A big thanks to Dr Crippen for writing about what I was going to post about today. It means I can go back to sleep.

The short version is that there are some pillocks that don't want to have to look at the injured servicemen coming back from Iraq and Afghanistan.

It was drawn to my attention on one of the ambulance forums, partly because we have a fair number of ex-forces people in the ambulance service and partly because, while some of us may disagree with the purpose behind the wars, we do respect and honour the people on the ground actually doing the fighting for our political masters.

the other thing to post about is that, as you are probably aware, there is wide flooding around the UK at the moment. The British Red Cross have set up an appeal fund. If you have a spare couple of quid please head over there and donate to that or one of their other causes.

(...and now I head over to PC World to get something for my brother, then to Homebase to get a tonne of stone for my mother. Then I shall collapse back to sleep).

One litre of Red Bull and two litres of Coke Cola and I still don't feel up to facing the day.

I think I have caffeine tolerance.

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Once more my job gave me two calls that are in contrast to one another, both involving children.

The first was an eight year old boy who'd fallen over and taken a small chunk out of himself. Nothing too serious and something that would be fixed by three sutures. The only thing (and yes, I may be a bit harsh here), was that he was constantly crying. His mother was also weeping as if he was about to die.

I asked him if it was the pain that was making him cry, but he told me that it just 'stung' a bit. He was crying because he was scared. I explained that it wasn't serious, that he'd be home in an hour and that it wasn't a problem.

But still he cried.

His mother also wouldn't stop crying, even though I explained the same thing to her.

No matter what I did or said, it made no difference, the crying continued. As did the wailing, the sobbing and the shrieking.

So I put a plaster on the wound and took him to hospital. By the time we got there I had a splitting headache. I'm reminded of what my mother would have said. She would have taken one look at the wound and told me to, "stop crying or I'll give you something worth crying about - it's hardly a scratch and your own fault for climbing trees".

Didn't do me any harm.

...And across the globe eight year old boys are given machetes and AK47s and are fighting in armies.

Later that same day I went to an adult who had been beaten up. He didn't speak English, his son and his daughter in law didn't speak English.

His eleven year old granddaughter did.

She was bright, she was sensible and she was pretty much the only contact with the non-Punjabi speaking part of England that the family had.

She had been born in England, which makes me suspect that her parents had been here for eleven years without learning any English. Which is a poor effort by any standard.

So they relied on her to deal with any place that didn't have translators. I spoke to her about it - she had helped them navigate the maze of benefit offices and social services. She had been there while her mother had another two children, translating what the midwives said, she was the translator between her family and her school.

She was now translating for me while I tried to determine why three men had broken into their house and beaten up her grandfather.

She had been forced to grow up incredibly quickly while her family came to rely on her. I wondered if she has got used to the quizzical looks all the adults in the house was giving me when I tried talking to them.

Very, very sad that this eleven year old girl had to deal with all these adult problems.

From TheyWorkForYou.

Sandra Gidley (Romsey, Liberal Democrat)

"To ask the Secretary of State for Health how many (a) male and (b) female teenagers were admitted to accident and emergency departments on grounds related to drunkenness in each month of (i) 2007 and (ii) the last five years, broken down by NHS trust; and what treatments they required, broken down by category."

Dawn Primarolo (Minister of State (Public Health), Department of Health)

"We do not collect data relating to alcohol-related attendances at accident and emergency departments." [Emphasis mine]

Tables have been placed in the Library which supply data for teenagers admitted to hospital [Emphasis mine] via accident and emergency with a primary diagnosis of T51 toxic effect of alcohol (i.e. more severe than general drunkenness and loss of inhibitions) for the last five years, broken down by gender and health care provider. The information provided in the tables does not include instances of the toxic effects of alcohol as secondary diagnosis."

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From the BBC

"The introduction of 24-hour drinking laws may have trebled alcohol-related admissions to A&E departments in inner city areas at night, a study claims.
Researchers at London's St Thomas' Hospital compared overnight visits before and after the 2005 law change.
There were 80 alcohol-related visits in March 2005. This hit 250 in 2006, the Emergency Medicine Journal said. "

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We 'code out' all our calls. There are two or three numbers to write down that represent what has happened to our patient. The first number is the 'type of injury' code. So (from memory) - Code 01 is 'Illness known', 02 is 'illness unknown', 03 is 'fall', 14 is 'assault' and so on.

Then comes the injury code. 01 is 'abdominal pain', 75 is 'minor head injury', 69 is 'vomiting', 23 is 'epileptic seizure'.

