It was the milkman that missed her. The milkman who phoned the police and told then that he hadn't seen her for a few days.

The police were already there when we arrived. The house was secured, the battering ram was fetched and used on the wooden door. A panel popped out and we were able to enter.

She was lying face down on the floor, old and naked and unmoving. One look was all it took to realise that she was beyond our help.

So we stood over her body. The police and us, trying to make sense of her death. Was she an alcoholic? There were a few drinks bottles around the place, but not the 'usual suspects' of strong lager or cider. Was it violence? The only marks on her body were from where her blood had pooled. Was it suicide? There was no note, no empty pill packets. Ill health? We couldn't find any medicines.

It looked like she had just died, in earlier times it would have been called 'old age'. Now, probably 'cardiac arrest'. The result the same, the heart just runs out of beats.

Her front room was cluttered with her belongings, the doors at the top of the stairs were secured. The police entered them, there was nothing there except the hints of a long lost husband, a man's coat, the hospital appointment card in his name, the bedrooms covered with cobwebs.

Downstairs then, that was where she lived and slept. Ate and drank. And drew.

The walls were covered with her drawings, beautiful colourful pencil drawings of all subjects. She had an eye for the human face, she obviously liked to draw wildlife. Everywhere you looked there was a small colourful picture, out of place in this dark and crowded room.

An unfinished drawing rested on a table.

And at the bottom of each drawing her signature.

We joked with the police, especially the probationer. We chatted and did what we needed to do, the paperwork, the reports, contacting the coroner. We looked through her papers, to see if there was someone to contact, or some reason for her death. To the outsider our chat would seem disrespectful, but to us it's just life, another one gone soon to be forgotten as we move on to our next job.

Still she lay on the floor, we couldn't move her until the coroner came.

But my eyes weren't on her, her bare flesh, her outstretched hand.

They were on her drawings.

After two days of meeting good Social care managers and GPs, what else should I find today but a superb pair of Social workers.

Blimey! It's enough to have you regain your faith in human nature.

Quick nurse! I need an injection of cynicism.

Two consecutive days at work, both starting and finishing exactly the same.

Both days start with an early morning call to a 'maternataxi' which, while I moan, is a nice way to ease into the day. Especially at six-thirty in the morning.

Both days ended pretty much the same, but that's not the remarkable thing about it.

Both calls were to GP surgeries, both patients were men in their fifties and both were suffering from a chest pain that could have been cardiac in nature. Both had been feeling the pain for eleven hours.

Both men were also in high risk groups, one a slightly overweight Asian gent with diabetes, high blood pressure and high cholesterol. The other was also overweight and had previously had a heart attack and regularly suffered from angina.

But this coincidence of time and illness wasn't the surprising thing. I'll tell you about the GPs and regular readers will soon realise what is unusual.

The GP of the first patient still had the patient in his consulting room, he'd started treatment by giving the man an aspirin, which is really rather important. As we entered the room the GP apologised for not having an ECG. He had also phoned ahead to the hospital to prepare the medical team for the patient. I explained that we would do an ECG in the ambulance and if the patient was having a heart attack we would take him to the cath-lab for immediate angioplasty. The GP didn't know that we could do this and asked if he could see the patient's ECG once we'd done it.

When we showed him the normal ECG, the GP apologised for calling us out. I told him not to be silly, as he'd had a good suspicion of the patient having a heart attack and had started the appropriate treatment, and that this was remarkable.

The second patient was also lying in the GP's consulting room. In this case, not only had the GP given the patient an aspirin, but they had also done a ECG. Not only that, but there was a typed note with the patient's medical history on it, and were in the process of phoning the patient's wife to let her know what was happening.

Compare this to the usual GP situations I find myself in.

These separate GPs had made completely reasonable diagnoses and had started treatment. This, rather shamefully, shocked my crewmate and I. We are much more used to attending to 'heart attack' patients that are sitting out in the waiting room, haven't received any medical treatment and are clutching a roughly scribbled letter addressed to 'Dear Doctor'. That, and the GP will be hiding in their room.

Two days on the trot, two superb GPs. What with yesterdays post, I may well run out of things to moan about.

Well, I can have a slight moan, both GPs booked their patient into a hospital far away from our station, thus making us late off home - but you can't have everything. After all it was the closest hospital to the surgeries.

Can I mention, for no real reason, that Medgadget have opened the nominations for the best Medical blogs for this year. No reason at all... Nope. None.

It's sad I know, but in all my years working in healthcare I've never met a social services person who filled me with confidence. I'm sure that there are thousands out there, but it's just that they seem to hide under the table whenever I'm around.

So it was a real pleasure to meet a social care manager who actually gave a damn.

We were called to our patient, a woman in her 80's - let's call her Doris, by the social care manager.

