My brother and mother are off on (another) holiday to Miami, this means that they have the full 'collection' of all the 'C.S.I.' cities. It also proves that teachers are paid too much.

I can't go because not enough of you bought my book*. I am therefore poor. I hope you are all happy.

Bread and water for my dinner tonight, then down the pub to sup from the drip tray.

What I have been tasked to do by them is to feed the stray cat that has adopted them. This means cycling down to their place every day, as I can't afford the petrol.

On a (very slightly) more serious note - I have no ambulance work until next Saturday, but lots of running around doing writing type stuff. There are even two days of early (6 a.m.) starts.

So today will be spent playing World of Warcraft and watching England most likely lose at rugby. I also think that my mobile phone has broken itself - it must have heard me talking about the iPhone.

I've decided to go to the MCM Expo tomorrow, as that is the day that they hold the talk that I'm really interested in. The one about how to break into comics.

Right - I'm off to kill elves or some-such.

*Although reading the reviews that people have posted does massage my ego nicely.

So we narrowly avoided telling someone 'injured' in a minor RTA to bugger off after he started arguing with the policeman trying to help him out. Instead we distracted him by taking him to hospital so that his bruises could be seen to. If we'd let the man continue he would have really started to annoy the copper.

A nod and a wink to the officer and he was spirited away before his fists started to fly.

My brain is disconnected somewhat because, after my last night shift, I stay awake for the next twenty hours (total time awake will be 34 hours) in order to reset my body clock to 'real' time.

I'm answering emails today - I hope that at least some of them make sense. Perhaps I should put a disclaimer in the signature?

Currently rather enjoying this.

Which beats me crying over this because my brain is currently mush. (If you know where it is from then excellent - if you don't know, I'm not telling you as I don't want to spoil anything).

Why the rapid return to 'real' time?

Tomorrow there is the London Expo, a few things during the week, and next weekend the Mac Live Expo.

Busy, busy, busy.

Can't be sleeping now can I?

While I sleep - a round up of some stories that have been sitting in my brainpan. Some of these were sent to me by readers, do keep up he good work. Please excuse any random kneejerkage - I'm drunk on lack of sleep.

The Healthcare Commission judged LAS as 'good' for both its use of resources and its services - a better rating than any other service in England.

First off, well done to the LAS for being the 'Best in the Country' - this really deserves a blogpost of it's own, but I thought I'd mention it here in case I forgot.

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A union has taken legal advice after ambulance managers posted details of the salaries of call centre staff on the internet.
Ray Salmon, of Unison, said the details posted on the internet included staff members' length of service, their grade, how much they earned, their date of birth, personnel number and what redundancy payment they would receive.

But then WMAS do something a little bit naughty - if you read the article the irony is rather rich, as other staff have been disciplined for releasing information in the public interest. (Begin Snark Mode) Also of some surprise is the sight of a Unison rep for the ambulance service doing something (End Snark Mode).

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A woman who won the title Nurse of the Year from a magazine is to leave the NHS because she is fed up with cuts and reforms.

"what I see as a waste of resources is when I'm sitting in a big meeting, and as a clinician I am the cheapest person there at £35,000 a year, and decisions are still being put off to another meeting."

She's a better person than me, if I were paid £35,000 to sit in meetings I'd probably put up with it. I can't blame her, banging your head against a brick wall wears a bit thin after a while.

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Individuals can no longer be held responsible for obesity so government must act to stop Britain "sleepwalking" into a crisis, a report has concluded.

I'm getting rather brassed off at the growing lack of personal responsibility. "It's not my fault that I'm a heroin addict", "It's not my fault that I'm an alcoholic", "It's not my fault that I kept eating after I stopped being able to see my feet". Apparently the government are force-feeding people like pâté de foie gras geese. Maybe people would like rationing brought back?

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Heroin and cocaine addicts on the government's treatment programme are being given drugs as a reward for clean urine samples, the BBC has learned.

The National Treatment Agency (NTA), which runs the £500m-a-year scheme, admits the practice is "unethical".