'62' is alcohol related.

The small problem is that where someone has two types of injury, for example they had a seizure due to alcoholism and cracked their head open, there are only two boxes to write numbers. For the fitting head injury mentioned that would be as 57/75 ('fitting - other cause', 'head injury - minor'). There would be no place to write down the '62' - alcohol related.

Couple that with the problem that the boxes are very small and easily forgotten and are therefore are occasionally not filled in and you have an obvious lack of data on how alcohol affects A&E attendance.

There are some vague figures mentioned in parliament. But these are only for people admitted to hospital - not for that much more common breed of people who are treated and discharged or are allowed to sober up and make their own way home. Or for those that attend, are violent and are thrown out.

So the St Thomas' Hospital study is incredibly important, and should be going on nationwide. During nightshifts alcohol probably accounts for 40-60% of my work, half that during dayshifts. Yet it would seem that no-one is recording or studying the numbers and types of people using the NHS for this reason.

Again from the BBC

"Both the Department of Health and the Department of Culture, Media and Sport, which was behind the legislation [to increase licensing hours], were dismissive of the findings, noting that the study only related to one hospital in one particular month."

So why isn't there a more widespread counting of the number of alcohol related attendance? Something done all year in all hospitals, something involving ambulance service trusts. Just a simple tickbox asking if we considered alcohol the cause of the injury or illness.

If it were recorded and studied, might it not make a difference in how we provision care, fund hospitals, amend licensing laws and tax alcohol?

Or is that why it's not done?

Because this sort of thing happens.

And because I noticed it because Rachel 'twittered' it.

(Yes - I'm paying a bit more attention to my other blog now - there may be reasons behind this...)

Ceci n’est pas une post.*

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*Because my brother is rather ill due to complications due to his wisdom tooth operation. He has been hospitalised and is being 'shotgunned''** with strong antibiotics. He should be alright in a few days. The LAS have been great and not only let me run to see him when he first went into hospital, but a lovely DSO has also granted me emergency leave for today so I can make sure he is getting the treatment he needs***

** Possibly a made up word.

***I know the hospital, and don't trust it - I've already noted a few mistakes they have made. IV antibiotics before blood cultures being drawn sort of thing.

Two jobs, both of which revolve partly around the inability for my patients to keep their blood on the inside. I can go weeks without seeing a drop of blood, on this day there were two patients. One after the other.

Two patients - one who had just had her wisdom tooth removed, the other had his arm sliced open to the bone when caught between two lumps of machinery.

Both patients stressed out by their injuries, both trying to be brave and both being nice to me in their own particular way.

One patient bleeding at least half a litre of their blood over my ambulance, needing me to blue them into A&E

One patient, a few drops of blood at the scene, the dressing that was applied caught a small amount of blood.

She was sped into hospital after trying not to cough blood over me.

He took a more leisurely ride in where his arm would almost certainly require surgery.

Her problem would be solved by her bleeding stopping, the work of a few people.

His problem would be solved over months of work by a complete team of people.

Two patients - different but alike.

More from the Mail.

"I always carry a large pair of scissors. Issued so I can cut a patient's clothes if necessary, they're my one form of self-defence if I'm in real danger."

Yes. Apart from them not being sharp (because you don't want to cut a patient's flesh by accident). And not heavy (because they are cheap NHS plastic). But you can use them to rub against the back of someone's hands to get them to drop you.

My one form of self defense is running away really quickly, or not being there in the first place.

I hate being made to look like I'm aiming to stab people.

...And while I sit on station waiting to the floor of the ambulance to dry due to my last patient having some difficulty keeping their blood on the inside I have a chance to moan at the Daily Mail.

I'm in today's edition and they make it sound like the words are coming right from my mouth rahter than an accurate reporting.

The first paragraph is the worst, making it sound like I'm some sort or hero being surrounded by knife-wielding maniacs. Trust me, if that were the case I'd be driving away quicker than you can say, "Look at that sensible man driving away from the armed nutters".

After the hyperbole it settles down a little, but if you are a regular reader then you know that the words aren't my own - it is quite interesting to see how it's been written for the style of the paper, words like 'horrific', 'shocking' and 'pressure cooker'.

It's not a huge misrepresentation - but it does make it sound like East London is a war-zone rather than a place that can get a bit rowdy.

Still it *is* the Daily Mail, so what else did I expect when I chatted to the reporter earlier in the year.

You can read the full article here.