No ambulance blogpost today as I indulge in writing about one of the other pleasures in my life on my Mental Kipple blog. Mainly as prevarication against giving my flat a nice tidy up.

An excerpt,

...Traditionally beta-testing has been to release a piece of software to a group of users in order to bash the code around in real situations and to report bugs to the development team. This is done so that the final product is as bug free as possible....

So if the initial few months of a game release are the ‘real’ beta, why have a ‘beta’ phase at all?

Publicity...

If you interested in more serious writing about PC gaming then I suggest you give Rock, Paper, Shotgun a look - superb writing from some of the best in the game, where in a recent post Gillen writes,

Basically, playing a Medic rapidly turns me (and probably you) into a curmudgeonly surgeon who’ll make House look like Bertie Wooster. Because, you get to see people f**k up, just to annoy you.

Which speaks deeply to me.

(Even five years ago it would have been inconceivable to me that I would be writing 1,500 words for *pleasure*)

There is joy in my heart because one of the finest living British gentlemen has a blog.

(Tip of the hat to Euan for pointing this out)

It's funny how things work out, I was going to write about a recent 'BBA' today and both Nee Naw and The Guardian wrote about this subject yesterday.

So here is a 'Born Before Arrival' from my point of view.

It started, as is becoming increasingly common, with Dispatch putting out a general broadcast over the radio to see if there were any ambulances available to deal with a baby about to be born at home. We were at the hospital just finishing off our paperwork so we offered up for it - paperwork can normally wait.

Whizzing round there we were first on scene and were met by the husband of the patient at the front door, he was looking a little bit stressed. He directed us upstairs where the mother and child were laying on the bed. The baby was wrapped in a blanket and was being held by the mum.

The calltaker was still on the phone, but hung up before I could say what a sterling job they had done. I would later contact Dispatch and tell them to let the calltaker know how things had turned out (something I probably wouldn't have even thought of doing were it not for Nee Naw's blog).

A quick chat revealed the mum to be a lot more chilled out than the father. I congratulated her on making it all look so easy while checking the baby out. He was happy, breathing and had all the required fingers, toes and other items of anatomy. The fluid on the bed was nice and clear, so it seemed that the child had not become 'distressed' during the delivery. A check of the mother showed that she was also in good health.

A second ambulance crew turned up, and as one of them has only been out a year, we let her deal with the final stages of the birth. She offered the chance to cut the cord to the father, but he was still a bit scared and refused, so she had to do it. I advised her as to the best way to do it without getting splattered in blood.

In cases like this we get the hospital to send a midwife to the house - if everything is fine then the mother and baby could stay at home. While home births are riskier to mother and child than hospital births, if there is a chance to avoid going to hospital it's a nice idea to take it.

The midwife arrived, and this is where I started to grind my teeth in anger.

She walked upstairs and didn't even say hello to the patient (or to us). The first words I heard from her were, "I'm going to inject you to deliver the placenta". We confirmed that the baby was fine and the mother hadn't even been torn by the delivery.

But the midwife still wanted her to go to hospital. I asked her why and she told me that all home deliveries had to go to hospital because of policy. I'd never heard of this before, but I'm not about to argue with someone who is supposed to know what they are doing. So we took mother, father, child and midwife to hospital.

We settled the patient into the delivery suite and was just about to leave when another midwife grabbed me and said that she 'recognised' me. I always wonder what I've done wrong when someone says that to me - guilty conscience I guess.

It took a while to remember, but I realised that I used to nurse with her when I was an A&E nurse. We had a little 'catch-up' and I asked her why the other midwife had felt the need to drag our patient to the hospital.

There was no need I was informed, no change in hospital policy and no good reason why there should be any concern for the baby or mother. She had no idea why she had been forced to come to hospital.

Then the first midwife came out of the delivery room, sucked her teeth and told us that she was, 'going on her break'.

Suddenly I had a motive for her bringing the patient to hospital.

Of course, this is all supposition. I can't prove anything - even the rudeness of not introducing herself would be hard to claim as both patient and midwife are Nigerian, and so it could be a cultural thing. If I did complain I could be accused of not being 'racially aware'. Any complaint would have to come from the patient.

Normally when midwives come out to a BBA, they are lovely and we get on really well. In my area a lot of them have huge chips on their shoulders while the midwives from outside of my area are much nicer - but all of them have always acted with courtesy and professionalism. It's a shame this one had to spoil it.

But still - it was a good job with a happy ending. And we can do with as many of them as possible.

UPDATE: A slight change to the post due to the discussion in the comments to this post.

Here is something a bit shocking that I didn't know (and should have considering that I used to be a nurse). In the UK there is no legal ratio of nurses to patient. If a trust wants to have one nurse looking after twenty patients, they can.

Anyway, I won't waste time telling you about it when zarathustra of Mental Nurse has done a top job of doing so.

So if you agree, and live in the UK, go and sign the petition - they need 200 signatures before October the 6th and are nearly there.

And it might make some hospital administrators a bit nervous - which is always a good thing.