Here we go again. I think that there are better treatment options than hooking someone on Methadone instead of Heroin. This seems an awful, awful practice - the pressure of bribery coupled with the pleasure of being able to get high again, just on a government mandated supply. Is it any wonder that people remain on Methadone for years and years? I'm with Theodore Dalrymple and Mao Zedong on this one.

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Nearly 13,000 nurses across Finland are threatening to resign next month in a pay row, trade union officials say.

I don't think that much will come of this, I'd suspect that the union would blink first. Would that we had an ambulance union with that much power in the UK to balance the 'reforms' that the government is forcing on the NHS. Instead we have a union whose idea of representing us is to roll over and agree to everything - including an agreement that new members of staff are allowed to be treated like crap. Of course if we did strike the government would just privatise us all.

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Bloggers are now finding themselves prey to censorship from repressive governments as much as journalists in traditional media, a report says.

At least I'm unlikely to find myself imprisoned because of my blogging. There is always someone worse off than yourself.

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The BBC's online services will be made available free of charge at thousands of wi-fi hotspots around the UK.

The corporation has agreed a deal with wi-fi firm The Cloud, which operates 7,500 hotspots around the country.

I love the BBC, but this is just wrong. Signing up with a private company in order to provide content that I've already paid for with my TV license just isn't cricket. This is also I suspect a way in which the BBC is trying to get around the regulators ruling that people who don't run Windows should be allowed access to iPlayer functionality. Unfortunately, in the same breath they contradict themselves.

From September 7th.

"The BBC Trust has committed to making sure the BBC would meet calls for non-Windows versions of the iPlayer "as soon as possible" said the government statement."

Then October 15th.

Ashley Highfield... "We need to get the streaming service up and look at the ratio of consumption between the services and then we need to look long and hard at whether we build a download service for Mac and Linux. It comes down to cost per person and reach at the end of the day". He added: "We are not ruling it out. But we are not committing to it at this stage."

'Committed' to 'not committed' in the space of five weeks - I guess that the media world is fast paced indeed.

And yesterday, another turn around.

Are the people at the BBC (who still have jobs) feeling dizzy yet?

Essentially it all comes down to DRM - if the BBC were brave enough to offer content without DRM then platform agnosticism would be a trivial problem. But unfortunately someone somewhere has decreed that all content should expire after 30 days. Just like my old VHS recordings from 20 years ago. Because we all know how home taping has killed the entertainment industry.

The people that I know at the BBC are forward thinking, brilliant people. Unfortunately it seems that their management are holding them back. Give these sorts of people some power and you'd easily have your efficiency improvements. I have real sympathy for those on the shopfloor who are going to lose their jobs.

You know - sometimes I should just blog by Twitter posts. Then you too can watch as a man slowly loses his mind over the duration of a single nightshift dealing almost exclusively with drunks, druggies and fools.

One more nightshift to go before a bit of rest.

(Tweets, like blogposts read from the bottom up - Leeisserow asked my why the police don't take the 'drunk and incapable any more).

Now I'm going to sleep, try not to miss me too much.

It's 3 a.m. in the lonely hours of the morning and I'm nervous.

We are in the bedroom of a six year old boy. His mother found him having trouble in breathing half an hour ago.

His airways are so tight that every breath that he takes turns his chest inside out. He is trying to breathe so hard that I'm waiting for his breastbone to snap under the strain.

From across the room I can hear the air whistling through a tiny airway. He has the classic posture of the asthmatic trying to force air into their lungs - he's sitting upright, hands on knees.

He can't cry - he hasn't the breath for it.

I want him in the ambulance. No, I want him in hospital.

But we can't go just yet. The single mother has two other children, both under the age of five and they can't be left alone in the house. They need to be woken up and dressed. One needs to be thrown, still sleeping, into a pushchair.

I'm counting the seconds, I'm waiting for the boy to start turning blue.

I'm eyeing the kit in our bag, how much experience has my crewmate had in intubating a closed down airway?

We are already giving him all the drugs that we can. He's so sick that he quietly accepts the noisy nebuliser mask.

I help the mother dress one of her children - socks and shoes slipped onto sleepy feet.

Then it's time to go. Like all parents she worries about out insistence that we leave the child topless as we walk out into the cold air. It's due to his high temperature I tell her. I don't tell her that it's also so we can easily see that he's still breathing.

