As is normal these days the nursing home that we went to was 'well known' to us. The patient had the normal 'difficulty in breathing' which I have learnt means anything from a cold to the patient not breathing at all.

As we arrived I spotted two Healthcare Assistants standing outside smoking. "Another ambulance", one of them commented, "This place is a right dump".

I couldn't really disagree with them.

So we made our way up to the patient - no-one was there to show us where to go, again not unusual. Our FRU was already there, he's a good bloke and I trust his clinical skills completely. He'd already done a full assessment and was talking to the nurse in charge. From the sound of the patient's breathing and his high temperature it was obvious that he had pneumonia.

So I asked the nurse how long he had been coughing and having trouble with his breathing.

"Ten minutes", she replied.

Now, you don't need to be a medical genius to realise that his breathing must have been horrible for quite some time. But given the amount of times I've heard that "the patient was fine until five minutes ago" from a nursing home nurse I suspect that there is a whole load of medical books that need rewriting.

The patient was seriously ill, and you don't get like that in ten minutes. My guess would have been that he was unwell for at least a day, yet no-one thought to call a doctor or us until it looked like the patient might die.

Yet again the nurse in charge of his care didn't seem to know anything about the patient, when I asked about the patient the nurse seemed to think that giving me a list of their medicines counts for this. Sadly this is also not unusual. I did my usual trick of pretending not to know what a certain drug does, then ask the nurse to see if they know. It is essential that a nurse knows about the medication that they are giving someone so that they understand the effects and side effects that can occur. Unfortunately in many of the nursing homes we go to this is a rarity.

In this case she was unsure as to why he had been recently prescribed some antibiotics.

I used my 'ex-nurse' knowledge to write a quick entry in the patient's nursing notes - that way nothing can be added after we have left. It's a little trick of mine that satisfies my bloody-mindedness.

So we moved the rather ill patient to the ambulance and while treating him waited for the accompanying member of staff. We waited and we waited, I was considering just driving off. Eventually one of the usual foot-shuffler 'nurses' made an appearance and we left for the hospital.

It's depressing, and I've written about this before, but it's all too common to find this sort of neglect going on in nursing homes. The companies who run these places make huge amounts of profits, yet the care is what I, in fact what most people, would call sub-standard. If the number of people with dementia continue to increase, then more people will need nursing care, and if the care isn't there at the moment I dread to think what it will be like in the future.

Two links to finish off - one is to Inspector Gadget who tells us of a terrible story where two scum who left a police officer brain-damaged have just had their sentences reduced. The other link is to a great work of fiction by Rocky Mountain Medic.

Oh, and hello if you came here from the Daily Mirror.

For those in the UK Panorama tonight has a programme on violent patients in the NHS (BBC One 20:30).

Us ambulance crews are verbally and physically abused on an almost daily basis – it has gotten that we tend to ignore the verbal abuse that we get.  It’s only with the increasingly common physical assaults that we fill in the required forms.

Let me give you an example from my last night shift, a not unusual job.

We were called to ‘woman collapsed in the street’ at gone midnight.  We arrived to discover our ‘patient’ lying under a bus stop with what appeared to be her worldly possessions in a plastic bag.  There was no-one else around except for the minicab driver who had called us from hi office that she had ‘collapsed’ in front of.  While my nose can no longer detect alcohol my crewmate for the shift was able to tell me that the patient smelt as if she had been dunked in a brewery sewer.

A quick check in her bag revealed nothing obviously medically wrong with her (medicalert bracelets or ‘I am an epileptic’ cards).  It did however reveal that the woman had been released from custody earlier in the day.

I tried to wake her, but she screwed her eyes tight and refused to talk to us.  The problem is that we can’t leave her on the street; someone else would call us and we would be back and forth all night.  Likewise if she froze to death we would be to blame and, if she were stabbed later in the night we’d also probably be to blame.  The police also wouldn’t be interested, they have stopped taking people who are drunk, one too many deaths in custody is to blame for this.  So, as she refused to go home or to her hostel, the only place that we could take her was to hospital. 

I was in a good mood, so I explained all this to her, that we couldn’t leave her here, and that if she didn’t come with us the police would probably be called and that they might take a dim view of her drunkenness (a bit of a bluff, but it sometimes works).

So she started to swear at us, she threatened to hit me and she was generally rather rude…

Again, this is all water off a ducks back to me.  At one point she tried to kick me, but I’m an old hand at drunks in the street and by the cunning tactic of stepping out the way managed to avoid a scuffed shin.

Eventually we managed to hoik her up and into the back of the ambulance where, after a bit more swearing, she settled down.

She did give me a dirty look at the end of the journey though.

I would say that I get a patient who is verbally abusive at least once or twice in a shift.  I don’t mind violence from people who are medically unwell (e.g. diabetics with low blood sugars, post seizure epileptics).  But can I really count ‘drunk’ as a medical problem?

I also count myself lucky that I work where I do – unlike the hospitals where people become frustrated by long waiting times and percieved injustice I’m often seen as a friendly stranger who makes everything better.

For further stories of assaults you can look here, here, here and here. Unfortunately these won’t be the last.

