We have a huge amount of equipment on the back of our ambulances, from the complicated hydraulic trolley, through various splints, oxygen delivery systems, a defibrillator and ventilator to the machine that can measure the carbon dioxide that a patient breathes out.

But it's often the simple bits of kit that are most useful.

We were called as a second crew in order to help them with a 'difficult removal'. It wasn't a good sign when we arrived on scene and had to make our way up four flights of narrow communal stairs to get to the front door of the house. Then we had to negotiate another narrow stairwell to get to the bedroom that the patient, and the other ambulance crew, were.

The patient was one of those 'generally unwell' people - nothing specific and he would need further tests in hospital. The problem was that he was too weak to move - that and his blood pressure was incredibly low. Dangerously so.

The original crew had given him a load of fluid into a vein in an attempt to raise his blood pressure enough to get him out of the house - for some reason this wasn't happening. The crew were concerned that if they sat him up to put him into the usual carrychair the blood would drain out of his brain. This would be a bad thing.

So we put our minds together and decided to use one of the simplest bits of kit on our ambulance. A carry sheet.

A carry sheet is, at it's simplest, a canvas sheet with handles attached. You put the patient on the sheet, all grab a handle and use it like a very soft stretcher. I believe that it is going 'out of favour' because health and safety gurus think that it is bad for our backs. The thing is, out in the real world, you sometimes need to use equipment in an 'unapproved' way in order to get the job done. The need to improvise is just one of the reasons why I love my job.

We dutifully explained to the patient and his wife what we were going to do, then rolled him onto the carry sheet and prepared to carry him out the bedroom, down the stairs, across the walkway, down four flights of stairs and out to the waiting ambulance.

Headfirst.

I would imagine that it didn't feel very safe, four sweating, puffing and groaning ambulance workers carrying you down all those stairs. Narrow stairwells are a complete nightmare when you are moving at three abreast. Then you have to bend the patient around corners. All headfirst in order to keep the blood flowing to his brain by keeping his head lower than his body.

By the time we huffed and puffed him into the ambulance his blood pressure had raised a little.

Fear of being dropped will do that to you.

I'm busy creating a presentation on 'citizen journalism' at the moment for Birmingham on Friday - the problem is that I don't know what my target audience will be, so I'm maybe aiming it a little too low. Stressed. Not good. But at least my knee is much better.

It had been a busy day - running from A to B and back again dealing with some rather unwell patients, so a call to an elderly lady with a cut leg was going to be a nice change of pace.

We'd been told that she had fallen on the bus, but was now at her home. As we pulled up we could see one of the council's buses parked outside, they are used to take the vulnerably elderly to day centres and the like. The pavement was soaked in soapy water.

The driver of the bus met me, he looked a little worried as he showed me to our patient. She was sitting in a chair, her leg was raised and although the bus driver and his mate had used a towel to try and stop the bleeding her leg was still leaking a fair amount. Still it was a fairly simple job - bandage up her leg and run her drive her into hospital where they could properly clean and close the wound.

All throughout my treatment of her, the patient was more concerned with making sure that the bus workers didn't get into any trouble. She was a little bit... 'dotty', which her neighbour assured us was normal for her. She wasn't worried about her leg, nor really about the amount of blood that she had lost (not a huge amount, but it looked like a lot), all she was worried about was the bus crew.

For their part the bus crew had done a lot of good, especially given the fear that a lot of council workers have of being sued when acting outside their 'protocols'. They had made her comfortable, had given her some effective first aid and had cleaned up the pavement and her garden path. They had even brought her shopping in and put the frozen things in the freezer. Given what a lot of other workers would have done, they had acted above and beyond their duties.

And all they were concerned about was that the patient got better.

It's so refreshing to come across some care-workers who actually care, unfortunately it is rarer than I would like.

David Cameron is to announce plans to scrap many of the government's health targets including those on waiting times, the BBC has learned.

Of course not - but one can live in hope...

If we could hold conversations with animals, would we all be vegetarians?

The simple answer would be 'No' - we kill people so why wouldn't we kill animals.

Since recorded history we have invented progressively more lethal ways to kill our neighbours, rather shamefully we have consistently used such equipment upon those members of humanity that are 'of the other'. This killing has gone on for generations despite our ability to communicate with one another. Did the fact that the Nazis and German Jews prevent the Holocaust? Does the shared language in Sri Lanka prevent the killing between the different people? Did the ability to understand one another prevent members of North and South Ireland from killing one another? One final example - the genocide in Darfur.

It is obvious that an ability to communicate does not stop violence.

As humans we have found more and more ridiculous reasons to kill one other, from fighting over resources (oil, gold, water), tribal conflict (Ireland, Sudan) to the craziest argument of who has the biggest God.

This previous criminal history of humanity of a whole lets me believe that, even were animals able to talk to us, we wouldn't stop for one instance in our pursuit of meat to eat. Once you understand that we will kill each other over the shape of the nose, because you own more of a type of mineral or because your God is 'wrong' - is it so wrong to imagine that we would continue to kill in order to live in the fashion to which we are accustomed?

Finally, if we can kill and torture great apes, which have been shown to be able to communicate, for novelty ashtrays and medical experimentation - then what makes you think that we would pay any attention to the cow saying "No!" as it reaches the bolt-gun operator.