Once again, patients are waiting for ambulances rather than ambulances waiting for patients.

What is interesting is the reported tone of the Derry Mayor (and I may just be paranoid here), when he says about finding out what the other ambulances in the area were doing,

"Were they on emergency services, were they on emergency duty, were they transferring people and stuff like that," he said.

"I think that is something that needs to be addressed."

Which sounds very much to me like he wants to know if they were on a break, skiving or otherwise not 'working'.

Or it could be very interesting to see if they were dealing with people who were demanding an ambulance for a wart they'd had for the last three weeks. But I doubt that this particular follow-up story would make national news.

It was about ten minutes before the start of our shift and my crewmate and I were checking the ambulance, making sure that it had all (or at least most) of the equipment that it should have. Before you ask, this is unpaid 'work', but it just makes life easier as it's almost certain these days that as soon as that clock ticks on the hour we'll be sent out on a job.

I was just noting down the mileage of the vehicle on my paperwork when the dispatcher on the other end of the radio asked if there were any ambulances available to deal with a cardiac arrest in the area. No-one answered so, after asking my crewmate if she minded, I told dispatch that we'd be happy to do an 'early job'.

Well, it's fifteen minutes of overtime (around £2.50 after tax) and we'd only get the call once our shift started in ten minutes anyway. This way the FRU wouldn't be stuck on scene dealing with it on his own.

So we raced around there as best we could in the busy evening traffic and got there fairly quickly. Entering the front living room we saw the elderly patient lying on his back on the floor while the FRU worked on him. There were some family members also in the room, one of which would turn out to be the patient's son.

We were told by the FRU that the patient had collapsed after an hour or two of chest pain and that his son had been doing CPR while waiting for the FRU to arrive. He'd already been 'shocked' once. So while the FRU secured a breathing tube and my crewmate placed a cannula in the patient's arm I would do the CPR.

I knelt down, put my hands on the patient's chest and pushed.

Immediately the muscles of my lower back went into spasm. Utter agony. I suppose this is what happens when you spend hours sitting in an ambulance cab, and then have to do exercise without being able to 'warm up' first. I knew I would have to do CPR for at least the next three minutes.

Yep, pure bloody agony. And the longest three minutes I've ever had to do CPR for.

But that wasn't all.

While doing CPR I could feel something sticking into my hand. I thought that it was the edge of the defibrillator pad, but when I looked down I noticed a small wound on the patient's chest.

It turns out that the son, who'd been given excellent instructions on CPR by our calltaker, had pushed a little too hard, cracking the patient's ribs. Couple that with the patient's history of a coronary bypass operation and what was sticking me in the hand was one of the wires that is used to wire the breastbone together. It had gone through his skin, torn through my glove and was scraping against my hand.

I looked at my blood covered hand and had an instant PEP flashback. A wave of nausea hit me, and it wouldn't go away for the next hour, even after discovering that the wire hadn't actually breached my skin.

While we checked the rhythm of the heart on the cardiac monitor I folded up a bit of card, a discarded wrapper from our defibrillator, and placed it over his chest. I warned the others about the wire and then had to do another three minutes of CPR while my crewmate secured the cannula.

My back was in agony and all I wanted to do was curl up on the floor in agony while trying to get rid of the feelings of nausea.

Luckily it was only those (long) six minutes before my crewmate was able to take over the CPR from me. She later told me that she thought I may have been in pain. It might have been the muttered, "arghbuggerit" every time I pushed down on his chest that clued her in.

I was freed up to get the trolleybed ready as we were going to 'scoop and run' and by the time I'd arranged it all the patient's pulse had returned. He still wasn't breathing for himself, but it was at least a step in the right direction.

So we loaded him up and 'blued' him into hospital. Throughout the transport I kept telling the son that he had given his elderly father the best chance possible by doing CPR and, that no matter what happened, he'd done everything right and that it was no fault of his own.

It's unlikely that the patient will ever be discharged from hospital, but you have to try in those circumstances.

Luckily for my back, our next patient was heavy but also used a motorised wheelchair, so was an reasonably easy transfer (and I may tell you about that job tomorrow). The job after that was our fatal car crash, so the pain in my back was soon forgotten.

Luckily I now have a week off to relax.

Well, I say 'relax' - what I'm actually doing this week is seeing if I have the discipline and ability to 'work from home' on my various writing projects and other little side jobs. I'm working from nine until five all week with no World of Warcraft (or Tabula Rasa beta) until after 5pm. Just in case I seriously have to start looking at getting a different job.

...We get the call to the RTA, a car has crashed into a bus, normally these things are 'nothing' jobs. We put on the blue lights and head towards the crash...

...The radio bursts into life, there is an officer who 'lucked' onto the scene - he tells Control that he needs a lot of ambulances, the fire service and the police. The injuries are all serious. We wonder if he is talking about the same crash we are going to...

...We crest the hill, with one look at the car and the bus we know it's going to be serious...

