I spent twelve hours working a night shift, picking up drunks and druggies. Then I had four hours sleep, travelled in to the Apple shop to see a genius. Dealt with my computer then went back to work for thirteen and a half hours without a break, once again dealing with drunks and druggies.

I am having a sense of humour failure.

The previous night had us going to the same drunk twice.

"I vomit", he says in a thick Russian accent as we drag him out of an alleyway. He then spits on the floor, no sign of vomit.

So we take him to hospital where they check him out (even though he is apparently a regular) and discharge him.

A couple of jobs later we are called to him again because he is 'unconscious in a bush'.

Once more, our only real option is to return him to hospital where he settles down to sleep in the waiting room. He isn't homeless, he just gets drunk in the street.

So... Guess who our first patient is on the following shift.

This time I'm so annoyed I call the police on him, they move him along (whatever happened to arresting 'drunk and incapable' people? I'm guessing that they have run out of cells).

The big question will be... Will I see him again tonight?

(Actually, the big question is rather, 'Will he survive seeing me again tonight?').

My laptop will take 7-10 days to repair; which is hassle I could do without. What makes it annoying is that I'm busy over the next week or so, and could have done with it to keep my life in order.

I'm going to have to use my old windows laptop in the meantime as the old Mac that I'm using to type this has a flaky wi-fi adaptor that only works sometimes.

Last night was very busy, I nearly run out of room on the paperwork to list all our jobs. We also had the pleasure of a 'late job'.

Picture the scene, after eleven hours of work without a break we are looking for an 'off job', something nice and simple that means we are at hospital when the end of our shift rolls around.

We get a perfect job sent to our screen, a not seriously injured child, not far from the hospital - it'll do us just fine.

Except, as we arrive on scene we get cancelled for a 'higher priority' job. A transfer from one hospital's ITU to another hospital.

So we turn up and wait an hour and a half for them to get the patient ready for transport. They faff around with lines and drips and photocopying notes while I stand there and watch the minute hand of the clock drift past the end of our shift.

Finally we are on our way, so we whizz to the hospital, off load the patient and then watch as they faff around even more before returning the equipment and travelling doctor back to us.

An hour and a half after our twelve hour shift finishes and I'm falling into my car for the drive home.

I'll be back in ten and a half hours.

For more of the same.

Will the people of Newham survive?

My Mackbook’s hard disk has died, which means buying a replacement.  Luckily most of my stuff is nicely backed up.  It’s still a headache I could have done without.

Especially since last night I spent most of the hours of darkness in the bathroom with liquid coming out of one, or both, ends of my digestive tract.

Which is why there is no decent blogpost today.

Sorry.  I’m back off to bed.

UPDATE: This also means I'm pretty much without email, because going through 300+ mails that I got overnight via a web client is enough to make my eyes fall out of my head.

I've spent all day clearing my Inbox of unreplied to emails - If I ever let it get like that again, somebody shoot me. If you have been expecting an email from me and didn't get a reply, then I send my apologies and advise you to resend your email.

For those that are interested about joining the London ambulance service... We aren't recruiting. Sorry.

In a fit of 'doing things', I've signed up on Livejournal, Facebook and Myspace. I'll happily accept 'friends' from anywhere, but I would ask that you tell me a little about yourself - there is a bit more on this over here. I'm still playing around with them, as well as wondering what kind of content to put up on there, chances are that they will remain mostly unused or used for small dumps of writing.

Additionally loads of people read my Twitter feed - I'd be interested in finding out who all you lot are as well... I like finding out about people who know me because of this site.

Tomorrow is Laura's audition for X-Factor at Arsenal, I'll be with her and I may post up some pictures somewhere.

I'm curious, are there any people who work with leather reading this blog? How about blacksmiths? Preferably within a couple of hours drive of London - it's for an article that I'd like to write.

Further non-ambulance blithering will be on Mental Kipple, which I have been shamefully neglecting.

---

Finally two nice ambulance links sent to me by readers-

A lovely written article about the Yorkshire ambulance service following the 'Tonight' programme. (Thanks Clive).

Then a story about a 'patient' who would have suffered from a broken nose had I been sent to him. (Thanks Matt)

I came out of the house and started coughing. I was glad that I'd needed to leave, it was so I could get some fresh air.

Picture the house, an elderly married couple, both chainsmokers, both requiring home oxygen for emphysema, both suffering from recurrent chest infections. As our patient put it, "I think they are fed up with me down at the hospital, I was only there a few days ago".

