This blog has been many things over the years, it's been a place to rant, a place to explain what us ambulance people do, a place to celebrate what we do well, a place to defend the service from inaccurate news reports and a place to criticise some of the planning that occurs.

The benefits of this blog are many and varied, I've met people I never would have otherwise, done things that I'd never have imagined and made some very good friends. Doors have been opened to me.

I enjoy writing this blog. I like having a place where I can write and people listen to me - I know that sounds egotistical but I'm not alone in liking an audience. Sometimes it's hard to motivate myself when I'm coming off a twelve hour shift, but other times I can't sleep because of something I need to write.

Why am I telling you this?

I've been sitting on an application form for the position of Press Officer for the LAS for the past week or two. The reasons for even having this form are many and varied and will be a subject for a future blogpost. I'm not qualified for the post, even though I think I would bring a breath of fresh air into the role. The chances of me even getting an interview are tiny, if not non-existant.

But it was only this morning that I realised that I can't go for the post.

It's all to do with credibility.

Would you trust me, dear blog reader, if you knew I was now part of a PR machine? Would I still be able to rail against some of the inadequacies of the NHS, the Government or the LAS if I were further on the 'inside'? Would such a job role completely neuter this blog?

I think that it would, so the application form (no shift work, less heavy lifting, more money, just as much fun) has gone into the bin.

It's a damn shame, but this blog has come to mean so much to me over the years that doing something like this would make me feel like I've 'sold out'.

It would have been nice to have a kettle always within reach though…

Ambulance Nut works for the Trust mentioned in the last post and has a few important things to say, things not reported by the news story that I linked to.

It's important to see how media reports differ from reality.

(Thanks go to Ambulance Nut for drawing my attention to this).

For those that are interested, I was invited onto the Radio 5 Live show to talk about this very sad story. The BBC are lovely so I had a cab to a studio in London, while the presenter sat up in Manchester. Stephen Nolan the presenter obviously plays the devils advocate while I play the voice of reason.

As is normal with talk radio there are some… interesting viewpoints, although I'm quite sad that no-one surpassed the first caller in comparing me to the Nazis.

You can listen to it again here, my segment starts 1:08:50 into the stream. I don't think it will be up for too much longer.

I am grateful to the ambulance and police workers who phoned in to support me - It just goes to show that I'm not mad, or at least I share my madness with other people.

I had my first letter of thanks yesterday, the first one I have ever had.

It was a lovely simple job, one of those jobs that you tend to do a lot of. The call was to an elderly woman who had maybe collapsed. The problem that faced us was that she had collapsed behind her front door and no-one was able to gain entry.

We never really know what to expect from this sort of job, sometimes the person is fine, they've just fallen over. Sometimes the person is seriously ill and this is the reason behind the collapse. Occasionally the person will have died in the night.

The, also elderly, sister had gone to our patient's house and was unable to raise her. She'd then gone to the police station and they had contacted us.

We arrived to find the police already there, they were waiting for the officers who had the battering ram as there was no other way to get into the flat. An officer had just brought the sister of our patient with him back to the house.

So the door splintered inwards and the police officers entered the flat. We follow them in and listen to see who finds her first.

Thankfully she is alive and lying on the bedroom floor. She's a stick of a thing and well into her late eighties.

We quickly check her over to make sure that she doesn't have any injuries, then pick her up and lay her in bed.

What then follows is little more than a more extensive examination of her and a bit of the old 'chat'.

We talk to her and her sister while checking her blood pressure and the like about such diverse subjects as dead husbands and playing 'knock down ginger', about how out patient hates doctor yet how kind her GP is.

It's nothing unusual, it's nothing that we don't do for all our patients in order to put them at ease.

We arrange the GP to come and visit her and leave.

But somehow a card of thanks makes it's way to us, the sister walked up to the hospital and asked the ambulance crews parked outside to make sure that we got it. So I return to work, look in my letter tray and find the card.

It's a simple little thing, it just says 'thank you', but it means a lot to me.

His wife lets us in, it's one of those houses that are so clean I feel bad about traipsing my boots all over the carpet. Our patient is a man in his eighties sitting in a chair. He's spotlessly clean, wearing a shirt and a tie, hair brushed back.