For once my big fear isn't a complaint from the mother - it's that the child will die in the back of our ambulance.

I pass the blue call over the radio to prealert the hospital, the radio isn't working too well so I have to repeat some of it. I don't think that the radio operator understands one of the medical terms that I use, it's not their fault as it's pretty obscure. The broken radio means that I can't be sure of the read back.

I don't care, as long as they have the paediatric doctor waiting for us there I'll be happy.

We are 1.9 miles from one hospital, 2.4 from another. I go for the further hospital, the drive is straighter and I can use the A13 which at this time of the night is clear. The other hospital has too many speed-humps and side turnings on the route.

I'm listening to what is going on in the back of the ambulance. My crewmate sounds relaxed and over the sound of the engine is the reassuring noise of the child's breathing.

I glance at the speedometer - I'm hitting 80mph, I didn't know that these ambulance reached that kind of speed. I'm thankful that the road is clear and empty, and that there are no hazards.

I spot the patient's young sister looking at my face in the rear-view mirror, her eyes wide open now.

We pull up to the hospital and I take care of our patient's siblings, I bed them down in the relatives room while the doctors and nurses and mother look after their brother.

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It's only half an hour later that I'm talking with the paediatric nurses - while it looked touch and go for a bit, our patient responded well to the medications that we can't give. His breathing is back to normal.

I love the paediatric A&E nurses at this hospital, they are experts at what they do and despite the cynicism that is endemic in the NHS, they really do care for their patients.

We are chatting and laughing at the memory of our fear. We have fought back against death, and this laughter is our victory cheer.

The family are reunited.

I still have that memory of fear though.

It's getting late in the year, so the nights are drawing in and I find myself driving to work in the dark and making it home again before the sun rises above the rooftops.

At 4 a.m. in the morning I feel like killing myself as my body just wants to shut down. Instead I find myself going to people who have called an ambulance because they have had a nightmare.

There are a few bright spots, an easy home delivery results in a happy baby and family. We save the life of a six year old and think that we've done something good.

But these are overshadowed by the sixty-five year old drunk woman who makes to hit me and tells me to "fuck off" as we pull her out of the freezing puddle. The patient who calls us 'just because' at five in the morning could do with a thump as well.

I'm not eating well, pasta for three days running in order to try and keep my energy levels up through the night, it's not the most interesting food.

The nights are wrecking havoc with my heart palpitations, I'm trying to keep off the caffeine, but I think that the missed beats are my bodies way of telling me that the job is slowly killing me. I'm getting more of them every night.

A station officer tells me that I could always swap to permanent day shifts - I ask myself how I am supposed to survive on a 25% paycut that coming of rotating shifts would mean. From £10 and hour to £7 an hour? For the same work - no thanks.

The job is going down the drain - we are pulled from one directive to another. I hear something that makes me angry - looks like the slow privatisation of the NHS has reached the ambulance service. I wonder how I'm going to write about it, to describe my utter disgust at the idea of 'private' FRU cars.

I waiting to make a mistake that'll cost me my job - will it be my 'attitude' to another wasted call that does for me? Will I be so tired that I miss a treatment or diagnosis? Will I cause a crash in my ambulance? Will it be something that I write on here?

I float around my flat, all enthusiasm drained from me by that 4 a.m black hole.

It's that time of the year again. Maybe I should start thinking about better living through chemistry.

I've mentioned before about the superb care the people of London get in respect to heart attacks. They get diagnosed in the ambulance by a twelve-lead ECG, they will then get taken to a specialist centre for the gold standard treatment of an angioplasty. It is excellent and I love it, it improves the patient's outcome and gives us ambulance crews a warm fuzzy feeling to have done something other than pick up a drunkard.

I've had two such cases recently - both of them men in their early forties, both of them not recognising what was happening to them. Neither of them had any sort of medical history, it had just struck out of the blue. Both of them waited before they got treatment.

The first was an Eastern European chap who'd had pain in his chest since the morning, he'd gone to work and feeling unwell waited until his work was finished before walking to the hospital. It was only when the nurses there did the ECG that it became apparent that he was having a heart attack. We were called to 'blue light' transfer the patient to the angioplasty centre. He'd already been transferred to the CCU, so we also had a nurse coming with us. Like all CCU nurses she was excellent with the patient's care, all the paperwork was up to date, she kept explaining things to the patient to keep him informed and she treated us like professionals.

