It has been in the news recently that the BBC has hold of documents showing a large increase in the number of 999 ambulance calls. This is the reason why my phone hardly stopped ringing yesterday as various BBC radio stations wanted interviews. (I had to turn two of them down because I was going to be spending a rare evening with Laura).

One of the reasons given for the increase in calls was the recent British Heart Foundation urging people to call for ambulances if they get chest pain. In my own experience there hasn't been a huge increase in calls due to this, I suspect that the LAS has the official figures, but in my area people don't need any encouragement to call us out.

When I started working for the ambulance service we would get around 2,500 calls across London each day - now it isn't unusual to get 4000+. While a government spokesperson says that there are more ambulance staff than in the past (which is true), it doesn't follow that there are more ambulances. Ambulances which were covered by staff on overtime now staffed by reliefs.

I don't think that there has been an increase in the actual number of ambulances in the last fifteen years; yet we have increasing call numbers and our ever expanding role.

I would say that there are a number of reason why there is an increase in calls.

• The lack of GP services 'Out of hours', since GPs were allowed to stop covering out of hour services the quality of primary care during the hours of darkness have plummeted. Due to decreased GP cover we are going to more and more 'primary care' situations, jobs that would normally be under a GP remit.
• The increasing 'I have the right' brigade - people who know that they have a 'right' to an ambulance as a free taxi to hospital. All thanks to the 'Patient's Charter'
• People want healthcare when they want, rather than when it is available. Waiting for an appointment to have your foot wart removed is such a chore, you want it off now? Call an ambulance to take you to hospital.
• A general lack of education - a simple chest infection in an otherwise healthy person isn't going to kill you; but some people do believe that a cough is something life-threatening.
• A lack of magic cures - I've lost count of the number of people I've been to recently who have seen their GP for a chest infection, have taken two of the prescribed antibiotics and yet they aren't feeling better. Then they call an ambulance. Here is a hint - there is a reason why there are 28 tablets in the pack...
• Increased population, more and more people are living in smaller places, buildings are being thrown up all over London, yet there isn't a corresponding increase in healthcare provision. And the government is closing two A&E departments in our area, because, you know, they are full all the time.
• 24 hour licensing, I know it's an unpopular view in some circles, but we are going to more drunks, and alcohol related calls than ever before.

One of the problems is that we are trying to solve all these problems by throwing ambulances at them. We are covering for reduced GPs by implementing ECPs (Emergency Care Practitioners, GPs on the cheap). Who is going to want to get an appointment for a GP when you can dial 999 and have someone turn up at your door when you want. We aren't refusing ambulances to people who don't need them, partly for fear of being sued or making a mistake. As a whole, health education in this country is dreadful - barely going beyond 'safe sex' and 'stop smoking' messages. Drunks in the street are going to a nice friendly A&E department rather than a less comfortable police cell where they are charged with an offence.

Part of it is that we are mollycoddling people for fear of being sued, and having bad press. If the ambulance service continue this way then I can't see things getting any better. Because of the lack of funding from the government we are having to change the way we work in order to meet those useless targets; this will lead to problems with patient and crew safety - but that is a post for another day.

Without a sea change in society as a whole and in the funding and measurement of targets in the ambulance service, despite the LAS' best intentions, things aren't going to get any better.

The BBC news forum has some hilarious comments (and it does point out some of the weird ideas that people have about the ambulance service).

As I type this there is an *awful* segment on blogging on the BBC breakfast news.

I reckon I'm going to have two complaints put in against me this week. Not from patients, nor from relatives, but from random members of the public.

You see, I've been 'rude' to two of them.

Take the first one. We were called to a teenager who'd been run over by a car, he had quite a nasty injury that threatened the health of one of his limbs (I'm being deliberately vague for various reasons). So I parked in the road as there was nowhere else to park that wasn't on top of his head. We did a few bits at the side of the road, then scooped him up into the ambulance. We then had to do a lot more 'stuff' to him before heading off to hospital, partly to stabilise his injury and partly to make sure that his big obvious injury was indeed the only thing wrong with him.

I then hear a knock at the back door of the ambulance and, thinking it's the police, go to have a look.

