Absolutely fucking fuming, so please excuse my language.

I leave the station, having headed back home from doing one of the coolest things ever (more of which later), turn into the car park to drive to work and discover my car is gone.

Some thieving scumbag has stolen my car.

Along with the car is a uniform or two, some hi-vis jackets, my personal travel first aid kit, my work phone and, most importantly, my work ID card and my entry card to one of our local hospitals.

Top Team Leader and top AOM (my local management team) have given me permission to blow off tonight's shift so that I can kick something soft. They know that if a patient pissed me off tonight I'd be likely to be less than gentle with them.

I think that this brings the number of times my (lovely) car has been stolen up to eight. I'm feeling that familiar feeling of wanting revenge, of wanting to punch someone in the face repeatedly - but because they stole my property rather then try mugging me, there is no-one to punch.

It's the feeling of powerlessness that gets me, the desire to visit bloody revenge on the shiftless scum who did this to me. They are probably the sort of people who I spend my night shifts picking out of the gutter, drunken and violent. At moments like this I think, "Fuck it, let 'em die".

So instead, if you were the person who stole my car, here's a suggestion.

There are some plastic vials with a drug in them - if you want to get really high, why don't you try injecting it into your bloodstream and see what happens?

It'll make at least one of us happy...

I may feel saner in the morning.

UPDATE: I'm getting special treatment, because of the uniform and ID card, 'intelligence' is being passed to the counter-terrorism squad. This makes me hopeful for a dawn raid with the suspects being tazered. In the head. Several times.

And normally I'm quite liberal...

The daughter of a 77-year-old man who died two days after falling over said she may sue an ambulance trust.
Henry Purnell, of Great Yarmouth, had been drinking heavily before he fell.
He suffered a fractured skull and died in hospital from severe brain injuries two days later. An inquest jury has returned a verdict of accidental death.

No comment, or blogging today, as I'm off doing something wonderful - more on which later...

You know, I've been trying to think of a way to write about this for quite some time now (and the related subject of planning around it), but each time I've thought about how to write it I've always been scared that I'd come across as racist.

So here we go, lets give it a try and just write my impressions without putting any value judgements on it.

In my area we have a large amount of immigrants. For reasons that I presume are cultural many of these groups tend to start having children earlier than your 'native white' woman. They also tend towards having lots of children.

I tend to take more immigrant birthing women to hospital than 'native white' women. Is this just because 'native white' women tend to be financially better off and therefore own a car or have other transport?

Recently I've been finding that, on taking birthing women to hospital, they tend not to have any empty beds.

It doesn't end there.

Having lots of children places a strain on the ambulance service, the A&E departments and GP surgeries. When an infection starts spreading through the schools we get lots of calls to sick children.

If there are a lot of children in a house then all the children tend to get sick.

People who do not oppose immigration, and I count myself as a moderate member of this group, would say that if there are more people in the country then there are more people to work in the medical services industry.

Except that it doesn't work like that, I can count on the fingers of one hand the number of, for want of a better phrase, 'minority ethnic*' ambulance people. For some reason it's less of an issue for nursing staff and GPs.

(Heh, maybe 'minority ethnic' people aren't as daft as folk would make them out to be - what sane person would want my job?)

This lack of 'minority ethnic' ambulance people is at least partly because the government doesn't give us enough money to hire more people. I don't think that the LAS recruited anyone for an eighteen month period recently.

But there is no simple solution, can you really tell people to stop having quite so many children? The majority of the people I go to aren't that rich (otherwise they wouldn't live where they do), so taxation isn't the answer. Where does the money come from?**

So we muddle along. Myself? I can see us ambulance people delivering more babies at home as birthing mothers get turned away from midwife units (the second child I ever delivered was born at home because of this).

A while ago I took two 'native white' women to the midwives, both in labour, one after another. Both shared the same first name. Both were on a Methadone program. I mention this à propos of nothing.

Oh well, so it goes.

UPDATE:Just watching the local news, apparently in my area three out of every four births is to an immigrant mother, which reflects my experience.

*Because, if you are born in England you are a native Englander. But I understand that it's not as simple as that.

**The first person to comment, "By not fighting unwanted, improper and pointless wars" wins a cookie for stating the obvious.

I've decided to delete Dr. Crippen from my blogroll. His latest post and response to comments has been the final straw and he has gone from a critic to writing things that for those of us who are used to internet communication are 'trolls' to cause argument. In this latest post he gets upset when someone mentions that a GP might have been less than perfect, and in response proceeds to insult every other medical/social care group with a blunderbus of incorrect thinking and generalist thinking.

He then goes on to answer critical comments with a standard 'you just don't understand' (implying that only he has insight into the entirety of the NHS), and that he isn't insulting nurses by calling them 'nursey'.

So I'm going to take my own advice and stop feeding the troll. No more links coming from me Dr. Crippen, you have been unwilling to engage in discussion, so I'm going to stop trying.

