The second thirteen hour shift on the trot has me rather tired.

So I'm off to bed.

Not enough energy to write the blogpost that is percolating through my head.

Up at five in the morning to do it all over again.

Nighty-night all.

Here's a thing - when there is an ambulance news story I often get emails from people asking if I've seen it. I've yet to see as many people email me over a story as this one. (And I like getting these sorts of emails, as sometimes I'll have missed the story).

An elderly couple say they are distressed as an ambulance worker wants to sue them after falling during a call to their Lincolnshire home.

The technician fell over on 82-year-old Joan Boardman's driveway in Louth as he went to fetch a stretcher.

The Boardmans have now received a letter from his solicitors saying he is seeking damages for personal injury.

Now the important thing is that I don't know any details of this case - so anything that I have to say on the subject is pretty much guesswork and supposition.

The first thing that I would suggest that if the ambulance worker suffered an injury, he would be off work on full pay for quite some time (I think it's six months down here in the LAS).

Secondly - I would suggest that if he had injured himself in a place of work, say a factory, then yes - health and safety law applies. I don't think, and I am certainly no lawyer, that health and safety law doesn't apply to homeowners in their own home. There isn't, as far as I know, any legislation saying that a path on private property has to be well lit.

Thirdly - We work in inherently difficult situations, lighting is often poor, sometimes there is a lot of rubbish around the place we work and occasionally there are some everyday hazards, like loose carpeting and the like. Accidents sometimes happen and falling over is often no-ones fault but your own.

I would also disagree with the comment from the Unison person who said,

"I can understand people finding it hard to believe but of course if someone is injured during work then somebody has got to take liability."

Now a disclaimer - I don't like Unison - but even with that said, has there ever been a dafter thing said? We don't live in a perfectly predictable world and sometimes things go wrong for no reason apart from blind chance. Actually without that randomness of life my work would be a lot more boring.

Sometimes I trip over my own feet - should I try to sue the maker of my boots? Or should I sue my mum for giving me 'clumsy' genes?

It all sounds incredibly silly to me. I'd sue a business if I went up on their catwalk and it collapsed, and I'd sue someone who assaulted me when I'd been sent to help them, but to sue because I fell over on their path is just plain wrong in my eyes.

Of course if a lawyer wants to point out how everything I've written here is wrong, they are welcome to leave a comment.

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Second disclaimer - if the above makes no sense, my apologies. I've just got in from a long twelve hour shift and I'm utterly shattered - especially as we got a late job out of our area.

Having just spoken on how to market an idea to bloggers to MSF (short version, we like truth and we also like stickers to put on our laptops), I received an email.

Hello,

I was reading your blog and I see you have a very impressive way of describing things. The information you provide is very helpful. So I was wondering if you could take a look at our product *Pseudoscience deleted* and write a review about it.

this is a link to my site: www.*utter-twoddle*.com

I would really be interested to know if you could do an unbiased paid review for us.

Bad enough, but here are two other tips.

1) Don't use CC:, us BCC: when you send the email, then I won't see the twenty odd other bloggers you have sent this exact same email to.

2) Don't send it to someone who actually enjoys debunking fake science. Not me but the superb Black Triangle. I think they missed a trick by not also sending it to Dr. Ben Goldacre as well.

So - let's see what happens if I answer their email. The first thing I'll wonder about is if they'll have even read this blogpost.

The second is if they pay up when I test them and find them to but utter rubbish*

That's unbiased isn't it?

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More seriously, if you really want to learn how to market to bloggers talk to Gia. She's my friend so it's an utter pleasure to mention her stuff on my blog - especially if it brings back memories from my past.

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*Assuming they are - I have a scientific mind and am prepared to be surprised.

There are places in this job that become regular haunts for us ambulance lot. Often they are places that you wouldn't want to be in, the worse types of estates, the hostels full of drug users, the crack houses.

There is one place that lets me feel a little happy to be going there - just so long as it's for nothing too serious.

We have a borough special needs school on our patch and it's a lovely place. It's always clean and cheerful and colourful. The children all seem happy and, strangely for a school, so do the staff.