The reason for us being there was to look at Doris' leg. One of them was described as 'black', and as we travelled up to the flat I wondered what I would see. I was grateful when it turned out to be lipodermatosclerosis, a condition where, due to problems in the veins of the leg, te leg turns dark and 'woody'. It's something I saw a lot of when I was gadding around with the district nurse service.

It's a chronic condition, and one that the Doris had been suffering from for some time. Unfortunately Doris is a little confused sometimes and so couldn't explain how long she had the condition.

Also in the flat with the social care manager was Doris' day helper - a carer who comes in three times a day to help wash, dress and do the little things around the house that need doing. I could tell that the social care manager wasn't too impressed with her, partly because of all the notes she was taking and partly because she told us so on the lift ride down.

The care manager had called us because (not being medically trained) she wasn't sure why Doris' leg was a funny colour. I also don't think that she particularly believed anything that the carer said about it.

The care manager also made a note of the heating of the flat, the rather shoddy windows, and tried to persuade Doris that she might enjoy visiting a day centre every so often. On the ride down in the lift, after Doris had told us that she didn't want to go to the hospital, the care manager explained how she hated that particular 'care' supplier, but that her hands were tied in that she could just select another one.

She also explained how she would need to 'be creative' in order to get Doris the care that she needed.

All in all I was impressed by the enthusiasm that she showed to her job - it was a real refreshing change and I left confident that Doris was in good hands.

It's getting to be that time of the year again, the time of Christmas parties (drunks), Work parties (drunks), grannies who hit the port a bit too much (drunks), people depressed and drinking alone (drunks) and the people who are stone cold sober and have to deal with them (us and the police).

November was the busiest month in the history of the London ambulance service. It doesn't help that there is a grotty chest infection going around at the moment that has made a lot of ambulance crews feel particularly unwell in addition to increasing the number of calls.

December seems to have continued in the same vein as November, we start the shift and seconds later hit the streets, rest-breaks aren't being given and a new computer system to aid dispatch is making us dizzy.

I'm obviously a glutton for punishment as not only am I working the nights of the 24th-28th of December*, but I'm also doing a bit of overtime on New Year's Eve night.

On foot.

In Trafalgar square.

With two St. John ambulance people to help me.

I also get a new title - 'Forward Incident Team', or FIT. I think I'll need to be as I need to carry all the kit that I need with me for twelve hours**.

But it's not all bad working over Christmas, I get to sleep through the Queens Speech and the Bond film. I might get to deal with the more humorous 'topical' injuries ("How did you get the bauble stuck up there!?"). If it goes the same way as every other year I've worked it there will also be some horrific tragedy, there normally is this time of the year, either someone dropping dead or killing themselves in front of the kids.

There is one particularly poor showing though - I work in a hugely Islamic area, but the rotten sods all close their kebab shops for Christmas, so I'll end up starving. It's not as if Muslims celebrate Christmas, do they?

There is one slight glimmer of hope - that of the patient or relative offering you a small item of food.

We aren't supposed to accept 'tips', but the odd chocolate or mincemeat pie isn't seen as a problem. And who's to know?

Of course you do need to do a rapid assessment of the situation. Accepting any food that comes from an opened packet needs you to look at the hands of the people who've been eating the other items of food. If they rub their hands against their brown-stained trousers, I wouldn't accept.

Likewise food from the crack-house you've just resuscitated someone in is probably not that clean.

Actually, food from resuscitations are a bit tricky all round, as you may feel you are being rewarded for 'polishing off' gran. Or they may just be offering you the portion that their dead relative was about to eat.

It is rather rare though, which is why a recent job surprised me. We were sent essentially as a transport service to pick up an elderly lady who needed some hospital treatment. We go there to find her daughter already present, it was obvious that this would be a job where the most we would really be doing would be having a chat with the pair of them.

So we were both pleasantly surprised when the daughter (who, again, isn't the sort of person to be celebrating Christmas) gave us a box of chocolates.

It was such a nice gesture that it put my crewmate and I into a brilliant mood for the rest of the shift.

So - like last year, please consider your local ambulance crews. If you are near a station why not send a card, or a box of chocolates as a thank you for us being there when you have the world's worst day. And we are there 24 hours a day, 7 days a week, 365 days a year.

Except me - I'm trying to lose weight.

*Not by choice, and my regular crewmate has been lucky enough to get them as annual leave.
**For which I can only say, "You've gotta be kidding" before offloading it off onto my St. John teammates.

As spotted by Mr Ellis

Also, please note - the competition still has a few days to run. Get those entries in now, and yes, you can enter more than once.

Night-time in London.

I'm carrying our equipment down to the river. From this distance I can only see it as a dark ribbon against the lights of the city. It's choppy, so the lights don't reflect, it looks like ink.

The wind cuts right through my hi-vis jacket and the fleece I'm wearing underneath it. We are following a marine policeman down the steps into the dark.

We have two patients, both of which have spent time in the freezing Thames.