All throughout the patient didn't want to 'be a problem', he'd agree to anything, offered to help us (including walking to the ambulance!) and when he reached the angioplasty centre he told the doctor that they could 'do whatever they want with him'. He kept apologising that his English wasn't too good, but we muddled along fine.

The Consultant who performed the operation told us that once a patient had been through an angioplasty they normally gave up the smoking that nearly killed them. As this was the only risk factor the patient had, and as he was a really pleasant chap, I hoped he would find the strength to give up.

A really nice job.

The second job was picked up from the patient's place of work. Our FRU was already there and as soon as he saw us he shouted across that the patient would need a stretcher. As soon as you laid eyes on him it was obvious that the patient was having a big heart attack. He was sweating, he was clutching at his chest and he was scared that he was going to die. It was a perfect 'Hollywood heart attack'.

We wheeled him onto the ambulance where a very rapid ECG showed a big heart attack. My crewmate put the pedal to the floor while I tried to gather as much information as possible. The chest pain had started a few hours earlier, but the patient had ignored it and driven to work. He also had a phobia about needles, but the angioplasty centre managed to get the required needles into him through a combination of persuasion and brute force.

It's amazing to watch the screens as you see the blood flow return to the heart when the blockage is cleared. To know that the patient's chance of recovery is very good makes you feel that you have done a 'proper' job.

Both of these patients had a 'widowmaker' - a Left Anterior Descending Myocardial Infarction. These are the sorts of heart attack that can cause you to suddenly drop dead. Both were very lucky, despite their waiting to get treatment.

Both of these lives have been saved - but their outcome would probably be better if they had called an ambulance when they first got the symptoms.

Seriously - don't hang around with chest pain. If it's not obviously a pulled muscle (from lifting heavy objects or from coughing too much) then call an ambulance - the worst thing that can happen is that you get effective treatment quickly, the best thing is that you get a clean bill of health.

Oh - and quit smoking and/or taking cocaine.

As a public service announcement here is the British Heart Foundation description of the symptoms of a heart attack

“The most common symptoms of a heart attack tend to be pain in the centre of the chest which can spread to the neck, arm or jaw. It is often associated with nausea and shortness of breath.

“While women can experience the classic symptoms of a heart attack, they often present with more vague symptoms. These include a dull ache or heaviness in the chest, indigestion like pain, or feeling light headed with chest pain."

You only have one heart, don't take it for granted.

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I have the physical manuscript of the American version of Blood, Sweat and Tea - the one where they take out all the letter 'u's. Every page as a column of red copy-edit changes. I don't think that the copy-editor likes ellipsises much either...

What strikes me as amusing is that the American publishers sent me (by FedEx) the printed out manuscript and want me to send it back with my alterations on it. Wouldn't it have been much simpler, cheaper and kinder to the environment, to just email it to me? They want it back in nine days - for the next four 'days' I'm on night shifts. I'm tempted to just fire off an email saying that they can do whatever they want with it.

Recent news means I get to comment on this again...

Sorry.

In the dumbing down of the NHS, other healthcare professionals are to take over the job of doctors - these people normally have the word 'practitioner' tagged onto the end of their job title. There are Emergency Nurse Practitioners (who look at minor injuries in the A&E) and there are Medical Nurse Practitioners (who do most of the scut-work that House Officers used to do).

Now we have Emergency Care Practitioners who are Paramedics with some extra qualifications who are tasked to go out to out 'minor' calls and dissuade the people from going to hospital.

Research has shown that half of the people who call an ambulance don't need hospital treatment and that only 10% of our calls are 'life threatening'. ECPs are sent out to these 'non-emergency' calls in a desire to stop patients from going to hospital and to cover the lack of GPs providing out of hours cover.

I've talked about this previously, here and here.

But what has me thinking about this again is two recent news stories. In the first a Paramedic has been suspended by the Health Professions Council (on which I shall probably write later) because a young woman died.