Some of the children there are regular customers of ours, normally because they are epileptic and while the staff can easily cope with a simple seizure, sometimes the child has more than one and so needs more medical assistance than the staff can provide.

Unlike some of the nursing homes that I go to the staff member that accompanies the child in the ambulance always knows them, and they will spend the journey trying their best to comfort the child - a far cry from the 'nurse' who neither knows the patient or does anything but sit motionless in the passenger seat.

We went there today, a new child with severe problems - the staff who came with us talked to the child all the way into the hospital and gently stroked his hair. You can see how much the staff care for even those children they are yet to know well.

And it's unforced, it just comes naturally to the staff. I've seen it in some nursing homes, where the care of people is as important as the job itself. The staff walk around with smiles on their faces and we often have friendly chats with them.

So I come away happy, knowing that out there, in little pockets, there are people who really do care for others, who don't tick boxes and count pay-cheques.

And I'm glad that I've never had to go to anything too serious there.

Some people might have noticed that my publishers The Friday Project have gone into administration and are being sold.

What this does is place any sequel to Blood, Sweat and Tea into a kind of limbo (along with, I presume, any royalties). I know that they can't comment about it until the sale has gone through.

What I do hope is that Clare and the others who work at TFP are all alright - they have always been very nice to me and I wish them the best whatever the future holds.

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From tomorrow I'm back at work - which, because I'm looking forward to it, obviously makes me bonkers.

"Days in the MSF clinic can veer between hectic - seeing hoards of outpatients; over 4,000 a month) and unreal - truck upon truck of patients with gunshot wounds arriving within hours of each other. But the staff we work with here, who have unfortunately seen all this before, carry on with such continued compassion and determination that one can only feel strengthened by their example.

"The biggest challenge I've faced so far has been with the acceptance and stoicism of the people of Sudan. Recently I saw a boy of 13, with a horrendous dilated cardiomyopathy [disease of the heart muscle] who I could only encourage to go home and enjoy what remained of his life."

On Monday I was given the pleasure of speaking to Medicins Sans Frontieres at their meeting of their 'webby people'. I'd been warned that, based on the meeting last year, they were all rather sceptical of the use of blogging.

Unfortunately for me (who'd prepared for a fight), they appear to have come round to the idea nicely, there was a general agreement that social networking and blogging wasn't in fact a huge terror.

Also at this afternoon session was Karina Brisby of Oxfam and Tom Mansel of Justgiving.com (who have helped people raise more than £240 million for various charities). I was there as someone who (a) blogs, (b) has turned out to be quite sucessful about it and (c) has managed to do so without getting fired.

The general gist of the chat was essentially that you *can* trust people to blog responsibly, that people are more interested in what individuals have to say rather than PR departments and that blogs enable storytelling which interests people more than dry accounts of situations.

And that sometimes a picture is worth a thousand words.

They are a good bunch of people, and the stuff that MSF deal with makes my problems (and the problems of a lot of the people I go to) pale into insignificance.

They certainly gave me a lot to think about.

The London Ambulance Service today announced a new initiative designed to improve their response to emergency calls. The new scheme named ' Complimentary Rapid Access for Patients' will enable ambulances to turn around much quicker at hospital.

Instead of the traditional handing over of a patient to the A&E department, which takes valuable time, the patient will instead be placed into a sturdy plastic shell. All paperwork will be affixed to the outside of the shell; then as the ambulance passes the hospital the patient will simply be slid out of the back of the vehicle. There will be no need for the ambulance to actually stop moving.

Experts estimate that this new proceedure will enable ambulance crews to reach more patients within the allotted eight minute target. Ambulance staff will be discouraged from stopping at the hospital for a cup of tea or a toilet break, as the government considers ambulance crews as being able to work twelve hour shifts without such luxuries.

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Of course this isn't true; but it wouldn't surprise me if some bright spark hasn't suggested something similar.

It's 'silly season'; April approaches and with it the cut-off point for us to hit our government mandated eight minute ORCON target. Normally around this time of year certain management types in ambulance trusts across the country start sweating.