This blogpost is an attempt to win a laptop over at Lovetolead - I just need people to go to the site and vote for it. Yes, it would make me very happy to win a laptop. You have all week - Do you need me to beg?

It is funny how you find yourself going to the same people, I'm sure that some form of 'Power Law' applies to patients as much as everything else. while sometimes you can get seeming 'clumps', other times the reasons for the repeat calls are easy to understand.

Take, for instance, a twelve year old boy. He had a history of collapsing at home and at school and previous medical tests had been performed to see if there was some cause for this. When I first met him he was waiting for an MRI scan.

He had collapsed at home - my immediate sense was that this is a family that cares for him very much, nothing tripped my 'spider sense' that there was anything wrong. My own examination of him didn't show anything unusual, his behaviour didn't lead me to think that he had had a seizure. His blood sugar was normal which ruled out him being an undiagnosed diabetic and everything else I did drew a blank.

He'd been to hospital a day earlier and, after a battery of tests, they had discharged him. The tests had shown nothing. I was more than happy to take the boy to hospital, his family were nice and I've developed a 'risk adverse' attitude to leaving children at home.

I later talked to the unit and they told me that, although they could find nothing wrong, the paediatric team were going to admit him overnight for observation.

It was only a day or two later when I got called to him, he had collapsed on a public green on his way to school. One of his teachers was next to him. This time he wasn't moving or talking but a quick assessment told me that he wasn't really unconscious. So I got him up and took him to the ambulance. One teacher went to phone his parents, the other stayed to talk to my crewmate.

Once more all his vital signs were normal and once his father turned up we took him to hospital.

It was only after we put him to the paediatric waiting room that my crewmate turned to me and told me what I had suspected from the first time I saw him. The teachers suspected that he was being bullied although the child would not say anything to them about it. We passed this information on to the hospital and, after checking with the notes of his last visit, the hospital let us know that the paediatric consultant was thinking along the same lines. Various meetings were going to be planned with the school and the social services to fix this problem.

I'm glad that the hospital were taking things seriously, we've all heard of schoolchildren who commit suicide over bullying, so it is important to have support services like this. This isn't the first time that I've seen a child become physically ill due to bullying, I suspect that unfortunately it also won't be the last.

For my part I'm glad that I could provide a safe and reassuring environment for the time he was with us - He might not be physically hurt, but that didn't mean that we would ignore his mental health. It's not all about bandages in this work, and sometimes it's the stuff like this that makes you feel that you are doing the right job.

My bodyclock has taken a right battering over the last few days (for reasons that I *may* blog about later).

Until then I have something to share with you - a caution mind you, it had my mum rolling on the floor crying tears of laughter.

Enjoy

(And thanks to Peter David for posting about it)

I'd never been to the patient before although the person I was working with told me that the household was a regular place to visit. Two people lived there, an elderly man and his wife. He has diabetes and leg ulcers and finds it hard to get around the house due to Parkinson's disease. His wife has quite far reaching dementia although she is physically fitter than her husband.

Social carers come around a couple of times a day.

Apparently the normal calls to this house are for him feeling unwell with his diabetes or for her hurting herself moving around the house.

We arrived on blue lights as the morning carer had called us and told us that the husband had collapsed.

He was beyond 'collapsed', he was lying on his back in the living room, his trousers around his ankles and his entire body was shaking. When I tried talking to him all I could get out of him was incomprehensible grunts and groans. When I tried to touch him he would become combative and try to push me away.

I looked around, the carer had vanished. Unfortunately this isn't unusual and to be honest they often aren't missed.

My first thought was that he had a low blood sugar - a nice easy job, give him some sugar and wait for his gratitude as we 'cure' him.

His blood sugar was within normal limits. This wasn't going to be as simple a job as I'd hoped for.

I did a full examination and there was nothing that would suggest the reason for his collapse or for his confusion. Every time I tried to do something to him whether trying to examine or dress him he would try to strike me, so my examination wasn't perhaps the best.

His wife was alternating between pacing and sitting talking about shoes - thankfully she wasn't distressed. Actually she was quite cheery, I guess that she is used to us folk, dressed all in green, coming into her house and making things better. There was no way that we could leave her at home while we took her husband to hospital, she would have to come as well.

We made the decision that we wouldn't be able to look after both of them, I would have my hands full with my patient and there was no way that I could also keep her out of trouble. My crewmate called up Control and asked for another ambulance to take our patient's wife into hospital.

The second crew soon arrived and took control of the wife while I and my crewmate got our patient onto the trolley. Once we got him onto the back of the ambulance he immediately settled down, it was as if someone had flipped a switch in his brain. We went from wanting to 'blue light' him into hospital with me holding him down to being able to drive normally into hospital while I had a friendly chat with him.

So once more we left the patient at the hospital - the nurses there would also have to look after his wife while they investigated why he had become confused and collapsed. At the end of my shift the hospital's theory was that he had suffered a 'Transient Ischaemic Attack' or 'mini-stroke' which had resolved on it's own.

And they did take good care of his wife.

My knee still aches but I'm not as reliant on the cane, hopefully it'll soon be good enough to return to work.