For those that are interested, some feedback on how Da Book is doing.

Perhaps vindication of the whole Creative Commons thing?

Well... That's the last time I ask for questions, I'm going to spend all weekend answering these. Still, I did promise. Half are answered in this post, the remainder will in the next posting. It's all a bit quick and nasty but I refuse to spellcheck the questions.

(And where did I get some many insane readers?)

Let's begin.

I am starting medicine in September and was wondering how you get on with the medics to whom you hand over your patients, how do you rate your skills against theirs, In what way do they differ? Do medics get a chance to go out with you and see what you do and thus get an idea of what the patient has been through before they get to hospital.

We tend to hand our patients over to the nurses rather than the doctors. While we know that doctors are way more educated than ourselves we do pride ourselves on our 'real world' knowledge which can come in handy sometimes. The LAS do had doctor ride-outs and crews tend to like them because it normally guarantees a quiet shift.

If you were a dinosaur, which would you be, and why?

Want to be or most like? I'd say I'm most like an Diplodicus (or whatever they are called now) - a large, peaceful plant eater with a small brain.

How often do women "come on" to you? Ever gotten involved with someone you met on the job?

Not often enough (as in almost never), and yes - I have got involved with women on the job.

You seem to be slightly schizophrenic. Your blog was originally called "Why I Hate Humanity" :-), and you frequently say in your blog posts that you hate everyone the same.
BUT you come across as a really caring guy, who doesn't hate everyone at all, in fact you quite obviously care about everyone.

This was perhaps going to be a posting on it's own, but I'll touch on it here. When I started writing the blog I was pretty reactive. While writing this blog I've started exploring the thoughts and feelings of the people I write about. When you start putting yourself in their shoes you start to be a lot more forgiving.

Bless your heart, are you going to brave it, forget the shyness, and ask one of your many lady-friends on here out, and get yourself a date?

Nope.

What's your idea of a perfect date?

Can I be rude here...? But seriously, any date where we get on really well.

[On Speedbumps...] So, has anybody ever tried getting the damned things ripped up on the basis that they've been constructed in breach of the regulations?

Are they really? Hmmm, something I'm going to have to have a look into, as I do like causing trouble over such things. It doesn't surprise me to be honest as some of them are simply a row of bricks in the road.

Station supervisor asks if I'm 'up for another beer'

I'm always up for a drink, not a beer for the next couple of months, but definitely drinks in a pub.

If you could meet one person from the whole of history and either shake them by the hand or kick them in the reproductive organs, who would it be and which would you do?

Could I do both? I'd shake Sir Joseph Bazalgette by the hand, and kick either Osama Bin Laden or the bloke who dreamt up religion in the testicles.

If you bumped into a genie and he granted you 3 wishes, what would you ask for?

1) That everyone *knew* that when you die, that is that, no Heaven or Hell.
2) So that when you intentionally cause pain to another person, you feel that pain as well
3) Personal immortality, so I can see all the cool things humanity will think up.

Random acts of kindness and sensless beauty are words from some Daoist text are they not. Are you a Daoist?

Are they? I think I was drunk when I thought up the title... I've read some Daoist stuff, but I'm not one myself.

Do you think your experiences, that you've written about here (and in your book) are typical of ambulance drivers and/or paramedics in the LAS?

Absolutely, It's the feedback I get from my workmates and from ambulance people around the world - that it's the same stuff, just with different scenery.

Do you think your experiences are typical of ambulance work in general (eg, other locations in the UK, other countries, other specialties like Helicopter Air Ambulance or military medic)?

Well, HEMS go on 'sexy' trauma, and military medics probably deal with a lot less little old ladies than I do. I think that they have the advantage in that a lot of their patients are young and fit.

So your book takes off, Hollywood comes knocking, and you get to cast the actor who will play you; discounting Nicholas Cage who already made a middling ambulance/emt movie, who do you choose? And of course there needs to be a leading lady--and she would be....?

Why would there be a leading lady? For me... possibly Jack Dee (not as the leading lady mind you).

How would you like to work in ambulance comms, like us poor folk stuck in this red hot room whilst you have all the fun on the road??