The walls were yellow-brown. Actually everything was yellow-brown. An old Labrador had wheezed it's way up the hallway to great me, it's tail wagging furiously. My crewmate was attending so I was free to play with the dog.

Thankfully it was nothing serious, a chest infection that hadn't gone with the first round of antibiotics, our patient would need something stronger.

I could feel the tar seeping into my skin, there was a horrible taste in my mouth and I started wondering what the lethal dose of nicotine is. Would it be a good idea to get our hazardous rescue team out in their noddy suits?

They were a lovely couple, rattling and wheezing away, rows of cigarettes lined up like soldiers. Cigarettes put into cigarette holders, something that I haven't seen except in movies set in the 50's.

Hundreds of souvenirs, all covered with a patina of tar, nicotine and heaven knows what else told me of their life before they became housebound. they were quite happy in their life, they had each other, their had their 'little sin' and they weren't hurting anyone.

They were lovely, we had a little laugh and a joke with them, I stroked the dog a bit more and we took our patient off to hospital.

But I could taste that house for the rest of the day.

---

Browsing through the BBC news website I came across the following. Imagine being the ambulance sent to this call...

So it's not just St Georges day today - it is also International Pixel-Stained Technopeasants Day, go and have a look for lots of crunchy free stuff. I've included my own stuff. By coincidence I only signed up to Livejournal today.

Tip of the hat to Warren Ellis.

Cyanide & Happiness @ Explosm.net

I've come to the realisation that I use Twitter as a place to stick ideas for further blogposts, sort of a public memo-space. Which is a bit daft as I have a word-processor on my phone/PDA, but there is something about the immediacy of publishing that appeals to me.

Yesterday was the London Marathon, temperatures were high and all my patients were over the age of 60. They weren't running the Marathon of course.

Instead the St John Ambulance people were staffing it - I've got to admit a bit of jealousy that they get to do all the fun stuff like concerts and sports events, while I get to wrestle with drunks. And before you ask, no, I won't be joining them, there is still bad feeling between a lot of folk in the London Ambulance Service and St John ambulance. Most of it tied to the dispute of the late eighties.

Also, way would I do my day job and not get paid for it. I have a mercenary soul.

Going back to the Marathon, it's sad news that one of the runners has died, but given the weather it's not entirely unsurprising. He must have been running on pure willpower and my condolences go out to his family and friends.

I wonder how we are going to cope with the Olympics, loads more people and I doubt there will be any new A&E departments, in fact the government is trying to close down two local A&E departments. Given that Newham hospital has had to double up it's cubicles to see the 'normal' stream of patients, I dread to think what will happen when we have a couple of hundred thousand visitors to the area.

Returning to St John Ambulance, the current belief is that they will be in the 'security zone' of the Olympic park - they will then take patients to the outer cordon where we will take them to hospital. Now not wanting to give anyone any ideas, but I would have thought that it would be easier for terrorists to infiltrate St John ambulance than the LAS - that and we aren't recruiting people anymore. I'm sure we'll have plenty of our management involved though.

---

Today was going to be my 'writing and answering emails' day, the plan was to sneak around my mum's place and work on my laptop while she tops me up with cups of tea. Instead she has been on day 20 of her campaign of 'cleaning out the loft'. Loads of old computers, computer magazines, toys, books and cameras have had me looking up beauties like this, this and this on the internet. Because of this I have been prevaricating like an expert.

But I promise - all my emails will be answered by midnight tomorrow, (so if you haven't got a reply and expect one then it's probably gone astray).

Still, I have got my revenge on my mum with this picture. She nearly died with laughter after I told her what it was really a picture of... Is it any wonder I'm an atheist?

At midnight tonight I will have completed my year and a day abstention of alcohol; successfully at that! I shall be celebrating with a can of John Smiths and the company of some friends of mine.

Also for some reason I signed up for Facebook, I don't know why - perhaps my next step will be a MySpace Livejournal page... (I have a Myspace account that I forgot about)

UPDATE: Mum's just shown me a butter knife that she found in the loft (and is using at the moment) that was blown out of their house when a WWII bomb dropped on their street - she later found it buried in the garden while digging as a child. You couldn't pay for this sort of history.

Because, you know, I'm kinda happy to be English.

Related to the previous post.

Today (on a short shift) I went to six jobs.

One was genuinely and seriously ill.
One was a walking wounded.
One was a no-show.

...And three were maternataxis.

One of the maternataxis, who lived 600 yards from the hospital not only got an ambulance (with a paramedic on board), but also a FRU (with another paramedic). So that is two paramedics for someone who not only walked, but had contractions that could be measured on a calendar.

