So yesterday's shift was on the FRU (If you read my twitter updates in the sidebar, you may well get previews of upcoming posts).

Remember - the FRU is only sent to the most serious calls.

So on this shift going to serious calls I went to...

Two panic attacks.
One urinary infection.
One earache.

And that's it.

Nice to know I'm back to normal.

For the second time in two weeks I did a job where we did some actual good. To be completely honest it put my crewmate and I on a bit of a buzz for the rest of the day.

The job stated out as a bog standard chest pain; 41 year old male, pain in the chest radiating down his left arm. He is originally from the Indian sub-continent and people from this part of the world tend to have a lot of heart problems.

It didn't seem like a big job to be honest, he didn't look like he was having a heart attack - he wasn't sweaty, the pain got worse when he breathed in (often a sign of non-cardiac chest pain), he didn't have the 'feeling of impending doom' that is described daily in ambulance training schools across the world.

But he just didn't look right. I have no idea what it was about him, but there was something about him that set alarm bells ringing.

So we popped him onto our carry chair and wheeled him out to the ambulance in order to do a few checks before taking him to hospital.

His blood pressure was high, but everything else seemed fine. As we were preparing to do an ECG (a tracing of what is going on in the heart) my crewmate and I agreed that no matter what it showed we would be 'blueing' him into the local hospital, just based on the feeling we had about the patient.

His ECG printed out and we realised that we wouldn't be going to the nearest hospital around 400 yards away.

There is something that the LAS do exceptionally well, and that is to diagnose heart attacks (properly called Myocardial Infarctions, or MI's). We have good experience of spotting ST segment elevation MI's and dealing with them accordingly. Not so long ago the treatment for an MI was to have a 'clotbusting' drug which worked most of the time and has the possibility of some serious side effects (like bleeding onto the brain and death). Recently, in London at least, some specialist hospitals have been offering 'primary angioplasty' which is a surgical proceedure where a wire is threaded from your groin into your heart and the blockage is cleared manually. It's done under a local anaesthetic and is the gold standard treatment.

So now the LAS will diagnose a heart attack and instead of taking you to the nearest hospital for sub-standard treatment, will take you to the specialist unit for the best treatment possible.

This patient was having a massive MI. Absolutely life-threatening.

He had been waiting for a same day appointment to see his GP about the pain, but as the pain got worse he'd wisely called for an ambulance.

We gave him aspirin, morphine and GTN - good, immediate treatment for his MI, and blued him to the specialist unit.

As we arrived we showed the receiving doctor the ECG heart trace. He told us that, "That's all I need to see, bring him straight through". We moved him onto the hospital's trolley and left him in the care of the doctors while they assessed him for surgery.

Then his heart stopped pumping blood.

He was dead.

Rapid, effective treatment by the doctors restarted his heart within a minute and he was soon asking them if he had just fainted. During this I was explaining to the wife what was happening. English wasn't her first language so she was confused by what was going on.

He was rushed into the surgery room and the doctors asked if we would like to see the proceedure - as we were doing our paperwork we agreed.

An x-ray image of his heart came on the screen as they pumped a contrast agent into his blood to show where the blockage was.

There are two main arteries feeding blood to the heart, one branch of these was completely blocked. The doctor described it as 'The widowmaker'; a severe blockage in exactly the wrong place. This was almost certainly why his heart had stopped beating effectively while they were preparing him for surgery.

We watched as they did a bit of delicate plumbing work to remove the blockage and restored the flow of blood to his heart.

While he will almost certainly survive this episode, I wonder what damage has been done to his heart; the MI causes part of the heart to become starved of oxygen and this can reduce it's function.

If he'd waited the hour to go and see the GP, he would be dead.

If he hadn't called for an ambulance, he'd be dead.

If we weren't routinely trained to recognise MI's and take them to the right place, he'd be dead.

If the primary angioplasty wasn't available, he'd probably be dead.

Everything went right on this call, we felt that we had saved his life (a rarity in this job), and it let us feel that we had earned our pay today.

Another 'good' job.

And our next two jobs were picking up unkempt homeless drunks from the street. It doesn't do to get an ego in this job...

For the medically minded, he had a VF/VT arrest, corrected after two shocks and a complete blockage of the LAD about 3mm from the base.

I'm too tired to post about the good job of today, so instead a short post on our last job.

I called up Control on the radio after dropping our patient off at the hospital.

"Control, I need to return to station to clean out the back of our motor - we've just transported one of our 'local legends'. Is there any infection control policy for patients who are infested with insects?".

"Erm...", came the reply, "Just scrub everything really well".

So we returned, used every cleaning product that we have and then used the ambulance jetwash to hose out the interior.