No thanks. (although aren't you air-conned?) I quite like not having my every move watched over and audited by an officer. An I've heard some of the nutters you have to be polite to.

Also, have you ever (or ever seriously considered) hurting someone or delaying their care due to their conduct? I'm guessing that this answer is no since I whole-heartedly believe you would never do any such thing, but you never know.

Considered it? Yes. (More so in A&E), have I ever done it? Not on the road, no. But as a nurse I've delayed stitching up people's heads because they were obnoxious drunks or similar.

Do you think about what you're going to write about in your blog, and how you're going to write it, before you sit down at your computer - or even while the events are actually taking place? I wonder if you have a "running commentary" in your head?

Yep, after every job I sit and think 'Can I turn this into a blog post?', but the actually writing happens as I sit in front of my keyboard, part of the side effect of writing how I talk.

Related question Do you write these things as they happen or store up the "good" ones to keep the blog ticking over?

I make quick 10 word or less notes on jobs that I can write about in Ecto. Then if I'm not at work I can go back and write them up properly.

What new fun item are you going to take up as a way to open up (ie new leisure pursuits) on your off hours?

Between Work, Writing, (new) Social life, Sleep and World of Warcraft I don't have time for any new leisure pursuits.

Do you agree that a 14 gauge cannula is an acceptable means of discovering whether a patient is feigning unconsciuosness?

No - there are better ways of waking people up that don't involve them possibly spraying blood around. A god old fashioned sternal rub works wonders for me.

You mentioned you hadn't cannulated for a few years and declined the offer of cannulating a patient recently (in da book). Do LAS EMT's routinely cannulate or were you referring back to your A&E days?

I was referring to my A&E days. EMTs in the LAS don't cannulate, although they sometimes will under the supervision of a paramedic - mainly for folks who work together for a long time.

Any tips for getting a job? (I'm finishing my nursing course first) I have tried contacting the local ambulance service but I have yet to hear anything from them....

Here you go...

Oh...and how old are you? My friends and I have been trying to guess, but we have no idea!

34. 35 in November.

Have you seen or read "Bringing out the Dead", and what did you think if so.

Seen it and loved it. It's one of the few ambulance films around. Once upon a time I tried writing a voiceover for an ambulance script. It was pretty much word for word the starting monologue for 'Bringing out the dead'. So that is how many targets it hits. And the gradual disintegration of Nick Cage is spot on for working nightshifts.

Who would you prefer to direct the movie of your life? My vote would go for Micheal Winner.

Uwe Boll.

*joke*

Mike Hodges.

Was I wrong to call 999?
Last week an elderly lady fell down some concrete steps backwards right in front of me. There are only four or five steps but she kind of wobbled half way up lost her balance and fell backwards. I saw her bang her head. I did first aid years ago but can't remember much. I went over to her when the fun began! She was deaf! I was extremely concerned because I couldn't communicate with her. After some help from the local cancer shop which we were in front of, we sat her on a chair (I was reluctant to move her immeditely) someone got her some water - (I wasn't sure if this was a good thing???) and I basicially held her hand (inspected her head - wasn't bleeding) and tried to communicate with her (unsucessfully it seemed). I then proceeded to tell the lady that I was calling an ambulance for her because I was concerned for her - she seemed to know what I was saying. Anyway since Im waffling - FRU (I guess) turned up - inspected her, had the same fun as I did trying to communicate (I have now decided to learn sign language) - said she didn't need to go to hospital and instead took her to her deaf club where she had been heading.
I did feel guilty about calling 999 but think I would have felt more guilty not and just leaving her to go on her way.

Nope - head injuries can be nasty and without medical training how can you be sure that she hasn't seriously hurt herself?

Have you chosen not to be a paramedic? I know you prefer to be in the ambulance rather than the rapid response car, is that anything to do with it?

Nope, I'll be going for the training as soon a a course comes up that I can get on. All our ambulances *should* have a mixed para/EMT crew.

Do you think paramedics get better training via the EMT route of the degree route? I reckon the former if nursing is anything to go by.