The boat that they both were on is docked next to them. Police and firefighters are already there, they have done their best to dry the pair off - our patients are wearing borrowed hi-vis jackets - ones that say 'Police'.

It was an accident - our first patient didn't mean to go swimming in the Thames. Our second patient did.

The first man had been on the boat enjoying a cigarette, he was leaning against the railing when he felt something 'give way'. Down he went into the Thames. Cold and dark, with fast currents and who-knows-what diseases.

The second man? Young, I'd wager not long out of school. He works on the boat, when he heard the shouted alarm he dived over the side of the boat. He was the one who kept the first man afloat while the cold sapped his muscles.

The first man - so cold he doesn't shiver. We work on warming him up, on not stressing his body. He'll get rushed to hospital on blue lights. He'll be fine, but I don't think he realises how close to dying he came.

The second man - standing by the heater, trousers off and borrowed jacket wrapped around him. He doesn't want to go to hospital - he quite fancies a warm shower at home though. I check him over and declare him fit to refuse treatment. I tell him that he probably saved the other man's life. He waves it off as if he doesn't believe me.

Every uniformed service there thinks that the second man should get a medal.

I look at the pitch-black freezing water churning against the dock.

And agree.

It's that time of year, and those length of shifts, where I'm finding it hard to motivate myself out of bed - let alone blog. So if my postings get a little sparse I apologise in advance. Oh - and I also have a book I'm supposed to be writing...

I've reached that point in my blogging career where if an ambulance story is in the media I'm phoned up to provide comment.

So this BBC article about solo responders and the concerns about using them so extensively has already had me woken up by one newspaper.

I don't mind - after all it's something I've been shouting about on this blog for ages. Please remember though that I'm just a worker on the road, if you want real information you should talk to the LAS Press office 020 7921 5113 (and who are a bunch of top folks by the way).

Still it is nice to have something that I'm concerned about in the news. For more on this subject you may want to check out the following links.

A simple description of ORCON (The government target we are desperate to meet)

Why I think that splitting crewed ambulances to man solo responders is a bad idea for patient safety.

Where I describe the plan to increase solo responders and decrease double crewed ambulances. (I'm a lot less enamoured of the idea now than when I wrote this).

One concern for staff and patient safety that often isn't thought of.

Where I moan about some of the hoops we have to jump through to get our targets - but the comments section has more information.

My solution to the 'target' question that will actually benefit patient care.

To summarise things as I see them (and remember - these are my views alone, not those of my employer).

The government wants to measure the performance of ambulance trusts. The main way of doing this is to see how many of our 'high priority' calls we get to in under eight minutes. There are often more calls than there are ambulances, so solo responders effectively double your workforce with respect to reaching this target. Once a responder reaches a patient, the clock stops.

Solo responders can't safely transport patients. They also are unhappy to leave people at home because they are scared they will die. Solo responders therefore can spend a lot of time at scene waiting for a double crewed ambulance to arrive.

Sick people need to be in hospital - it is better to get there in nine minutes and be able to transport them than to get there in seven and have to wait half an hour for a proper 'truck'. The government does not agree.

The eight minute target is from research over 20 years old - and it only deals with cardiac arrest patients, not with 'high priority' calls. The department of health has no copies of the ORCON paper on record -although there is one in the British library. Modern research says that eight minutes is too long to get to a cardiac arrest.

Although our ORCON response percentage in London is roughly the same as has been every year, our cardiac arrest survival rate has more than tripled. Doesn't this show that other initiatives (which aren't tallied up by the government) are far more important?

Getting to patients quickly is never a bad idea, but in concentrating resources on solo responders at the expense of double-crewed ambulances I firmly believe negatively impacts patient care. Sick people need to be in hospital.

In London we are about to start running community responder posts - first-aiders from the public sent to calls. This is so deeply wrong that I can't get my head around it. Again I suspect that this is to help us meet these targets. It's not like we are in the wilds of Scotland where it physically takes you an hour to get from one place to another.

This is just the beginning of the discussion - the plan is to have all but the most serious calls (like confirmed cardiac arrest) attended to by just a solo responder, a double-crewed ambulance won't be sent - once the solo is on the scene they will make the decision as to the patient needing an ambulance to transport them, or if they need a GP, or can make their own way to hospital.

The simple solution is that we need more ambulances and more ambulance crews - but the government won't reach into their pocket and give us what we need, so instead the ambulance trusts have to make these difficult decisions.

It's not the ambulance trusts fault that we are heading down the solo responder route - it's purely the government's focus on this out-of-date target and lack of motivation to give us the funding we need to continue giving Londoners the care that they expect.

Oh and people call us for utter rubbish like veruccas - which is why we are under so much strain at the moment.

I'm hoping that this will run and run and might cause some form of change - unfortunately I suspect that this story will soon be ignored because of some celebrity drug 'sensation' or we find someone else who has faked their own death.