Even the midwife at the hospital shook her head in disbelief.

So this is one reason why there are no paramedics (or ambulances) to deal with the real stuff.

I think it's time to start charging maternataxis; a bit more than an equivalent taxi fair would be reasonable.

I've just seen Tonight With Trevor McDonald.

Hmmm.

The programme does give the impression that if you get a Paramedic then you are guaranteed to survive, while if you get an EMT then you just have a 'stretcher monkey' and. will. DIE.

It also confuses 'Heart attack' and 'Cardiac arrest' and I believe that there is research that you are more likely to survive a cardiac arrest if you are attended to by a double technician crew.

You have read my blog, you know the truth.

The problem is this - it's down to the money that the government gives us (or rather doesn't). If we had enough money then we would have paramedics all over the place, an ambulance on every street corner. Hell, give us enough money and we'll see about getting a doctor on every ambulance. There is a limit to how much money you can throw at an ambulance service.

But...

We don't have enough money to provide the service that the government wants. It wants us to reach calls in under 8 minutes, so we split ambulance crews to put them on cars. We can't afford to train people up to Paramedic (because where are the wages going to come from?). We can't spare the people off the road to train them up, we need them manning ambulances now. Because of our chasing of (pointless) government targets the people who would train paramedics are being used to man FRUs and ambulances.

A friend of mine has been given the go ahead to train up to paramedic. His course starts in April next year.

Ah damn it - you've heard it all before, pointless targets, not enough money, raised expectations; just search this site for whenever I mention the word 'Government' to read my views about it.

The real problem is that there isn't enough ambulances and ambulance staff and those that we do have are run ragged dealing with crap calls.

The LAS has released a Press statement.

There are a number of issues that we would like to clarify following the broadcast of last night’s Tonight with Trevor McDonald ‘Paramedic Lottery’ programme.

Director of Operations, Martin Flaherty, said:

“Reference was made to London having a smaller percentage of paramedics among frontline staff than any other ambulance service.

“Firstly, our ratio is actually higher than the 34 per cent quoted in the programme when account is taken of our training staff and other managers with paramedic skills who also respond to emergency calls. Equally importantly, the figure itself is quite misleading, as we know that in the last six weeks we have had a paramedic working on an average of 60 per cent of our ambulances and 50 per cent of our fast response cars.

“We also believe that the programme downplayed the role of our emergency medical technicians and did not fully explain the extent of their training and skills, which enable them to provide life-saving treatment in the majority of medical and traumatic emergencies.

“As far as the tragic case of Kayleigh Macilwraith-Christie is concerned, we carried out a full investigation into our response to her and shared our findings with her family. We have always recognised that she could have benefited from treatment by a paramedic, although there is no way of knowing if this could have helped save her life.

“An ambulance with a paramedic on board was originally dispatched to the call, but the crew came across a serious road traffic collision and stopped to assist. A second ambulance was subsequently sent to attend Kayleigh, but this did not have a paramedic on it.

“We have since reviewed our response protocols for patients reported to be suffering a prolonged epileptic seizure or series of seizures, and have put in place procedures to ensure that control room staff will always look to send a paramedic to the relatively small number of calls we receive to these patients every year.

“We are also continuing to discuss with various bodies the possibility of emergency medical technicians being able to administer anti-convulsant drugs in the future.

“Every year our service responds to more than 300,000 emergency calls which are categorised as being potentially life-threatening, and the increased survival rates of patients who suffer cardiac arrests – doubled in the last eight years – is testament to the skills of all our frontline staff.

“We will continue to strive to improve the care we provide to all our patients, aiming to ensure that they get the most appropriate response for their needs.”

Ends

Background information:

* For the future – and in partnership with our staff’s union representatives – we are looking to review the make-up of our workforce, and this will include a significant increase in the number of paramedics.

We currently employ more than 1,000 paramedics, and by March next year this figure will increase to about 1,200. By 2012/13 we envisage we will employ in the region of 1,900 paramedics.

With their enhanced paramedic skills, more of our staff will be able to diagnose and treat patients with a wider range of conditions and, instead of taking them to hospital, will ensure they get more appropriate care for their needs - either at home, through a referral to their GP or social services, or at minor injuries units or NHS Walk-in centres.

