so once more we found ourselves 'blueing' into the hospital. The patient continued to fit until some rather strong drugs were given.

Our next patient was another 'fitter', this one however was a two year old girl. As we arrived she was still fitting. Prolonged fits can result in a lack of oxygen to the brain, so this justified another 'blue' into hospital. As we arrived at the hospital the child woke up and seemed fine.

I hate children - when they are ill they really put the wind up me.

Our last 'blue call' of the shift was to another child, this one was five years old who had fallen four feet out of bed. He had a painful shoulder and neck, had a huge bump on his head and was very drowsy.

I didn't like how drowsy he was - it's normal for a child to be sleepy after an accident, but this seemed a more profound drowsy than is to be expected.

As the child was a 'funny shape' I couldn't fit a hard collar to his neck (to protect against the possibility of neck injury), trying to put a collar on a child normally has them squirming and crying, but this child just lay there wanting to go to sleep. I had to make do with wrapping his head in a blanket roll, and old fashioned way of immobilising the head, but one that I think is more effective than the specifically designed equipment that we have.

So once more we found ourselves heading into hospital under blue lights and sirens and I'd like to thank my shiny new relief for a nice smooth ride. It's easy to get fired up in the moment, to start driving hard, all the while forgetting that your crewmate is getting bounced around in the back of the truck. this didn't happen - which made me grateful as I would have been the one bouncing around in the back...

Once we got to hospital the child seemed to make a full recovery, I suspect that the hospital will observe him overnight before sending him home.

I'm thankful that there was a nice doctor receiving the patient, she understood that I had my concerns even though the child now seemed fine. It's the curse of the ambulance service that in the nice controlled atmosphere of a resus room things rarely seem as bad as they are out on the road.

Still - no one ever lost their job by bluing in a patient that didn't need it. I'd rather be a bit of a worrier than have someone drop dead as I calmly wheel them through the doors after convincing myself that, 'they aren't that sick'.

So a busy night - but one in which we both felt we'd done some good work above and beyond the normal 'pick up drunk, take to hsopital, mop out vomit' that I often find myself doing.

Just to remind you all – this is my own personal view, not that of the LAS or any other authority.  I have no official capacity to evaluate government policy or to pass judgement on it beyond that of a ‘civilian’.  I’m a taxi driver in a truck.

 

Half of ambulance trips to hospital may be unnecessary as patients could be treated at the scene, a report says.

The NHS Confederation said the myth the ambulance service was a "patient transport" system must be challenged.

The report said crews were becoming more skilled and in the future nearly two thirds of patients would be treated at the scene in England.

Some 77% of 5.5m emergency calls each year end up with patients being taken to hospital.

But the NHS Confederation said this would change in coming years.

It warned the number of emergency calls had more than doubled in the last decade and it was essential patients accept more will be done out of hospital if the service was to cope.

And it said ambulances were increasingly being staffed by emergency care practitioners, who have a wider range of skills than paramedics.

They can prescribe more drugs, take blood tests and refer patients to GPs to reduce the number of emergency admissions

Full BBC Article Here

This leads on from Peter Bradley’s report to the government on the future of the ambulance service.  Mr Bradley is also the chief executive of the London Ambulance Service.  In the report it is stated that only 10% of 999 emergency calls require the trauma/stabilisation skills that we EMTs and Paramedics have.  The other 90% of calls do not have life threatening illnesses or injuries, but have ‘urgent primary (or social) care need’.

That word ‘Primary’, what it means is the sort of thing that General Practitioners are trained in.  Doctors who have to do a couple of years at university, then another five years or so working in teaching jobs at hospitals.  Remember that training period, It’s important.

Compare that with the training that you need to do in order to be an EMT.  You spend 20 weeks in training school learning anatomy, treatments and diseases as well as how to drive, how to safely move a patient and how to deliver babies.  A year of post-training experience and you become a fully trained EMT-3. It’s short but intensive – and at no point does it compare to the training of a doctor, instead it turns us into people who know our job and do it pretty well.