Six of one and half dozen of another to be honest. The EMT route gives you more experience of working the streets before making you up to paramedic, but it looks like the degree is the way to go if you want career advancement.

what is the ditterence between a paramedic and an EMT?

We do the same job, but paramedics can intubate people who aren't breathing, cannulate and have some more drugs to play with. They also carry the can for anything an EMT does wrong...

I am part of the SJA team that assists out of Oldham & occasionally Newham. How do you feel about us?

I think you are mad for volunteering to do this job for no money, but you do get some nice stadium/event jobs I suppose. Like everyone else I take people as I find them, I haven't got anything against St John.

I've heard you describe you vehicle as a Materni-taxi, and I've seen a couple of mentions of it being used for that purpose, but have you ever had an actual unplanned front room delivery to deal with?

Two or three... They do happy and I don't moan about people who are about to give birth, just the ones who use us as a free taxi...

How can one speak of the outer boundaries of the universe when the universe is infinite?

It's not infinite, it is bounded by the light cone of the Big Bang (give or take the possible fluctuation of physical constants in the forming moment of the Universe). Speed of light * age of Universe = Size of Universe.

Yes, I was a physics nerd.

Are there no paras on the bus/trucks then?

We are supposed to have mixed para/EMT crews on all frontline ambulances.

2) and is that why you've not put yourself forward for para training?

Nope, lack of courses/time/brains.

3) What's the relationship between the crews and HEMS now? used to be sh*t

Not too bad to be honest - we might not like it when they 'stay and play' but when we need them they are excellent. And they make a real effort to be nice to us crews. So it isn't anything like it used to be.

4) Are ECPs still around in LAS (the rumour mill says they've been made redundant and re-employed as paras).

We have ECPs in Newham, but it all depends on PCTs funding them. Remember the big plan is that we get more and more ECPs out there (to cover for GPs and so the government can shut down yet more A&E departments.)

5) Can you guys thrombolyse STEMI patients?

LAS can't (and it would be silly as we diagnose and take patient's for primary angioplasty), but where there are miles between hospitals the outer counties firms do.

6) Are you up for a (non-alcoholic) beer when I'm next in town?

Sure!

In a fight who would win a mars bar or a pot noodle?

Pot noodle, for the reasons that are made in the comments.

Do you enjoy US emergency TV series? And a related questions. Do you ever find yourself watching episodes of Casualty and trying to diagnose things before they do, or shouting at the TV when they do it wrong? And I can accept that on the telly, Casualty, ER, etc have a duty first of all to entertain the public, but is there anything that they get consistently wrong that gets your back up?

I like Third Watch and ER (well, until it became more concerned with the love lives of it's characters). Casualty makes my teeth itch because the ambulance crews (and nurses and managers) don't act like they would in real life. That and too many people survive CPR, too many babies are born to quickly and loads of 'Why are they doing it like that!' moments. This is why I don't watch Casualty...

Has the success of this blog and your book had any impact on your professional life and dealings with colleagues / patients, in either a positive or negative way?

Yep, my mates have something else to rib me about. My patients don't often know about my 'fame', and my crewmates know me too well.

Because I've been 'in school' this week it has felt like I've got a normal 9-5 job. Consequently I've had what some people would call a 'social life'. With the exception of Wednesday I've gone out and met with some lovely ladies. It's been nice having a chance to meet other people (something that is normally quite tricky with shift work). But it's all over now - I have nowhere to go tonight and during the weekend, which is a bit of a shame as I've really enjoyed this whole social thing. Although it will give me time to answer some of the questions that people have asked in the last post.

I'm back to normal shift-work on Monday, which I'm looking forward to but, it has been nice to experience what is normal for so many other workers. It's good to have a bit of company even if it is for only a short while.

So, I'm going to start planning some Blogmeets where bloggers and readers can meet up for a friendly drink. Once I sort out a few details I'll put something up here, but consider this an open call for suggestions.

Ok, something a little different...

Ask me questions in the comments field for this posting. Just leave a comment with your question and your name. If you don't have a reader account (which you can make following the link from the top right of this page) then you can log on as 'guest' with a password of 'guest'. You can leave more than one question, but depending on response I may answer only the first one you ask.

