It's not because she's young.

It's not that she's seriously ill

It's not that I don't know what it is that's made her helpless.

It's not that the only reason that she is standing is because her husband is struggling to hold her up.

It's not when she goes into a seizure and becomes incontinent.

It's not me being covered in her urine as I help her husband lower her to the floor on the crowded landing.

It's not the possibility that she could die from this illness or be permanently disabled.

It's not the way she looks at me with utter terror in her eyes.

None of those things kept me awake tonight.

It's the sound of her four young children behind me, wailing in fear as they realise that their mother isn't playing a game.

We ambulance people are finding ourselves called to the Barkantine centre quite a bit these days. Amongst other things it is a birthing centre.

It's really rather nice actually - it's clean and airy, the rooms are large and have all the amenities like an en-suite bathroom, birthing pool, televisions and big bouncy inflatable balls (I have no idea, the midwife who taught us how to catch a baby never told us what that could be used for).

The staff are lovely, when I have seen them dealing with medical situations their clinical skills have been good, they also seem very happy at their job, something that is a rarity in some of the hospitals I visit, and yet I find it incredibly important. Their bedside manner has also seemed excellent, again something that I've found lacking with some staff in some hospitals.

So, why do I find myself going to such a paragon of 'how things should be done'.

Well, we are used as a a transport service when things start to go a bit wrong.

To be fair, from the policies that they have they do tend to err on the side of caution. For example if the labour is progressing too slowly we will get called to transport the mother to the Royal London Hospital Maternity department (and that department is quite a change from the Barkantine I can tell you), the Barkantine midwife will travel with them.

A little while ago I took a mother and baby to the hospital because the baby was a little strange and needed some medical attention that the Barkantine couldn't provide. Hopefully nothing too serious, but my knowledge of neonatal medicine is rather thin.

So, while it is indeed a superb place to give birth, I have just one small problem with the Barkantine - it's not in a hospital.

While they only accept patients with no expected complications, such things can always occur which is when we are needed, and while I don't begrudge them using us as a transport service, because we do this for other hospitals, it does seem to be a bit wasteful of resources.

I'd also hate to see something bad happen to a mother or child because of a delay brought about by the wait for an ambulance and the following transport through the streets of London.

The Barkantine is excellent, it's just in the wrong place - it should be in a hospital, with access to theatres and a SCBU, Consultants and 'Crash teams'. These options should not be twenty minutes away by blue light transport and dependant on there being an ambulance nearby that isn't dealing with yet another drunk.

So, when the new Royal London Hospital is built, can we transplant the Barkantine to the roof there please?

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I'm working Friday, Saturday, Sunday nights - so don't expect an answer soon to any comments or emails.

Jacqui Smith says public demand means people will be able to pre-register for an ID card within the next few months.
The cards will be available for all from 2012 but she said: "I regularly have people coming up to me and saying they don't want to wait that long."

The fuck!?

"Please Jacqui - let me pay you £30 or more so that you can store my data on a huge database that will almost certainly not go missing (unlike many, many other cases of dataloss) all so that you can catch those nasty, nasty terrorists. I'm more than happy to have £50.1 billion of my tax money going into this scheme rather than into, I dunno, the NHS".

When is it we can get to vote this shower of fools out of government?

Here is my statement of intent :

I refuse to carry any national ID card that is based around a national database and would rather go to prison than submit to this attack on my privacy and security. They will have to get my biometric data* by force and I will shred any ID card of this type that I am sent.

I would rather emigrate (And I love London and the UK) than be forced into this scheme of waste and evil. I will vote for any political party that guarantees scrapping this white elephant.

*Which is still hideously flawed and throws up too many false positives and negatives. To be fully informed please visit No 2 ID.

Seasonal Affective Disorder - You know it's getting bad when you look at the blank, white page of your blogging software and your mind just shuts down.

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So lets tell you about the future of the NHS, and how it's going to drive me crazy.

On my patch we have a hospital. This hospital has two buildings, one is the traditional hospital that all UK residents know and love, corridors, wards, doctors, porters, nurses, radiologists and others walking around. Slightly grubby, dodgy café, doctors running clinics.