Some trusts have already had inaccurate figures, I couldn't possibly comment on whether other trusts have similar problems; lets just say that it wouldn't surprise me in the least if we hear more accounts like this whether it's due to computer error, human error or someone purposefully 'massaging' the numbers.

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From Monday, in order to try and improve our ORCON, the London Ambulance Service is going to stop us from doing any 'administrative' hand-over.

How we book patients into hospital in the past has gone something like this. We arrive at the hospital. We show the nurse the patient and let them know what is wrong with them. The nurse tells us where they want us to put the patient. The nurse gets on with looking after the patient. The ambulance crew heads to the reception area and 'books the patient in' by giving the receptionist all the relevant details. Paperwork is generated by the reception staff that enables the clinical staff to perform such tasks as sending off blood for tests and arranging x-rays.

From Monday we will no longer be talking to the receptionists - instead the nursing staff, as well as looking after the patient, will have to book in the patient. Or send a relative to book the patient in for them.

No possibility for anything to go wrong there then...

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In my memory this has been tried twice before; at least once when I was myself an A&E nurse. Neither time has it worked in the patient's favour. The ambulance crews would hand over to us nurses, then we'd have to make sure that the patient was booked in. Sometimes (because A&E nurses are occasionally busy) paperwork would be forgotten, or lost, and the patient would disappear off the system.

This obviously can have serious effects on the safety of the patient, especially patients who are sat out in the waiting room.

This is why we book our patients in at reception - it's because then we can be sure that the hospital has responsibility for the patient. That the patient shouldn't get lost in the system.

It's that bit more work for us, but we do it because it gives us peace of mind.

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I'm not sure how this is going to be enforced. I suspect that for a few weeks we'll have some Team Leaders or Duty Officers sitting at the hospitals making sure that we follow the protocols. I leave it to the imagination of the reader as to the effect such staff could have on ORCON if they were working on ambulances instead.

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I also suspect that this initiative will only last for around a month. April brings in the new year of ORCON targets, and so a rapid turn-around at hospital won't be so important after April 1st.

Until this time next year.

What I do hope is that no-one dies because of this. If someone does die, sitting in the waiting room, or in the toilets I know that the hospital will do all they can to shift blame on someone else. That blame will doubtless be on the ambulance service; and it won't be the manager who thought up this idea, it'll be the poor bloody road crew who get the short end of the stick.

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Part of our Visions and Values is -

Clinical Excellence
We will demonstrate total commitment to the provision of the highest standard of patient care. Our services and activities will be ethical, kind, compassionate, considerate and appropriate to the patients’ needs.

Could someone please explain how not bedding our patients securely down in hospital fits this value? The last time this was tried patients disappeared and spent hours waiting for treatment while the hospitals didn't know they were there.

All this is to fit in with the clinically irrelevant ORCON standard (do click on this link - it makes interesting reading when the BMJ agree with us. Particularly "The strategies introduced to meet the targets can be detrimental to patient care and also have adverse effects on the health, safety, wellbeing, and morale of paramedics.").

It is just another way that the ORCON standard is having a negative impact on the effective and humane treatment of our patients. Anyone who wants to disagree should take a look at my proposed solution, and then tell me that ORCON is the ideal measurement.

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If we really want to be living up to our Visions and Values I think we should be kicking and screaming at the government to get ORCON measurement off the table, or at least made vastly less important. It's not evidence based and it's having a detrimental effect on patient care - and this latest initiative is just one more example of this.

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I want my management to take this in the manner that it is meant. As a call to realise that bending over backwards to fulfil the inappropriate targets set by the government is no way to lead a service, and that we need to start pushing back against these diktats. That we, as ambulance trusts, need to start fighting for our patients, so that they get the service that they deserve, not what the government finds easy to measure.

No sooner than I hit publish for this post than I note that Mousethinks has written about the problems caused by slavishly following the A&E targets.

(And if I do get sent my P45, anyone got a job for a jumped up first aider who is experienced in all sorts of internety stuff?)

It's all the fault of Sony - they've turned me into a lawbreaker.

While I was America (nice place, shame about the government - although you may as well say the same thing about the UK) I spotted a demo model of the Sony Reader (PRS505). I'd been wanting to see what 'E-Ink' looked like so I had a bit of a play around with it and thought it was rather nice.

