A double stabbing has just occurred in Newham. Even we ambulance folk are noticing more knife crime. It's probably unrelated to Saturday's fatal stabbing though. Brings the total number of stabbings in this area since Friday that I know of to...

...Five.

Domestic violence is obviously a big and nasty problem; but you know...sometimes you have just got to laugh.

We were called to a case of domestic violence, injuries unknown but the husband was still on scene - so we waited for the police to arrive before us. There are a number of times I'll happily turn up to a job with a chance of violence, but domestic violence gives me the willies. There is way too much chance for very angry people to be carrying knives.

We arrived on scene and I think the police had been there for some time, there was a male shouting, waving his hands and talking into a mobile phone. The police were looking more than a bit fed up with this person.

As we got out of the ambulance it soon became apparent that this male was our patient as he waved a finger in our faces - a finger with the barest of cuts on it. It also soon became obvious why the police were looking so fed up - he was one of those people who simply wouldn't listen to you, he was more interested in running back and forth while ranting and raving about whatever was on his mind.

It seemed that he and his girlfriend had been arguing, he had grabbed her and in return she had bitten his finger. The way our patient was carrying on you would think that his finger had been bitten off. Well...the 'cut' was more like a scrape than anything, it would need a clean and maybe some prophylactic antibiotics, but hardly a suitable job for an ambulance.

After some trouble we managed to get him into the ambulance and warned him that if he didn't calm down we'd throw him out the back. Well, he calmed down a bit, but he was still shaking and ranting when we got to the hospital, but at least the volume was a bit more sociable.

What struck me is that he moaned and cried about his bite wound by an order of magnitude more than the patient who had degloved her finger.

Utter rubbish, but when someone calls for an ambulance we have to go, even if it is for a scrape to the finger.

I've written a review of '300' over on Mental Kipple (my other blog that I really should write more for). Do please read it and let me know if it's useful.

...It is shot very prettily though, a vast majority of the scenes could be printed out as posters, the lighting and composition reminded me a lot of Caravaggio, and the comparison doesn’t end there with the large amount of stabby, stabby and beheadings in the film...

And I've just come back from a viewing for 'Sunshine', which will also get a review in short time.

Blair has been speaking about 'personalised' services,

"Other proposals include introducing more NHS "walk-in" centres, especially in places where there are not enough doctors"

Because, rather than employ doctors to provide primary health care, you can employ less skilled people for less money to provide a sub-standard service. How will this impact the ambulance service? Well if people want to see a doctor, they'll call us to take them to A&E because it's free and they think they'll get seen sooner.
That and we will be the ones providing the sub-standard care, because people will have the 'choice' to be treated at home by an ambulance Emergency Care Practitioner with a bit of extra training. ECPs are cheaper than doctors, especially when the Primary Care Trusts stop funding them and the ambulance service keeps running them anyway.

First off - Go buy this book, huge amounts of the money you spend will go to Comic Relief.
Although Comic Relief on telly gets me trying to hibernate for a whole week to escape it; I suspect that this book is actually a good thing, and funny as well.

We found ourselves going to a woman who had a 'broken finger, bone sticking out'. This looked like it was going to be a pretty simple job, finger injuries are normally pretty simple.

Not this one.

As we entered the room we could tell that it wasn't a 'standard' broken finger. The workmen in the room had wrapped her hand as best they could and then held it above her head.

The patient had completely degloved the finger - her ring had got caught on a fence and had torn the skin off the finger. The skin of her finger was bunched up around the top joint of the finger, held in place by her ring. There was no way that we were going to be able to remove the ring and the skin was white and chalky - what this needed was immediate medical treatment before the tissue completely died.

So we 'blued' her into the local hospital where they cut her ring off and started to arrange transfer to a plastic surgery centre. Unfortunately the first choice was unavailable as they had no beds. So the next nearest facility is actually outside of London; my crewmate and I volunteered to take the patient there and Control agreed. It's nice if you can keep up this 'continuity of care' and I soon found myself driving 28 miles on blue lights to the hospital.

Of course, when I got there I didn't have any idea where the ward we were transferring the patient was - so I asked one of the local ambulance crew directions and he jumped into the ambulance to direct us. The patient was soon safely on the ward, slightly dazed on morphine, and with the best chance that she has (however slim) to save her finger.

The paramedic who helped me emailed me the day after to apologise for not taking us straight up to the ward, but his Control were already on his back. I still find it a bit weird to be 'recognised' if only because people talk to me after I've left them...

I've just spent the last five hours trying to polish 800 words; it's not easy this writing lark when you aren't writing for a blog, but instead for a format you've never tried before.

I think I've got the 'blog post' format down pretty well, but to write for something else when you have never really studied writing is harder than you would imagine.

I'm looking forward to my 'day job' tomorrow, as I can do that job pretty easily.

Over the radio today I heard what sounded like a nasty job. It started as our Control asking for any free ambulances to deal with a 24 year old female who was having a seizure; I couldn't take it as I was dealing with my second 'maternataxi' of the day (waters intact, contractions every few hours).