...I jump out of the ambulance and head to the car, I ask the officer what he wants us to do - He tells me that we can't wait for the fire service to arrive to cut out the first patient as his breathing is so ragged. We agree that he needs to be out of the car immediately and that a possible neck injury is a low priority...

...We get him out and I watch as he takes his last breath...

...We work on him, he is so young we have to make the attempt. The DSO and other FRUs work on the other people in the car...

...He is lying lifeless in my ambulance and the BASICS Doctor declares him dead - then we rush off to the next casualty...

...This one gets sedation - I write the dose and time on his chest so that the information doesn't get lost in the chaos. Another ambulance crew speed him to hospital...

...The next one is declared dead as the firefighters cut him out...

...The other dead man is left in the car, there is nothing to do for him, it will be some time before the firefighters are able to free him...

...I check on the people in the bus, there are some injuries that will need hospital treatment. I'm trying to keep them calm and relaxed. My crewmate and I move from our 'all-business' personalities to our 'reassurance' personalities in the time it takes us to walk to the bus. I deal with the multiple casualties one at a time, my crewmate helps me out...

...My ambulance becomes a mobile mortuary, the police are checking for identification. The blood is pooling on the floor...

...I'm sitting on the back step of the ambulance, two of the dead are in my ambulance, one, wrapped in a sheet, is at my feet. We are waiting for the undertaker...

...The police investigation team is chalking the outlines of vehicles and taking photographs of the scene...

...My paperwork is done. It seems like such little bit of writing for such a serious call where three men have been killed...

...Medical equipment and wrappers mix with the debris of the accident. There is the familiar 'tick-tick-tick' of our blues lights revolving in their housings...

...Back at the station I have a facemask on as I use the jetspray we use to clean the outside of the vehicles on the floor and trolley of my ambulance. My crewmate is doing the gentler job of cleaning the equipment. The blood comes off eventually...

...It's time for our next job.

There are jobs that stay with you. I'll always be able to remember this job, it won't cause flashbacks or have me waking in a cold sweat in the middle of the night. But I'll always remember it, and every time we drive past the scene we'll see those ghosts in our mind's eye.

So it would seem that I'll be taking an effective pay cut this year as inflation outraces my pay packet. Unison (which, for better or worse is the main ambulance union) as agreed to a below inflation pay rise, staggered over the year.

I don't belong to a union because I begrudge giving them my subscription dues when they agree to stuff like this, so I don't get a vote. Much like I didn't get a vote to decide this current Prime Minister.

Still, what do I expect when our Prime Minister has cosy little chats with the Milk-thief.

It's an incredibly cheery thought, as I get ready for a run of twelve hour night shifts this Friday, Saturday and Sunday that the government values me so much. I'll bear it in mind as I destroy my body through shift work and unhealthy eating that, in order to protect inflation, I have to suffer a reduction in my quality of life by getting paid less in real terms than I did last year. I'll think of this as my back starts to ache from being stuck in an ambulance for twelve hours straight, only getting exercise as I carry people younger than myself down several flights of stairs.

And then our Health minister comes out with garbage like this,

"What is important is that we build on this, involving the workforce in the key decisions about the future of the NHS as we modernise patient care. Involving staff in this way is the key to boosting morale."

I can picture him smirking inside as he spouts this bullshit.

It seems that more and more often I think about getting out of this job and instead do something more reasonable, like writing for a living or working with computers. Unfortunately my computing 'A' level dates back to the years of the 8086 processor, and while I'm fairly smart about computers, I have nothing formally useful on my CV. That and starting on the bottom of the ladder (again) is just too depressing to consider.

And if I'm depressed now, I can imagine how I'll feel after my run of nights...

Job offers to the usual email address.

At least one of the Lib Dems has had a reasonable idea. Nothing will come of it of course, but it is a nice idea that gets him some news coverage.

UPDATE : Mousethinks points out an even better way of looking at the problem. One that in my blaise acceptance of abuse I'd completely forgotten about.

First up I would like to thank Dave for sending me the link to yesterdays post. It was bad form to forget to credit him - my only excuse is that I was laughing too much.

Another short post from myself today as I shall be mainly replacing my car battery (which should take minutes), and then I will be upgrading my Macbook's hard drive (which will probably be the work of hours and more than a little bit of swearing).

Also there is shopping. I need cow juice to put in my tea.

As I left you with something funny yesterday, I thought that today I would link to something much more thought provoking.

Three blogs from America, one a police officer, one a paramedic and one an ER nurse, collaborated on a call that they all shared. It shows how all these services work together to try and do the best for our patients and is powerful reading.

Start with the Police officer's entry.

Then the Paramedic.

And finally the Nurse.

While I'm out running around doing all those things us shift workers have to fit into odd days here and there I shall leave you with a wonderful discussion thread.

Blu-tones's adventures with Picolax and the bum clinic.

(And tomorrow I perform major surgery on my Macbook by trying to cram a 300Gb hard drive into it. Should be fun. But it might result in a bit of a delayed blogpost.)