It's the driver of one of those big stretch limos - the sort of things that are hired out by hen parties. He wants me to move the ambulance so he can drive down the street.

I try to explain that I've got a seriously ill patient in the back of the ambulance, and that it needs both of us crew to look after him. I say I *try* to explain but the man won't let me get a word in edgeways - he just wants me to move because he has 'kids and their parents' in the back of his limo. I tried to explain, but he just wouldn't stop talking at me. I'm conscious that my crewmate may need me in the back of the ambulance. Trust me, I'm not being purposefully obstructive.

Well, the red mist starts to rise at the corner of my vision, so I tell him to (and my exact words are), "Shut up!"

"That's a bit rude", he says, and then draws breath to moan some more, but I interrupt him.

"Yes! I know!", and I then storm back into the ambulance to deal with my patient. (I may have flounced back into the ambulance, my arms do get a bit flappy when I'm angry).

The limo driver then miraculously manages to squeeze his huge vehicle past the ambulance despite my not moving.

The second one was last night - the ambulance bay at the Royal London was packed with ambulances. It also had a bloke in a private car parking in one of the bays. I'm trying to park so that the 18 month old who has just had a fit can get in to the hospital to see a doctor. This car is blocking my way, and blocking the ambulances who may want to get out for another job.

"Excuse me sir", I call after the driver, "You can't park there, it's for ambulances only".

"Where am I supposed to park", he shouts back at me.

"Well sir, if you go around the back of the hospital you can park there".

"But then I'll have to walk", he shouts back.

I note the 200 yards he'd have to walk.

"So", I shout back at him, "You ignore the big 'No entry' sign, the big writing on the floor that says 'Ambulances Only' and stop me from being able to park my ambulance THAT ALSO HAS A SICK PERSON IN IT!". My arms may have got a bit flappy as well.

He turns around and heads into the hospital. I'm not sure that he heard the shouted "Pillock!" after him. I thought long and hard about putting a brick through his car window. I decided not to.

Needless to say this was highly amusing to the other ambulance crews in the area.

I wouldn't mind but I'm normally very placid. And again this person could put in a complaint against me and I'd have to defend myself to people much higher than me in the ambulance management food chain. Remember, my only complaint against me so far was from someone who assaulted me and was horrified when I told him that he 'slapped like a bitch'.

But I'm only human.

I wonder if it's anything to do with the negative pay 'deal' we'll be getting or the proposed new 'unsocial hours' payments which will probably end up screwing us over for the next couple of years.

Just picked up a patient who appears to be having a nasty reaction to 'Picolax' which is a laxative used to prepare the bowel before a colonoscopy.
I've given a fair amount of this stuff in my previous life as a nurse and can't ever remember anyone having this particular reaction.
As we took the patient into the hospital we were met with disbelief - the patient in the next bed had exactly the same symptoms from the same use of the drug.

Weird.

It's currently being reported to the people who look after this sort of thing under the 'yellow card' reporting proceedure. Perhaps it's a bad batch, both patients were given the drug by the same hospital, maybe it's just a coincidence.

I wonder if there will be any more this shift...

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Sent from a mobile phone, probably from the cab of an ambulance.
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Expletive Deleted.

Isn't it nice to be valued by the government? Pay rises below the rate of inflation which are also staggered which effectively means that my standard of living is set to go down.

Crap conditions, increasing demands, moronic running of the NHS and increased expectations with no increase of resources. Lies from the government who took money away from the ambulance service that made it's (worthless) targets. A screwing over of our new members of staff giving them barely liveable wages for years. An expectation to work harder, an expectation to increase our scope of practice and all this leading to increased danger to staff.

It's enough to make me want to strike, and I'm hardly militant. Makes me feel so happy to go to work this weekend and pick up drunks all night while the MPs sleep safely in their beds. Makes me want to punch someone... preferably someone in Westminster.

All I want is the same value money I had last year - now it's worth less.

Which is how I feel.

(And breaking news is that London Underground workers are getting a 4% pay rise. Maybe striking does work)

*This is all assuming that ambulance pay is in the same general area as other public service workers, something that I see no reason to be otherwise*

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...