The other building, 400 yards down the road is shiny and new. It is 'nurse led', there are posh coffee bars, the floors and walls are clean. Not much in the way of wards, but this building is only supposed to be used for day-case surgery. Nurses run the clinics and there is a sculpture outside. This is the future of the NHS, a pre-polyclinic polyclinic.

Which is why I'm surprised to find myself responding to a standard 'chest pain' inside this building.

The patient is there to see one of the nurse clinics, she develops a bit of chest pain and the first thing that the nurse in charge does is dial 999 for an ambulance.

I get there second as one of our FRUs was parked within sight of it. As I enter the room, not only have they moved the patient (resulting in us having to do a bit of searching) but there is a bit of a flap going on.

You se, a doctor has been called and he is panicking. He's shouting orders to the FRU, orders which could be extremely dangerous (for the medics in the audience he wants us to give GTN/NTG before checking a blood pressure). Our patient is sitting quite happily in her wheelchair watching our FRU take quiet control of the situation.

This is an absolute 'meat and potatoes' call for us, we deal with this sort of thing day in and day out - just by observing the patient and listening to her we suspect that it isn't her heart that is causing the pain.

But the doctor is screaming about getting 'crash carts' into the room and the nurses are running backwards and forwards like headless chickens. A manager from the other site arrives looking flustered - they confide in me that they turned up because they were worried about what these staff 'were up to'.

After a little more kerfuffle we wheel the patient down to the ambulance, do an ECG (which is normal) and transport her the very short distance to the A&E department where, after some more ECGs and blood tests, is diagnosed with indigestion.

I'm reminded of my nursing days when I saw a GP doing the world's worst CPR on a woman who had pretended to faint - I would have thought her trying to fight him off may have given him a clue that it wasn't a cardiac arrest.

This isn't a post about daft doctors and silly nurses though, after all if I were called upon to anaesthetise someone I'd certainly make a pig's ear of it. We do have our own area of expertise and I can't expect everyone to be as expert in the emergency treatment of chest pain as myself.

But.

This was a 'nothing' call, even without the benefit of hindsight - but as it was seen as an 'emergency', the best thing that the staff could think of was to call and ambulance and then a 'crash doctor' (and heaven alone knows why he was the only one to turn up, perhaps that's all they have staffing the crash team).

This points to there being a distinct lack of planning around what happens when something unusual happens, I'd dread to think what would happen if the patient had suffered a full cardiac arrest - they would have been little better off than collapsing in the street.

So, this is the future - you go to the nice, clean, artistically designed hospital for a minor treatment - but if you have a serious complication or something untoward happens the first thing they'll do is call for two blokes in a clapped out van.

Maybe it's just cheaper to 'outsource' emergency care to the ambulance service, maybe the next big thing for the NHS will be ambulances being called to deal with in-hospital cardiac arrests because then you won't need to pay for a full 'Crash team'.

I'm hopeful that somewhere in the planning for this 'healthcare centre' a manager getting paid a serious multiple of my pay-packet didn't think, 'well, if there is an emergency we can save money by just calling for an ambulance'.

I hope.

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Almost completely unrelated - my mum went to her hospital a few days ago and was told by a doctor that she should 'drink lots of water so that she doesn't catch diabetes', at which point she walked out in disgust. The same doctor recommended physiotherapy for something that would only be made worse by it. So its not just me that sees this sort of thing.

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Even more unrelated - does anyone know a good (or want to set up a) heavy RP guild on Warhammer:Age of Reckoning Ellyrion EU server? Edited to say *Obviously* for the side of Order...

(You can click through to Flickr to see the notes that I've added to my notes)

Just some notes that I made before going on Radio 5 Live to talk about this story.

Donal MacIntyre devoted part of his radio programme to it (and you can download and listen to it here, I don't know how long it will last).

So I got on the radio and said a few words (here for a few days - the section starts 1:03 in and again I suspect it only lasts a few days and won't let nasty foreign types listen to it).