The second is that the BMJ report that Paramedic treatment at home is 'viable' (I don't have a BMJ subscription so I can't read the original report).

It is obviously awful that a young woman died, but I honestly can't see that the Paramedic did anything worthy of being suspended. You can read the HPC report here. The patient, who had been having headaches for weeks previously and had been checked out twice and nothing had been found. Then when the patient became worse an ambulance was called and she was taken to hospital. She died five days later.

The Paramedic gets the blame.

I don't think that the treatment that he gave the patient was awful, certainly not worth suspending him in preparation for possibly sacking him. I've heard that he's previously been a damn fine 'medic.

This isn't the point of this post.

The point is that two other people saw the patient, that a hospital saw the patient - yet it is the ambulance Paramedic who is getting disciplined.

This is the tightrope that I walk every day. If I make even the slightest mistake (as in this case, not recording the patient's 'pain score'), then I can easily lose my job. I think that the reason why we are the ones to catch the hatchet is because we are reasonably cheap to train. It would also seem that ambulance trusts want to do anything to avoid bad publicity - so they suspend or sack crews in order to show that 'something has been done'.

So on one hand the government wants us to do more with some extra training (but not the 8+ years that GPs have), yet if something goes wrong we'll lose our jobs.

This government is going to have a rude shock when they realise that there aren't going to be a lot of ambulance staff willing to train up to be an ECP.

There is a simple rule that we tend to follow in order to keep our jobs.

'Take them to hospital'.

By taking the patient to hospital we are avoiding the responsibility if they later die. It is incredibly sad that we need to 'cover our backs' in this fashion, but it's the only way we keep our jobs.

Who is going to want to take that responsibility for another £2,000 a year? I know I wouldn't, and I have my nursing experience to back me up.

We do what we do incredibly well - we deal with drunks, trauma, chronic and acute medical problems. We deal with these by stabilising them and taking them to hospital. We do this very well. A bit of extra training will not turn us into Doctors, and we are fully aware of this fact. We are also mostly sensible people, and the feedback that we have got from the first set of ECPs won't have us running to join up.

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Birmingham was lovely, highlights were seeing Paul Cornell (a writer I greatly admire) speak and watching Alan Davis, Staz Johnson and Mark Buckingham work their astounding artistic magic on flipcharts.

Now I start on a run of four nights. I may be grumpy. Actually, no, I will be grumpy.

There is a GP out there that I'm not very happy with. But I'm not sure what I want to do about it.

Our call was to a sixty year old female who'd had a seizure in the GP office. Now, if you were a doctor, what would you do with someone having a fit? Would you provide the immediate care of giving them oxygen? Would you check more of their vital signs than their blood pressure, maybe even their blood sugar? Once the fit had subsided would you then lay them on the couch in your examination room in case they had another fit? Would you write a good letter to the hospital explaining what had happened? Would you volunteer to talk to the ambulance crew when they arrived in order to provide a professional handover?

Or would you leave the patient sitting in the busy waiting room with the receptionists to 'keep an eye on'?. Would you scribble a letter that had just a blood pressure written on it - no description of the actual seizure, how long it lasted for, no previous medical history or current medications? Would you write that the patient smells strongly of alcohol even when they don't? Would you hide in your consulting room when the ambulance arrives and let the receptionists deal with us?

Guess what decisions this doctor made?

I did challenge the doctor, he hand-waved about 'being busy' (the three other patients in the waiting room were obviously more important than the woman having a seizure). I decided to talk to the doctor about the presentation of the seizure - I'm not entirely sure that he was truthful to me. He told me that she was on no medications, something I later found out to not be true.

I'm sure that he's very good at dealing with sore throats and nappy rash - but surely his medical training wasn't so long ago that he's forgotten how to deal with a seizure?

It's too late for me to put in a formal complaint against him - but should I have done more than been sarcastic to him, if only because I think said sarcasm probably went straight over his head...

I mean, I'm just a big white taxi driver.

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It's Eid tomorrow, so...erm... Happy end of Ramadan? What this means in a more practical fashion for me, as I start work on a run of night-shifts, is that hopefully some of the people of Newham might actually be asleep at night and not calling me. I live in hope.