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.

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...