But I didn't get a chance to say as much as I wanted to. But I have an audience here - so here goes...

Sadly we don't tend to flag addresses for people who are just verbally abusive to us, as I said in the radio segment, I'm working next Friday, Saturday and Sunday nights and I fully expect to be sworn at on every one of those shifts. If I were to fill in forms for that sort of abuse I'd never get any work done. Instead we fill in the forms for those people who have either physically abused us, or have acted in such a way that there is a high chance of them physically abusing people in the future.

We fill out the form, explaining why we are flagging it as a dangerous address and then fax it off to Control (using the hospital fax machine, our station doesn't have anything so high tech as a fax machine...)

So the dangerous addresses are flagged by people who have actually been there. And trust me, if someone dies as a result of a delay by us waiting for the police, the person initially flagging the address will get some serious questions asked.

The flagged address system is a warning system, it informs and compliments our 'at scene' risk assessment. Sometimes we ignore it, sometimes we wait for the police. It all depends on the situation. If someone is reported as not breathing then we'll probably go in, if they are calling because someone in the house is drunk then we are more likely to wait for the police. An example of when it was right to enter the address is this one, while in this example it was right for me to wait outside for police assistance.

It's that sort of risk assessment that we make all the time, often without consciously thinking about it.

The address is reviewed every six months, taken off the register if there have been no further reports, at least that is how it was explained to me.

So why are people violent towards us? Obviously drink and drugs play a huge part, mostly drink. But I think that there is a more subtle thing in action here.

When I wear my uniform people do as I say, they don't see me as a slightly overweight bloke - they see me as a figure of authority, that I know what I'm doing and that it is in that person's best interests to do as I suggest. Conversely, the uniform dehumanises me - it makes me a 'thing' rather than a person and it's much easier to hit someone if you think about them as just being a 'uniform' rather than a living, thinking, feeling human being.

A lot of arguments are started because of the raised expectations of people to be looked after by the state, they don't want to wait for their treatment and they want an instant cure - this is why I would suggest that actual violence against staff is higher in A&E departments, although they do have security guards posted there now.

The dangers for ambulance staff have only increased - there are more solo responders now, and they go into situations where the police would turn up mob-handed. While solo's aren't supposed to be sent to assault cases on their own, I know that I attended a fair share of such things - often waiting ages for a proper ambulance to arrive. I remember one stabbing I was sent on and it took forty minutes for the ambulance to arrive. I'm just glad that the assailant didn't return to finish off the job he'd started.

The other huge danger is Call Connect.

Due to "call connect", the government's new way of measuring the "success" of ambulance trusts, we are finding ourselves going into houses without any idea of the possible dangers. Once we are out of the ambulance, there is no way for control to contact the crew.

The new 'Airwave' radios have been delayed, so there is still no way for Control to contact us once we are out of the ambulance. We are often sent calls that just give the address.

An example,

I'm sent a call to a house I'm just driving up to - no further information is given. If I'd got out of the vehicle then I would have been met by a house full of drunks, one of whom had been cutting herself open with a kitchen knife and was arguing with the other occupants. Thankfully I don't give a damn about the government's ORCON target so I waited until more information came down - then waited for the police. If I hadn't done that there was a good chance that I wouldn't be here today writing this post.

To be honest, I would be very surprised if an ambulance person isn't killed in service before the end of next year.

Edited to add that I found the Unison's comments in the original BBC story particularly unhelpful, seeming to care more for the people who hit us than the members of their own union, then realising that there was a fence that they had to go and sit on.

Now, I accept that in terms of the human body and the weird and wonderful things that it does, I am an expert. I have training - intense training on all functions of the body. I have training on the effect that drugs and chemicals have on people. I am aware of the natural progression of the normal life cycle.

I'd like to think that some other people might have a basic idea of such things - I know we don't come with an operators manual for this sack of meat and bone that we drive around, but I'd like to think that at some point you get the general gist of certain things.

Perhaps you might even recognise in another person something that you may indulge in a little yourself.