After dropping off this walking, healthy and not about to give birth any time soon patient at the hospital we heard a crew 'blueing in' a 24 year old female who wasn't breathing.

I don't need to explain how this would be reported in the media as I've written enough about it in the past.

It's still a damn tragedy though.

We have a number of policies concerning the care for patients, what we should do to them and what should happen if we don't take them to hospital. Sometimes we come across situations that fall outside our policies - it's for that we have to rely on our experience and our common sense.

We were called to a sixteen year old with 'learning difficulties' who was refusing to eat. The address seemed familiar and, sure enough, as we pulled up outside the door I recognised that I had been here a few days ago.

On that first visit the girl was complaining of leg pain, she was lying on the floor and very upset. I'm no expert but it seemed that the mental age of this girl was somewhere around that of a four year old. She was looked after by her mother, the father hadn't been seen since the birth of the child. She was screaming in pain and seemed, at first, to be inconsolable.

That all changed as we looked after her, she brightened up and was laughing and joking with us by the time we reached the hospital. The pains in her legs seemed to have vanished. She doesn't have good mobility at the best of time, so it's always hard to assess any change.

So we were returning to the same girl. This time her mother was telling us that she wasn't eating, the girl was lying on the same spot on the floor covered with a blanket and crying. As soon as we walked into the room a large grin broke out across her face and she started laughing. It seemed pretty obvious that the girl wasn't sick.

Her mother told me how the girl had cried when she had to leave the hospital. She had returned to hospital twice more in the last two days, so it seemed that this was a repeating pattern.

It seemed pretty obvious to me that the girl was manipulating her mother so that she would go to hospital where she was the centre of attention. Of course this was all assumption and I wondered if there was any way I could get proof of this.

I get on really well with the receptionists at our local hospital, they are all *extremely* lovely people. So I phoned them up and asked me what the girls previous medical notes said. This is probably going against a whole load of guidelines and protocols, but I needed to know if, by taking the patient in, we would be reinforcing her behaviour.

The medical notes basically agreed with my assessment of the situation - she had told the doctors that she liked being in hospital because, 'home is boring'.

The hospital was arranging for a follow-up appointment with the paediatricians and were also liaising with the social services to get the mother and her daughter the help that they needed.

So after some discussion with the mother we came to an agreement that we would leave her daughter at home, her mother would keep watching her and we would see if it could break the pattern. We agreed to help the mother wash her daughter for bed, even though her daughter was now throwing a 'bit of a strop' as she now knew that she wouldn't be going to hospital.

So she was left at home, a risk for us because if she were to drop dead it'd be us to blame - even if it were for a completely unrelated cause. But I'm of the mind that sometimes you have to be cruel to be kind.

(And kudos to my crewmate - as the female in our party got the job of helping the mother clean her daughter while all I had to do was talk on the phone).

We had another 'returnee' that same night. A twenty year old man who called us with abdominal pain. He didn't tell me that he had been to the hospital earlier that day but had left after ten minutes. I think he'd have a bit more waiting to do after that particular abuse of the service...

Laura is worth £7.52 an hour, I’m worth £10.09 an hour.  This is the sort of thing we have to deal with.

On the plus side we do get to drive down the wrong side of the road.

It's actually a bit of a question the reason why I write this. I know that there are doctors and similar who read this blog and I'm kind of hoping that they can answer the question that I have.

First a little background. Our patient is a 93 year old female who lives in a nursing home; she'd been discharged from hospital earlier this week following a chest infection. Over the past day she had gone off her food and was refusing to drink. The nursing home's GP was called and he prescribed something that scared the hell out of us ambulance folk.

One TSP of table salt, stirred into lemon juice to be taken three times a day.

I'm hoping that 'TSP' is teaspoon and not tablespoon.

Is it any wonder that she is refusing to drink when the next thing past her lips could be incredibly salty. I would also imagine that this would upset her stomach.

I know that if someone has a low amount of salt in their blood it is a problem - but I've never seen it treated in this fashion before. I would actually consider this 'treatment' abuse.

We contacted the LAS HEMS doctor (note their new website, they are even having a go at a blog, although they should get rid of the helicopter sound). He was also shocked by this 'treatment'.

So - before I put in a formal complaint about what I consider an inappropriate and possibly dangerous treatment, I just want to be sure that I haven't missed some brilliant new research that shows giving salty drinks to little old ladies is preferable to the way we normally treat a low salt content in the blood.

There is something about the reporting of this story that makes me think that it is only the police, door staff and ambulance crews who understand exactly what goes on when drunks get violent.

In my view it didn't look much like an epileptic fit to me. It does look very much like a violent drunk struggling for position - I've been restraining people doing exactly the same thing.

But of course, she's a woman and 'non-white', so the usual suspects start making comments that it is a racist attack, and one person compares it to the beating of Rodney King. I'm guessing these people have never seen women 'kicking off' in the centre of town after too much to drink. Just another way some people's perception of reality differs greatly from mine.

Feel free to discuss while I sleep between shifts (as opposed to sleeping on shift, which is tricky and rarely successful).