I'll answer them this weekend. Now is your chance to get that burning question to me off your chest.

(Try not to be *too* rude).

I honestly can't believe it, a Friday night and I went to someone who had genuinely been mugged.

Please allow me to explain...

Now, I may be accused of being overly cynical and those accusers may have a fair point, but given the amount of street violence that I see I have come to a few conclusions.

(1) Many people who get beaten up have done something to 'deserve' it. even if it is a stupid, childish or other pointless reason.

(2) As someone wiser than I said, 'For instant a$$hole, just add alcohol' - a large amount of beatings are fueled by alcohol.

(3) Truly 'random' violence is very rare.

This is what gives me confidence when I'm walking down the otherwise frightening streets in the dangerous parts of town during the hours of darkness. I'm not involved in drugs or gangs. I have no bank of 'respect' that I have to protect and, for this year at least, I'm not drunk and combative. This means that it is unlikely for myself to get mugged.

In the three and a half or so years I've been doing this job I can count the number of genuine muggings I've gone to on the fingers of one hand. This is obviously a good thing, I'd rather have frequent jobs to drug dealers who have beaten each other up than to an innocent who has just been robbed. With the former you can turn up and treat them while with the latter there is a distinct feeling that you will feel sorry for them - something that does your 'ambulance street-cred' no good whatsoever.

The poor soul that I attended to had been punched in the face and the criminals had stolen his bag. The local kebab shop had taken the victim in, had called the police and ambulance and had sorted him out with a towel (for his bust lip) and a bottle of water. The unreported kindness of strangers often makes my job bearable.

I was first on scene and quickly determined that while shocked, he wasn't seriously hurt. He'd need hospital treatment for a cut lip and eye, but wasn't in any danger to life or limb.

The 'street crime' squad arrived a minute or two after us, we let them use the back of our ambulance as an impromptu interview room so that they could get a description of the attackers. Two of the team questioned the patient, my crewmate attended to his injuries, meanwhile I stood outside (to give them room) and chatted with the final officer. As is often the case the police were sympathetic and professional.

With the details collected we took the patient and his friend to the local hospital. The problem the patient has is this - as the injury itself is fairly minor, they are often a low priority and are sent out into the waiting room. But I think that the psychological trauma of being mugged should warrant a cup of tea and a bit of a sit down somewhere quiet (not out in the waiting room with the noisy drunks). Unfortunately this doesn't happen because there aren't the resources available and this is a damn shame.

This is why we try to make the transport to hospital as nice as possible, as it's often the last time they'll get proper one-to-one care.

Today in 'school' we had a whole day on 'diversity', while I don't think it taught us East London crews anything new it was more interesting than expected. I have no idea what is in store for me tomorrow.

Only a short post today as I'm up to mischief a little later tonight...

Today in my training course I was reminded about how to deal with mental health patients, how to recognise child abuse and about the new folders we have to build explaining how we are continuing our education in order to get paid. Most of it was refresher stuff although there was an interesting bit about the capacity to refuse treatment. Something I should do a post on later.

There is a reason that I dislike working nights at this time of year, I suspect that it has to do with the love I have of animals. Even squicky ones. During the night, when it is damp, the snails come out. Perfectly camouflaged against garden paths, each one is like a little landmine of guilt. I have size twelve feet, my eyesight isn't the best and each snail that I crush makes me want to weep. I watch them during the day, their friendly little eyes looking up at me as they go on their merry way. Little do they know my unwitting genocide against their species.

I found myself the other night, picking my way through an overgrown garden to attend to an elderly man with a belly ache - nothing particularly serious but his garden path, long and dark was obviously full of snails. Soon to be deceased snails.

So out came my torch and I carefully picked my way between them, my crewmate (hoof-footed fool that he is) managed to splat one of them by accident. After discovering that out patient wasn't too ill my crewmate helped him get his coat and keys while I snuck out in the garden and started picking the snails out of the way of the partially sighted patient. I'm sorry to say that in my eagerness to save as many as possible one died in a 'friendly fire' incident.

The patient came shuffling out of the house and, despite my feeble torch light and my evacuation of as many of our shelled friends as possible, he still managed to step on two of them. Each one was a chain of guilt around my heart.