As I am a nerd and a shameful first adopter I managed to wrangle one into my grubby little hands.

It's really rather clever - the screen is easy to read, it's light and thin and it doesn't feel like you are reading things off the screen. You load the books onto it via your desktop/laptop system (and the software isn't Mac compatible, but there are workarounds).

So it came time to load some books onto it. First stop was the Sony Reader Ebook Store. It is from there you can pay for and download e-books. I quite fancied the Neal Stephenson 'Baroque Cycle'. I own them in 'dead tree' edition, but have never managed to read the whole three because the books are physically huge.

And then I hit a snag.

You see, you need a credit card that is registered in America to buy things from the store. Being a simple traveller from the UK I don't have such a thing. So my money is no good for them.

**Insert clever joke about current £/$ exchange rate here**

I want to give them my money. I give Audible my money for audio-books, I give iTunes my money for music downloads. But the rules of international marketing and the dumbness of Sony means that I'm not allowed to read their books.

What to do, what to do?

Well, I could scan the books in to my computer, perform OCR on them and put them on myself - but have you see the length of them? I could transcribe them myself, but then I may as well be reading them.

So instead I hit the bit-torrent sites and downloaded them.

I now have slightly wonky formatted copies of the books that I already own, books that I would have paid money for again for the ability to read them on my sexy new reader.

So lots of people have missed out on a sale.

Back in the day I used to illegally download music - now I have the ease of use of iTunes or eMusic, one day hopefully Amazon in the UK will offer music downloads. I'm happy to pay for these downloads because (a) Its the right thing to do and I'm no longer a skint student (b) It's just easier.

When video rentals for iTunes arrives on these shores I'll be using that, or a competitors service.

I like paying for my media.

I've downloaded books from Project Gutenberg and from Archive.org (including my own book), but I want to give real authors real money for the privilege of being able to read their books.

But Sony says I can't.

The counter argument is that I have no 'right' to format shift works that I already own - move, for instance, bought CD music into the MP3 format. Yes, if you've done this then you have broken the law and the record companies can sue you into bankrupcy. Allowing this 'format shift' is one of the key recommendations made by the Gowers report (even though the government is being slow to bring it into law).

Ethically I don't think I'm doing anything wrong, if I'm allowed to resell books that I've bought (which I am) then why can't I reformat them into another readable format for my own personal use.

But by making me jump through these hoops I'm reduced to illegality.

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With no work until Thursday, and no stories in my 'big black book of interesting ambulance stuff' I'm stuck writing about other things. Oh well, normal service will be resumed soon.

E. Gary Gygax died today.

For those who have never heard of him, he was the co-creator of the original Dungeons and Dragons Role-playing game.

This makes me incredibly sad - without D&D I wouldn't be the person who I am today. Gaming has taught me a lot, and not just those jokey '1001 things I learned from playing D&D' type lists.

I don't think I'd be blogging if it were for the effect that RPGs have had on my life.

Wil Wheaton says it best.

Rest In Peace.

I'm a twit sometimes.

Take yesterday. I'm supposed to be working four night shifts, so I arrive in work with plenty of time to spare (and so I can pop across the road and get my dinner, a half-pound heart attack in a bun).

My crewmate turns up, we get our kit on the ambulance and wait for the first call.

Then the resource center (who handles the staffing of vehicles) phones up my crewmate and tells her that she's single and they are sending someone to work with her.

The shoe drops - I'd booked these four nights off early last year so that I could go to SXSW, but then money became a problem so I couldn't go. I'd then forgotten to cancel the leave.

What a nice surprise.

I'm back at work on next Thursday - so I have a chance to do a load of things that I've been putting off because I haven't had the time.

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Just a quick comment on the news that the report on 24 hour licensing is to be positive.

It's not my opinion, there has been a 12% increase in alcohol related calls to the LAS in the last two years (without an increase of resourcing to deal with it). The Information Centre shows that admissions for alcohol have doubled in the last decade. And anecdotal evidence would suggest the same.

It just shows how detached from reality our policy makers are. Or how blatant the conspiracy between government and alcohol producers has become.