(I suggest other people who think the same way take the same action).

But like a hydra of goodness I remove one bad blog only to replace it with three good ones - Inspector Gadget, The Police Inspector's Blog, Mental Nurse, the blog of some mental nurses, and Mouse Thinks, the blog of an A&E nurse. All three blogs are excellent and I recommend them whole-heartedly.

There we were, driving towards station at 3am in the morning. We'd been having a nice shift so far - nothing too serious, no heavy lifting and no-one had tried to punch me.

We were just passing a local nightclub (well known locally for being a bit... 'dodgy') when a man jumped out in front of us to catch our attention. Here is a suggestion - don't be jumping out in front of a moving ambulance during a night shift. Sometimes we are sometime quite tired while driving...

I hopped out of the ambulance and looked at the patient the man was pointing at. He looked drunk, he also had a cut above his eye. He was lying on the floor and as I approached he tried to get up.

Staggering with his friends holding him up I tried to get a look at his wound. The patient wasn't interested in talking to me though, he just wanted to walk off.

Then I heard shouting from up the street and I saw why.

About 200 yards up the road two groups of men were fighting, proper fighting. I saw one man take a hell of a punch to the jaw knocking him to the ground. Two others then decided to kick him while he was down.

There was nothing that I could do - I'm not daft enough to wade into a group of fifteen people fighting, for someone who I don't know. Also I may have mentioned that a fair few people carry knives in this part of town. It's a part of town where there are no banks, they all closed down because they kept getting robbed on a regular basis.

So I called up for urgent police assistance - I had no idea what the mob would do once they finished hitting the bloke on the floor, would they suddenly take a dislike to men in green?

I love the police.

I really mean it - I think that they are superb.

I don't think they get paid much more than me, they get lied to by the government, they are everybody's scapegoat and they get called in when everything goes horribly wrong.

So two officers jumping out of a response car against a mob of fifteen people, any of whom might be armed with knives or guns, takes a courage that I don't think I have.

The crowd dispersed as more police arrived - the man who'd been kicked on the floor ran like a gazelle, two police in chase. They managed to catch him and slap some handcuffs on him.

I mentioned the other victim, the man who we'd been flagged down for, he'd also disappeared as soon as the police arrived. So, with a copper in the back of the ambulance we went to find him.

We met up with him further down the road. He'd made a lovely recovery and refused to be seen by us. He also refused to talk to the police. His friend, who was the man that had been chased and handcuffed also refused to talk to the police.

The CCTV footage was so poor that it was worthless as evidence, so the man was 'de-arrested' and they went on their merry way home.

I spoke to the Inspector who come out with the troops - they told me that they'd been alerted to the fight by the CCTV operator, but then our call for assistance had come over their radio so they'd put their foot down a bit more.

I love the police.

(Even when they use us to get rid of drunks).

Luckily, neither of the patients who refused treatment went on to die.

...please stop spamming my blog with your 'oh so clever' personalised spam comments. They all get emailed to me and I make a point of deleting them.

It just takes up time that I could be spending on other things.

Please stop being anti-social. Sure, I could come around your house and graffiti all over it, and sure, you could wash it all off - but it just isn't nice. >

On utterly unrelated news - I booked back as fit for work today. The foot isn't perfect, but it's better than it was and I'm guessing that my GP wouldn't be happy signing me off sick for another week.

Imagine being called to the third pub of the shift, like the other calls the patient is 'collapsed'. You arrive and the person is stinking drunk.

He's able to answer questions, an examination shows nothing serious. You tell him that you'll take him to hospital.

He refuses.

He becomes aggressive, swearing at you, flailing around to push you away.

You can't 'kidnap' him, even if you could there is no way to safely force him into your ambulance.

So you leave him with his friends, or the police arrest him. Then you spend the rest of the night worrying that there was something wrong with him and that you'll end up standing in a coroner's court.

That nightmare has just happened to an ambulance crew.

I have a problem with the sub-headline 'Paramedic refused to treat him'. It looks to me that they tried to treat him but that he refused.

99.99% of these jobs would turn out fine, the patient would sober up in the police cells, or back at home - unfortunately there is always the slight chance that alcohol is masking something more serious.

Obviously the report can't tell us everything that happened that night, and I wasn't there and anything I write about this situation is supposition. However I do have experience with calls very much like this one - a lot of experience.

I can see how the crew made the decisions that they did. I've made similar decisions myself.

Take for instance the report of being unconscious for ten minutes. Daily I come across people who don't know what 'unconscious' means, for some people sitting on the floor means 'unconscious'. For others groaning in pain is 'unconsciousness' and for some being dizzy means that they are 'unconscious'.

If the witnesses to an event have all been drinking and aren't medically trained, then you often take what they say with a pinch of salt.