But I still feel itchy typing this.

UPDATE: I woke up this morning and found myself covered in insect bites. So the itchyness yesterday wasn't imagined. I am f*&%king fuming... And wondering what diseases I can catch.

Two am in the morning and we are standing on the side of the road waiting for the fire service to take the top off the car in front of us. The wind whistles across the flats making us all shiver despite our fleeces and our jackets.

Two cars have been involved in a high speed RTA, the parked car that was hit has been shunted forward leaving ten metres long skid marks. The cars aren't too damaged but the seats inside have shifted around, trapping the occupants.

There are seven ambulances here, four fire trucks, half a dozen police and three ambulance officers with clipboards. There are eight patients, all but one need cutting from the cars and collaring and boarding. The only woman involved is 'walking wounded'.

The reason that it is taking so long for our car to get it's lid removed by the fire service is because of the position of one of the patients inside. He looks rather unwell and the crew looking after him really would like to get to him.

Our ambulance was fourth on scene. When I arrived I spoke to a station-mate to see what he wanted us to do, who he wanted us to look after. Normally he is the station clown, now he's all serious and professional, no fake beards or silly glasses now.

Everyone gets checked over, all the ambulance crews are calm, it's serious but it doesn't look like anyone is about to die; more a case of being careful moving the patients 'just in case'.

The roof comes off the car and with the help of another crew and some firefighters we get our patient out safely and strapped to a board. He is freezing cold. Not wearing warm clothing, the delay in getting him out and the terrible weather has us concerned for his body temperature.

We are in a new ambulance, so the heater works and turning it up to full we are soon sweating ourselves as we assess the patient and prepare for transport.

I get on the radio to pre-alert the hospital - For some reason the radio isn't working properly and our Control can't hear me, so I use my emergency phone instead. Thankfully it works.

I travel a mile over high speedbumps to get to the hospital, there is no other route and every bump makes me aware of my patient in the back being jostled around. It's not the first time that I curse the council.

After all our patients are safe at the hospital we stand outside and laugh and joke. We reconstruct the accident, we talk about the more injured ones and we mock the driving skills of one of the officers.

We occasionally help people.

It's a good job sometimes.

I haven't blogged for a bit so that the last post of mine would be at the top of the page for a while; I think it's an important issue that needs to be discussed in public.

I'm not as thin as I used to be. Come the end of April and I shall be engaging in that thing called 'exercise', my belly is resembling a pot and I get out of puff walking up two flights of stairs. This is not good for a youngish man such as myself.

It's good to see that my own mental image of my body is current though, otherwise I may well have got myself in some serious trouble.

We were called to a 'trapped behind locked doors', we arrived and the police were waiting for the 'enforcer', a ram that they use to knock down doors. Given that she was a little old lady, and that they could see her lying on the floor through an open window they didn't fancy smashing her door to pieces.

"Open window".

I looked at it, it was a very narrow opening but I thought that I would be able to make it.

The thing is; I'm a big kid at heart - give me a door to break down or a window to climb through and I'm a happy soul. It's not so much for the patient's benefit (although obviously I am thinking about the patient) it's more for the fun of the experience.

One of the police found a garden chair that I could stand on, and they eyed me suspiciously as I tried to slide through the window.

The fleece that I was wearing was padding me out too much, so I took it off.

I tried again, this time in was my pen, pen-torch and scissors in my shirt pocket that got in the way. I moved them into my trouser pocket.

One of the police asked if it would help if I were buttered up.

I pretended not to listen to him.

I managed to get my head and chest through the window, then my gut got in the way and there was a momentary fear that I would get stuck in this position, half in, half out the window. I sucked in my stomach and thought 'thin thoughts'. I managed to slip through the window only nearly killing myself in the sink.

I had a little ego boost as, panting heavily, I opened the door so that my crewmate could get in and we could look after the patient who was actually rather ill.

So yes... I need to lose some weight and get fitter than I am at the moment.

Tomorrow I shall be spending the day with Laura, the first chance to see her in a month as our shifts have been opposite each other. A nice trip to the museum I think.

At the moment when you call for an ambulance you tend to get a big yellow van with two people in it. One or both of these people will be an emergency medical technican, the other will be a paramedic or another EMT. Both would have done the training that lets you safely render aid, diagnose heart attacks, perform resuscitation and do all the other things that I have written about here for more than four years.

All this is about to change, and it seems that it is something that isn't being talked about. It is a shameful change in order to save money and meet government targets.

Soon, when you call an ambulance, you will get a 'driver' and a medic. the driver will have been taught to drive an ambulance and to do chest compressions. They won't be able to give drugs, they won't be able to diagnose - their role will be to drive and to lift and carry. This new role is an 'Emergency Care Assistant' or ECA.