Laura and I had an excellent night out yesterday courtesy of the folks at TrustedPlaces. They were celebrating their growth and recent redesign of their website with a dinner and party.

The only problem is that my ears are still ringing from the superb entertainment given by the London School of Samba. Drumming, dancing, stomping on the dancefloor - it was a really fun night. Walid and Sokratis really know how to run an event as it all went off very smoothly; although I suspect that they will be sleeping heavily this morning as they were charging around like loons last night.

It also reminded me that I have been a little slow in filling up my 'Trusted Places' across East London, I really need to write a few more reviews. Of course my reviews seem to concern themselves with people who have died on the premises...

Also I discovered that Laura has an account there - but she won't tell me her username. Although I think I've worked it out...

What they need to do is create an easy way to get information from SMS messaging. I'd like to text a postcode and what I'm looking for and the site to send back the location of the top three hits. While I have internet access on my phone it can be a pain to use, while SMS is very simple (as the success of Twitter shows).

Anyway - Trusted places only works on user generated content, so go and join up. (And apparently if you sign up from this link you automatically become my friend).

And I'm back to work from tomorrow - I wonder who I'll be working with...

As I alluded to earlier in the week, I had a special little day planned for yesterday. The people at the BBC who make the TV show 'Casualty' invited me to Bristol to have a behind the scenes look at the shooting of one of their episodes.

I've been a bit critical of Casualty in the past, the ambulance and hospital staff often do things that drive me crazy - I'd scream, "Why did you do it that way!" at the telly. It's why my mum wouldn't watch it when I went to visit her.

All that has now changed...

The day started badly when I ripped my favourite jacket, possibly due to having to get up at an unholy hour on my day off. The train journey was uneventful with the exception of a 'trespasser on the line' and I was met at the station by the member of the crew who arranged the visit. She then drove me to the filming base and we walked to where they were actually shooting.

Did I mention that it was raining? Not a problem as I'm used to it, but I wondered how the cameras would work in the wet.

*Everyone* on the set was really nice to me - some of them had even heard of me as the BBC has some copies on my book in their library.

The scene that they were shooting was a young man being hit by a van, and the van then crashing into a skip. The ambulance would arrive and take him to hospital. There are some pictures of the shoot on my Flickr page.

And I've even shot and edited together my own humble video (using my cheapish, oldish camera and iMovie).

I met up with a local ambulance crew who were doing a bit of overtime covering the filming, it took about two minutes before we were swapping stories and moaning about patients and they did a good job of looking after me. They drove me to the catering van and explained some of the things that were going on. They also gave me the rundown on what is happening in their trust...

I also met the show's ambulance consultant and he explained how it is a struggle sometimes to get things done right from an ambulance perspective. He gave a couple of examples - for instance, in the van crash in real life we would take the patient out through the back of the van on a long board rather than swinging him out. Unfortunately there just isn't room for the cameras in the back of the van and as it was the crew were racing against the fading daylight. So because of the pressures of filming certain corners are cut concerning the correct ambulance way of doing things.

So now I'm going to have to take into account money, drama, the size of cameras and the sun going down before I moan about an episode.

To be fair, the crew know that it isn't a hugely accurate programme, but at the load that they work under (two overlapping episodes every ten days) I'm amazed that they do as well as they do.

Various things...

• The catering is bloody lovely, I wish I could eat half as well at my day job.
• It takes *ages* to film one shot and moving equipment between shots takes a lot of time. It took all day from 9am to 6pm to film a sequence that will probably last less than a minute in the programme.
• The crew do care how good a job they are doing.
• There was a very scary doll in case the stunt didn't go too well - it wasn't needed in the end because the stuntmen did such an excellent job.
• The producer was roaming around filming things for the Casualty website - I probably made a complete fool of myself.
• Even close-up the makeup is astoundingly realistic.
• 'Real' ambulance crews are the same all the country over.
• There is a real 'Tom Reynolds' in Great Western Ambulance Service.
• On the set it looks like the assistant first director does most of the work - she definitely did most of the shouting.
• In order to keep the amount of rain on the van consistent there was a man who kept spraying it with water.

I've also got to hand it to the actors who play the ambulance crew - after a minutes instruction, a rehearsal and a filmed 'take' they didn't do a bad job at what is a very tricky manoeuvre. (Although I do know why you never see them in the process of struggling with putting their gloves on...) It seems that they only learn how to act out the ambulance skill a couple of minutes before they have to perform. Perhaps I could offer my services to run an 'ambulance boot camp'...

I did have one good idea on the way to the site, born perhaps of not enough caffeine. If they cut the length of the programme by five minutes, they could then use those five minutes to teach 8 million people some basic first aid (and perhaps even when it is inappropriate to call an ambulance). Failing that they could always shorten the National lottery programme by five minutes...

It was a really enjoyable day and I was very impressed by the friendliness and professionalism of everyone involved. I consider myself very lucky to have been given this chance to see filming.

Thank you BBC.

UPDATE: Link added to the BBC Casualty site as I rather shamefully forgot to put one in. (Probably because I wrote this at silly o'clock in the morning).