If you are unconscious for ten minutes there is a good chance of you occluding your airway and dying, someone sitting there chatting to you is unlikely to have been unconscious. I'm not saying it never happens, it's just unlikely.

So I can't blame the crew for taking the history with a pinch of salt.

But in any case, they tried to take the patient to hospital (where he would probably be sat out in the waiting room to sober up where the headline would then be 'Nurses sat patient in waiting room to die'). It was only when the patient because abusive and aggressive that they stopped trying to get him into the ambulance.

So at what level of aggressiveness do you stop trying to force someone into your ambulance? When they tell you to 'fuck off'? When they threaten to hit you? When they take a swing at you? When they push you away? When they connect with a punch? When they connect with a second punch?

At what point do our bosses, and the courts, or the press, want us to ignore being abused?

When can we kidnap people? What powers should we have to force people to submit to treatment and transport? If someone doesn't want to go to hospital and they seem to understand what is happening then we have no power to drag them to hospital.

So it's not as if the crew didn't try to take him to hospital.

The question comes down to asking if the head injury this person suffered is what caused the aggression. Unfortunately we don't have portable CT scanners and the skill to read recent onset cerebral bleeds.

Also injuries of this sort after a fall of this type are very rare - I can't count the number of 'drunk - head injuries' that I've gone to (and yes, I try to take them all to hospital), but I can't remember any that went on to die.

So, it's not incompetence, it's not a lack of care, it's not a "oh, he's just another drunk, lets leave him". It's a combination of it being illegal to take someone to hospital who doesn't want to go, of not wanting to have a fight in the back of an ambulance, and of the unlikely odds of this being something serious.

So, based on the reporting, I look at what this crew did and I think that I probably wouldn't have done anything different.

Honestly, what would I do? Take him to hospital in police cuffs for apparently only a graze to the head?

What would you do, without the benefit of 20/20 hindsight?

I have sympathy for the patient, his friends and his relatives. I also have sympathy for the ambulance crew, no-one wants their patients to die.

But that is the risk we take whenever we don't take someone to hospital.

Ok, no blogpost tomorrow so I thought I'd set up a moral/ethical/legal question to keep you interested. This was suggested to me by one of my colleagues (who will get a dedication in my next book - if I remember).

You are called to a young woman, apparently collapsed. As you get there you very quickly realise that she is faking the collapse. Her friends want you to 'save her!'

So far, so normal.

As you deal with the patient, checking for medic-alert bracelets and the like you take out of her pocket a small amount of cocaine.

The patient 'wakes up' and you are now holding a 'Class A restricted drug'.

Do you give it back to the patient, aware that this is bad for her health, and illegal?

Do you 'confiscate' it and dispose of it somewhere, knowing that this counts as stealing from her?

Do you call the police and have them deal with it, even though there is the issue of patient confidentiality and breaches the trust people have with the ambulance service?

If you take it to the police for disposal, what do you tell them? (Yes, I know they are unlikely to care much, but you might get a crusader)?

Or do you do something that I haven't thought of?

It's this sort of real world stuff that sometimes catches us out.

About my foot. I went to see my GP. Oh dear. Not a smile as I went in to the office (and I was the second patient of the shift for him), general disinterest from him. He wasn't going to examine my foot until I took off my shoe. He then examined my foot through my heavy sock. He's prescribed me some anti-inflammatories and rest. Then to return in a week if it's not better.

I've also got a sick note for this week, but I think that'll be the limit of the time I can stay off work - I'll just have to hope it's better by then.

I've always said that we should aim to get to patients as quickly as possible. But sometimes, just sometimes, I wish I could make them wait.

Here's an example of a call that tends towards waiting a long time for an ambulance and really shouldn't - Doris falls over in a shop and breaks her hip. All she knows is that it hurts and she can't get up. The shop staff call an ambulance and the call is given the lowest priority.

Doris waits two hours on the shop floor until I turn up in my truck to look after her. I hate this - Doris should be seen *much* quicker. I'm guessing that it also frustrates those up in Control who are forced to follow daft computer scripts.

So why is Doris waiting - well, not enough ambulances and too many calls that don't require an ambulance. I've banged on about this enough.

We are driving back from dropping a patient off at hospital and we get an emergency call to "Male, 25, headache for an hour". The priority of this call? One step down from a child having a fit, or a person who has stopped breathing.

The patient is only around the corner (and only 800 yards from the hospital), so we are there in seconds. Sure enough, the patient has a headache, but hasn't taken any painkillers for it. That's it. A simple headache.

The patient wants to go to hospital so, like trained monkeys, we take him to hospital.

Part of me wishes that he had been kept waiting, he's now going to expect rapid treatment like this should he, I don't know, scratch his face, suffer a papercut, or sneeze unexpectedly. Maybe he'll complain if he's kept waiting for an ambulance next time.

Meanwhile Doris is still on the floor.