So it annoys me somewhat when I'm forced to drive, at speed on blue lights, to something that I know is going to be nothing serious. Especially when there is an adult who can be deemed intelligent enough to be responsible for forty other people already on scene.

It annoys me that some companies write prescriptive policies that rely on 999 emergency services to do their work for them in the name of 'risk management'.

It annoys me when workers for said companies refuse to step outside their policies for cut and dried cases - when they are so fearful of being disciplined for doing the right thing that they need to call an emergency ambulance to do something that all two year olds can do.

It annoys me that our computer system (and management) in Control won't allow a calltaker to use their common sense in grading a call's response, resulting in me being a threat to other road users as they send me haring off on a call apparently only a smidgen less serious than someone who is dead, and about as serious as someone having a heart attack.

And much more 'important' than a gran with a broken hip.

What didn't annoy me was the patient - he'd had a little bit to drink but wasn't unconscious for it. In fact he'd done something that I've done myself in the early hours of the morning.

He'd fallen asleep on the bus.

I walked up to him, said hello and shone my torch in his face. He opened his eyes, looked around apologised profusely for falling asleep, then walked off the bus.

The bus driver looked sheepish.

It drives me bloody crazy - a person falls asleep on the bus and the bus driver isn't allowed to touch them. They call for an ambulance and because the patient is 'unconscious' it's a top priority call. Because of the eight minute target we are forced to respond at speed, ignoring other, almost more certainly deserving, calls. We get to the scene and wake the 'patient' up, often they are drunk, but sometimes they are just tired. We are then forced to do a full work-up on them and take them to hospital (unless the patient refuses).

I personally do at least one of these a week if I'm working late or night shifts. Often it's more.

Now, despite what our policy says, we'll normally persuade the person that they don't want to be checked out and go to hospital - this is because we have 'common sense', sure we could be bitten on the arse by thinking for ourselves - but I'd like to think that I can recognise the difference between someone who is about to die and someone who is merely asleep.

Unfortunately this common sense doesn't extend to bus drivers who are scared of accusations of assault.

We ambulance types often work outside our policies sometimes because it's in the best interest of our patients, sometimes because we would otherwise be without food and drink for twelve hours and sometimes because it's just the right thing to do.

(An example, we are supposed to wait for the police to turn up at violent incidents - if it's in a public place that we can safely reconnoitre I'll not bother waiting for the police, if it gets hairy we can always drive away).

Or maybe the drivers are scared of being assaulted themselves, in which case lets call for someone who's job it is to get assaulted, what with our intensive training of 'run away! run away!'

The LAS sometimes suggests that certain calls are unnecessary and would be better dealt with by a GP or Walk In Centre - perhaps we might try an education campaign directed to bus company executives and drivers, explaining that it is often possible to wake someone up without needing an ambulance for medical support.

Things that I have done this week.

• Resisted punching a patient after they became incredibly abusive towards me because the nurses at the hospital decided that they were perfectly suitable to sit out in the waiting room.

• Got a painful back and arm after trying to stop a drunk driver from breaking their neck after they had driven their car, at speed, into the back of a parked car.

• Breathed in aerosolised blood from a patient with a high risk of having a blood-borne disease.

• Dealt with a middle-aged woman who thought that her lifespan had been cut in half after being pushed over by a reversing car. Then wanted us to take her home before taking her to the hospital. She had no injury at all.

• Called the police to someone who was beating his Staffordshire terrier in the street, winding it up and letting it chase young girls.

• Picked up our regular, smelly, occasionally abusive drunk on three separate occasions.

• Had someone cough all over me when I had my face next to their mouth.

• Spent twelve hours sat in the seat of a Mercedes sprinter ambulance feeling my back slowly seize up. Every damn shift.

• Kicked a bucket.

• Had a grand total of three patients thank me when I settled them safely into hospital. That's out of approximately forty patients. Incidentally about the same ratio of patients who actually need an emergency ambulance.

• Inserted one cannulae, gave one dose of Salbutamol, one patient oxygen and argued with one 'carer'. Did not have to engage my brain with anyone or any situation.

And I get to see what happens tonight...

(I'm going to try and follow rule #1)