The report goes on to mention that only around 40% of patients are admitted to hospital, while ‘at least 50% … could be cared for at the scene or in the community’.

With revised education and training of ambulance clinicians, the number of patients taken to A&E departments by ambulance can and should be significantly reduced. Ambulance clinicians need to be competent, trained and empowered to do this and supported in making decisions for themselves – rather than feeling that they have to get a second opinion. Appropriate education, guidelines, pathways and clinical support need to be in place locally to enable and support this decision making process. 

So it is suggested that we can provide ‘primary’ (GP, lots of training) care to people by using ambulance people (taxi drivers with 17 weeks medical training).  Dr Crippen has a better breakdown of what this really means.  Now we do have some good skills, for example we are excellent at diagnosing STEMI (heart attacks) and transporting them safely to an angioplasty centre rather than a normal A&E.  But at no point does the ECP additional training does not turn these people into doctors.

So, how much extra training do you have to do in order to be an ECP?   In London at least you have to do eight modules of around five days study each.  You also have to do some hours of supervised practice (around 80 hours for certain modules).

Since the government removed the compulsion for GPs to provide out of hours medical cover the ambulance services have had to cope with the fallout – the patients don’t go away, they just go somewhere else.  If the doctor won’t come out then the patient will call out an ambulance and go to hospital.  The ambulance services/hospitals are getting overloaded, so the 40% of  patients who would not need hospital admittance need to be redirected elsewhere.

So do you offer more money to GPs to return to out of hours cover, or do you go the much cheaper route of training up ambulance staff?

The government reduces the pay of doctors who don’t provide out of hours cover by £6,000.  ECPs are not paid an extra £6,000 more than basic ambulance workers.

Money in the bank.

 

The ECPs that I’ve spoken to often feel that they are told to ‘get on with it’, but if something goes wrong they will be the first ones sacked – so, thankfully recognising the limits of their training, they also take most people to hospital.  No-one likes to take risks in the medical game.  Instead of an ambulance, they have become a people carrier for minor injuries.  Truly a ‘taxi service’.

I’m also told that a lot of the patients that they go to, while happy to see an ECP, also want to go to hospital, ‘just to be on the safe side’.  So once again the ECP is used as a taxi service.

I’d trust all the ECPs I know personally to deal with my family, they are all good people who know the limits of their training.  But how many ECPs will start thinking that they are a doctor?  With over-confidence comes mistakes.

The plan for the ambulance service boils down to this – Keep the number of ambulances the same, but increase the number of ECPs as they will reduce hospital admissions.

All the while call rates are increasing.  And in this litigation happy society we seem to be turning into, it doesn’t do us any favours to start leaving people at home.  It’s why I take everyone to hospital – I’m not a doctor, so who am I to decide who needs proper medical treatment.

As Dr Crippen puts it, “…consider this. If Elizabeth or Phillip, Charles or Camilla, Harry or Wills, or even Tony or Cherie have an acute medical problem, do you think they will see an ECP?”

It seems after some fiddling about, inspired by Hulver, that commenting is back up.  Can someone please leave a comment on this post to see if it *is* actually working and isn’t just on my system?

If it is working, then is seems that one of the little javascript widgets on my sidebar wasn’t behaving properly…

UPDATE: It works! Thank you Hulver for putting me on the right track. Bwah-hahahahaha!

London (soon to be the rest of England) is under a bit of a heatwave at the moment, temperatures of 30C have lead to all sorts of announcments. The Met Office have raised the Heat-Health level to 3.  The next level up is a National Emergency

The advice given is as follows –

Stay out of the sun. Keep your home as cool as possible — shutting windows during the day may help. Open them when it is cooler at night. Keep drinking fluids. If there is anyone you know who might be at special risk, for example an older person living on their own, make sure they know what to do.

When they suggest drinking plenty of fluids I don’t suppose that they mean beer.  So please stop stripping your top off, drinking nothing but pints of Stella and then thinking it's amusing to run out laughing in front of ambulances travelling on blue lights. It's not big, it's not clever and one day my eyes will be elsewhere and it'll be all I can do to wave at you as you bounce off my windscreen...