The number of properly trained staff on an ambulance will be cut in half.

I can see more than a few problems with this, not just related to plummeting staff morale as we feel less and less valued.

• It is going to have a big impact on patient safety. Us ambulance people aren't perfect all the time - there is always the chance for one of us to have a clinical error; with two fully trained staff there is a good chance that the other will notice if you are about to make a mistake. An ECA won't have the skills to provide this safety net.

• The EMT/Paramedic will have to 'attend' all the time. At the moment most crews take it in turns driving and attending. Especially with 12 hour shifts constantly being forced to sit in the back will lead to a lot of people going sick with stress. There will be no break from patient 'facetime', and given the quality of some of our customers I for one may end up wanting to throw the umpteen drunk out the back of the ambulance. I predict rocketing sickness due to stress.

• Likewise, the ECA will be expected to drive all the time, which may cause some concern, especially if it's on blue lights all the time. Currently if you feel a bit tired or your eyes are sore, or you just aren't in the mood for talking to people then you can switch jobs for a bit. With an ECA this soul saving trick won't be available.

• We get 'tricky' jobs sometimes, where you need the combined brain power of two medically trained staff - and an ECA, no matter how good their intentions are just won't have the medical knowledge needed.

• Our Agenda for Change banding is based around two EMTs or higher working together, EMTs will find themselves in a supervision role and I doubt we'll be getting any more money for it.

• Actually, will our Agenda for Change banding go down as EMTs won't have the responsibility of driving - less skill use would equate to less money.

• Are our newly qualified EMTs going to be made to work with ECAs one year out from training school? It takes more than one year to come to grips with this job, and it helps if you are working with someone who has at least the same level of education as yourself. Imagine being a year out of training school and being forced to work with someone who has no clinical knowledge.

• Related to the above point, it's a bit tricky to learn new stuff from someone who is less qualified than yourself.

• (This may seem a bit harsh but...) To work for the ambulance service you need a certain amount of intelligence, you have to pass the exams in the training course and then prove yourself throughout your first year on the job. ECAs may turn out to be people who aren't bright enough to pass as EMTs, and they'll be helping to look after your granny.

• When another major incident happens, half the people present aren't going to have any training in what to do. You can currently split the crews depending on the situation, so you may find yourself taking a patient to hospital with someone you didn't start the shift with. With ECAs that option has been lost. Also at any major incident you will have half as many medically trained staff as you do at the moment.

• It'll result in less EMTs being employed and is not going to do wonders for our job security.

The implementation of this hasn't helped matters much either. ECAs have been 'snuck in', the unions have been quiet and the first that many of us knew about these plans was when the first ones started turning up on station. It also would seem that our local management don't understand exactly how this new role is going to work; there has been a vague sort of notice going around and it seems that they are getting some sort of 'on the job' training at the moment, but no-one is sure.

With the whole dumbing down of healthcare under this government, this hasn't come as a huge surprise, what has come as a surprise is that no-one is protesting it. It's a stupid, stupid idea and I'm dreading working with an ECA; it's nothing against the people who will be doing the job, but they won't have the training to provide the care that has traditionally been part of the ambulance service.

It's the sort of thing that will have me leaving this job that I love so much.

It's coming up to 1am; and there has been another stabbing, a 'glassing', and two head injuries caused by blunt weaponry.

For the first time in ages I've put my stab vest on. It's a not so nice way to realise that I've put on a bit of weight since the last time I wore it.

We were sent to the 'glassing', but were informed that the assailants were still on the scene so we decided to wait for the police to turn up and make sure that we wouldn't get to be another stabbing...

...Unfortunately it was all for naught as a passing ambulance got flagged down by the victims friends. So there we were, hiding down the end of the road listening to the crew giving details of their 'running call'.

Luckily the assailants had disappeared.

We meanwhile were sent to a man who was so drunk he couldn't stand up. He didn't want to come with us, but it's too cold to leave the drunk and incapable 'patient' in the street to freeze to death. So we dragged him up and went to go to hospital.

The problem I had was that this incredibly drunk man kept pawing at me, then tried grabbing my arse while leering at me.

My crewmate found it all incredibly amusing.

It was at the hospital I discovered one of the weaknesses of the stab vests we are given as part of our uniform. In his drunken flailing around he managed to strike me in the testicles - needless to say I dropped to the ground like a sack of potatoes gasping like a fish.

Thankfully it was 'just' a glancing blow; so it only took half an hour for the pain to go. The patient was thrown out of the hospital by the security staff.

Another normal night in Newham.

Unfortunately.