I know it is strange to post about such things here, but these are the things that go through your mind at 2am in the morning.

(And yes, I know that snails are considered pests to gardeners - but I'm not a gardener, I think I'm a frustrated Jainist - although perhaps not, as I'd quite happily roll some of our 'regulars' into the canal).

Here is the clip of me on Sky News.

The reason behind me looking so laid back is that this particular body posture helps me to relax.  All my stress is in my neck and shoulders, so if I sit forward like most people on the telly then I would tend to freeze up.

Not bad for someone with less than four minutes TV experience.

Due to the timespan of getting me on there, it was kind of obvious that no-one had really read the book, which explains the vague questions that were asked of me.

I’m impressed by the presenter, he not only presents but makes production decisions when the video is running and checks his emails.

(He gets the same spam as myself).

And yes…I was wearing makeup.

With the exception of Midweek on Radio Four on the 20th of September, I think that’s the end of the publicity machine.  It’s been a bloody good laugh.

From tomorrow I’m on a training course, sitting in a classroom for a couple of hours is Hell for myself.

But other things are making me happy.

There is a 'genuine' job that I dislike above all others, and that is someone who has had a seizure in a public place and is now 'post-ictal'. The post-ictal stage of a seizure is the period after the fitting has stopped when the patient can become very drowsy or, and this is the bit I hate, can be extremely confused. These patients can also become violent and very distressed. It's normal and something that we learn to deal with, but I still don't like it.

We were called to a collapse in a supermarket, it's fun to go to these as you try to guess if the collapse is real. Wondering if the person was caught shoplifting, yes, I have a nasty cynical and suspicious mind.

Out patient was a young woman in her twenties, she was being restrained in the first aid room by the security/first aid officer. They could see that she was confused but probably didn't understand why the patient was fighting with them and wanting to walk off. The problem that we have is that we aren't really meant to restrain patients, but on the other hand if I let her waltz out into the traffic I think I'd be getting negative newspaper headlines unconnected with my book.

So we tried talking to her but she was still very confused. A quick check revealed nothing physically wrong, she was just in an agitated post-ictal state.

So we found ourselves essentially frog-marching the poor woman out the door to try and get her into our ambulance, she was fighting us the whole way. Again we aren't supposed to do this, but I believe that we are protected under common law to prevent someone from hurting themselves (something that really needs a post of it's own and some expert advice). She adamantly refused to enter the ambulance but she was in no fit state to be left alone.

Then our angel descended from the heavens.

A girl, about 10 years old, appeared from nowhere. To take one look at her you would instantly mark her down as one of those wasted youth who hang around on street corners. She came over and started talking to the patient, it turned out that she was her next door neighbour. After asking us if our patient had had a seizure she managed to persuade our patient to get on the ambulance where we could do further checks and provide a bit of treatment.

After some talking (and some persuasion from our 'angel') the patient agreed that we could take her home and as she was starting to recover we thought that this was a reasonable idea. It's something we sometimes do - provide a bit of treatment until the patient recovers and then the patient will ask to be either left where they are or to get a lift home. This is one 'taxi-ride' we don't mind.

All throughout our 'angel' was superb, she went back into the shop and bought the item that our patient had originally came out for, then she kept talking to her in order to keep her calm. Finally when we reached her address she made sure that our patient was safely indoors and offered to stay with her until her family returned home.

So because of our 'angel' a very tricky job became much easier and much more pleasant for the patient.

The reason why I don't like these jobs is that all the public sees is us 'fighting' with an aggressive and confused patient and no doubt forms the impression that the patient is either drunk, on drugs or insane. I hate it for the embarrassment that the patient must feel afterwards when they realise what had happened. I hate it because it's such a show we get the maximum number of rubber-neckers and you can hear people tutting as they walk past.

...And yes I hate it because I don't like forcing people into my ambulance.

I've been speaking to a young lady today, looks like I'l be on Sky News in the UK this Saturday at around 11am. Live...

I'm thinking of adding a line to my CV, "Will do TV, Radio, Print, Podcasts, or anything else for a bit of attention".