I’ve also seen news that over the past few days the number of calls described as ‘Collapse’ are up 48%, while calls to asthmatics are up by 13%*

Calls are up all over London – while we’ve gotten used to dealing with 3,800 calls a day, our rate is now around 4,800.  With no extra ambulances you can imagine how busy we are.  Remind me to tell you how we are expected to work without a break sometime.

In my opinion it’s the major failing of the ambulance service – we keep seeing these rise in call rates, yet I’ve never heard of there being more ambulances put on the road.  We need more ambulances and we need them now – unfortunately that isn’t the way our policy makers see things, something that I’ll be posting about in a short while.

*Actual numbers may be slightly inaccurate as I’m remembering them from our work intranet, which I’ve forgottten this months password to.

So I find myself on Saturday and Sunday sitting around with a strange feeling of something being wrong either with myself or with the world in general. It's a difficult feeling to explain, something like sitting with your back to an open doorway - something that puts you on edge.

Then it hits me - it's because the comments system on this blog has been playing silly buggers.

I must admit I possibly wouldn't have noticed if Vic hadn't emailed me, I would have just thought that people weren't interested in discussing 'non-ambulance' stuff.

(By the way, thanks Vic for letting me know - it's much appreciated)

Some people have taken to emailing me what they would have otherwise put in the comments box, but it's not the same. Emails to me don't spark up that reader-to-reader conversation that I love to read. This blog has become so important to me that when it isn't working properly it drives me mad.

So I've been moping around the house, unable to do anything to fix the problem apart from email America. It's partly that impotence that has been annoying me all day. Normally if I have a problem, then I would do something to fix it.

It doesn't help that I've also had a problem with my Macbook's battery at the same time; after calibrating it for the first time it refuses to charge (or allow me to reset the power management unit). So I'm stuck awaiting a replacement from Apple.

Once more, nothing that I'm able to do is immediately able to fix the problem and so I find myself wanting to pace up and down while growling at the people around me.

Just another character flaw.

But at least I'm back to work later today.

From the BBC – (Full story here),

Drink-related hospital admissions in England have reached record levels, NHS statistics show.

Hospital admissions for alcoholic liver disease more than doubled in a decade, reaching 35,400 in 2004/5.

Admissions for alcoholic poisoning increased to 21,700 from 13,600 over the same 10-year period.

The report by the Information Centre for health and social care also highlights England's binge and underage drinking problem.

Problem drinking

Nearly one in four secondary school children aged 11-15 reported that they had drunk alcohol in the past week when surveyed in 2005.

The average amount of alcohol consumed by this age group doubled between 1990 and 2000 and currently remains at 10.4 units (or about 10 small glasses of wine or five pints of beer) per week.

Young adults are the most likely to binge drink - a third of men and a quarter of women aged 16-24 said they had drunk more than double the recommended number of units on one day of the previous week, typically Saturday, when surveyed in 2004.

In comparison, older adults, aged 45-64, are more likely to drink smaller amounts regularly, on five or more days of the week.

Although high, the UK's consumption levels ranked middle against other European Union countries in 2001. Luxembourg topped the table, with its residents drinking an average 17.54 litres per capita per year compared to the UK's 10.39 litres.

But unlike other countries in Europe, the UK's alcohol consumption is still rising.

Well there’s a shocker…

"By presenting this data we hope that health professionals will be better equipped to put their work in context and to raise awareness of the dangers of alcohol misuse,"

We know that alcohol is bad for your health, you only have to spend one Saturday night shift in A&E to realise this.  The problem is that people just don’t listen to us when we tell them.  But it’s alright, it must be alright, just look at all the advertisements on the TV linking drinking to the world cup because can’t watch a football match without alcohol can we?

Oh I give up…

What would be of more interest is finding out why people (the young in particular) feel the need to drink so much.

And if you are wondering – yes I am still tea-total, yes it is hard especially today when my Macbook decides to stop charging the battery and the comments system on this blog goes down and the sun is in the sky and the pub is calling…