* Trainee emergency medical technicians undertake a 16-week training course. This includes a one week induction, followed by a three-week advanced driving module, then 12-weeks’ intensive training and education in the following areas:
o airway management and resuscitation including the use of airway adjuncts
o treating wounds and bleeding
o treating infectious diseases
o respiratory and circulatory systems including cardiac care, asthma, chest injuries and drowning
o musculoskeletal trauma such as broken bones
o maternity and neo-natal resuscitation
o paediatric care
o nervous systems and nervous disorders such as epilepsy
o poisoning
o diabetes
o digestive problems
o dealing with casualties at major incidents
o care of the elderly
o care of mental health patients

They then go on to undertake a minimum of five weeks' operational training, working as part of a crew attending emergency calls. Throughout this period they are accompanied by an experienced member of staff who supervises them and monitors their progress.

Emergency medical technicians are legally able to administer a wide range of drugs to treat conditions such as asthma, diabetes, severe allergic reaction, drug (opiate) overdose, certain cardiac conditions and are able to give basic analgesic and oxygen gases.

They are also trained in 12-lead ECG acquisition and interpretation, enabling them to make key decisions about the care and treatment of cardiac patients.

There I was, sitting outside the newsagent shop at the end of the hospital road. The newsagent who I'm sure I keep financially stable with my purchases of large amounts of caffeinated beverages. As I finish off the paperwork from my previous job one of our ambulances races past me on the way to a job. A woman chooses that moment to cross the road without first looking for big lumps of yellow metal and blue flashing lights moving at speed.

The ambulance misses her, but she stands in the middle of the road and swears at them. She then continues to walk across the road and I note that she spots my ambulance...

She stalks over to me and bangs on my window. I wind it down a notch.

She's angry.

"Do you know that ambulance?", she shouts at me.

I tell her the truth, I have no idea who it was.

"Yes you do!", small flecks of spit hit the window of the ambulance, "You ambulance drivers think you own the fucking road!"

She continues in a similar vein with much more swearing. Most of it directed at me. She won't let me get a word in edgeways.

I consider stepping out of the ambulance and punching her on the nose - I reconsider as it's not a good career choice.

I tell her to go away. Maybe a little less politely than policy would suggest.

Apparently, because we all share a uniform we all share a hive mind. Also I suspect that she wouldn't be shouting at me if she were to come across me in the street wearing my jeans and hoodie.

After all that I went to one of my 'happy places', off to the Tate & Lyle factory for a minor (but exceedingly painful) injury. I love it there, not only do they always have someone to meet us at the gate and escort us to the patient, but the arrangement of brick and pipework hits some sort of aesthetic nerve in my body. I'd love to roam around there taking photographs of the buildings and machinery there - it's a beautiful place.

It was a beautiful day, early afternoon and the sun was making everything in Newham look lovely. A stationmate had been showing his young children around the back of my ambulance when we got the call.

'Male, Overdose, not breathing'.

So we whizzed around there to find two FRUs already there, we climbed three flights of stairs and entered the flat.

Disused needles everywhere, unwrapped foil, empty drink cans, and the odd lighter fuel can on the floor. Two men were agitatedly pointing at our patient on the floor. The patient wasn't breathing, so one of the FRU pilots was breathing for him with a bag and mask. The other FRU was getting venous access.

The patient had injected some heroin and then stopped breathing, it's one of the things that sometimes happens when you inject a potent dose of heroin.

I busied myself with drawing up the antidote.

"He'll be alright", I could hear one of his friends say, "They'll give him an injection and it'll reverse it - I've seen it before".

The other man agreed, "I've had it happen to me six times". It was almost a badge of pride.

Antidote duly given and our patient soon woke up. He was a bit agitated and wouldn't stop talking about building things for the Olymics. We led him down to the ambulance and worked hard to persuade him to attend the hospital. One of his friends was trying to dissuade him. He wouldn't believe that the antidote ofter wears off before the heroin and it's very common for the patient to have to have a second dose.

Finally he agreed to attend the hospital and talked to me through the trip. Well, I say talk to, actually I mean he talked at me. I suspect that there may have been some amphetamines involved, he had that highly annoying behaviour.

So from a beautiful spring day, to a drug den in the space of a few minutes.

He walked out of the hospital less than half an hour later. I'm glad that they didn't have to waste too much time with him.

The next two jobs were drunk alcoholics who wanted us to take them home - we did, it's easy and it means that I don't get called back to them after they harrass another 'good Samaritan'. I do wish that they wouldn't paw at me though. It comes with the weather - if it is cold then they get drunk in their scummy hovels and we don't get bothered, if it's warm then they go out and get drunk where the public can see them. Then we get called.

What a waste.