He looks like a ghost, the blood has drained out of his face. As I enter he looks up at me and smiles.

We had been called from pretty much around the corner, the wife has already thanked us for getting there so quickly. She's called us because, as she describes it her husband had a fit.

He's normally fairly healthy, a bit of a cardiac history but no epilepsy or diabetes, nothing that would suggest a seizure.

I bend down to his eye level and start talking to him, my hand snakes out and automatically takes his wrist. I feel for a pulse.

Bom………Bom………Bom………

His heart is beating around 25 times a minute. It should be sixty or more. It's no wonder he looks so ill.

I give my crewmate the look. The look that says, "Uh-oh, something's wrong here, we need to speed it up a gear".

I tell her, "Let's get the gentleman in the back of the ambulance eh?"

She understands and jogs out for the carry chair, we don't normally move faster than a stroll. Given the type of call it was given as we've brought loads of equipment into the house with us, we can't always carry the chair in as well.

"I feel sick", says the man and his face drains of even more colour, something I didn't think was possible.

He vomits, his eyes roll back in his head. Warm brown liquid flows over his tie, down his shirt and onto his lap.

I look at this and scrabble to find that pulse again. I'm just about to grab his ankles, pull him off the chair and start CPR when he opens his eyes.

"I feel a little better now", he says.

His wife tries to help me remove his tie, but I'm the one with the gloves on so I tidy him and wipe him down a little while I wait for my crewmate to return. It's only been seconds but it felt much longer than that.

After being sick his pulse had come up a bit but it soon starts to drop again. We bundle him into the chair and rush him out to the ambulance.

We are only three minutes from the hospital and normally we wouldn't 'stay and play', but there are medicines that we can give to speed up his heart, fluids we can give to bring up his blood pressure and an ECG to do to see if the cause for this sudden slow pulse is due to a heart attack.

If it's a heart attack we'll be bypassing the hospital three minutes away for the angioplasty centre, which depending on the traffic, is at least twelve minutes away.

The ECG show a complete heart block not a heart attack, something I'm extremely grateful for.

I often joke with patients that they should only worry if I look worried. In this case I'm trying to keep the worry off my face.

"Let's get a line in him and give him some atropine", I say to my crewmate - then make a mental note to apologise to her later, she's the paramedic she knows her job. It's just that when things start to get serious I can get a little… directive. I think it's because I tend to think aloud and because I used to be a nurse - a rather bossy nurse sometimes.

Despite the medicines his pulse remains the same but at least his blood pressure is coming up with the fluids and with him being laid down.

We blue-light him into the hospital. Three minutes later he is on the hospital bed being looked after by two nurses and a doctor.

His wife is in the relatives room, the resus room is full and another call is coming in (another patient with much the same problem as ours), so the staff can't take the time to talk to her.

I fall back into my nursing mode. I sit with her and hold her hand, she thanks me again and I apologise that the hospital staff haven't spoken with her yet. I explain that they are very busy and she tells me not to worry. I explain to her what the doctors are doing and that the likely outcome is good now her husband is in hospital.

Meanwhile in the ambulance the timer is ticking up, someone in Control is watching this and will be wondering why we are spending so much time at the hospital. I don't even give it a thought.

I pop my head back into the resus room, the doctors are happy that our patient is stable - he's looking a lot better although his pulse is still a little low. I let the wife know. She thanks us again.

We clean the ambulance and get ready for our next call.

A little later one of my colleagues takes our patient to another hospital to have a pacemaker fitted, I hope it's all going to go to plan and that there is a happy outcome.

London Ambulance Service celebrates best year, but urges public to ‘use us wisely’
SERIOUSLY ill and injured patients in the capital are getting a quicker response from ambulance staff than ever before, but those who do not really need emergency help are once again being urged to use the 999 system wisely.
The 2007/08 year was the best in the London Ambulance Service’s history, despite a further rise in demand which took the number of emergency calls received up to nearly 1.4 million.
A total of more than 943,000 incidents were responded to, an increase of more than three per cent on 2006/07, and included 315,700 Category A calls (assessed from information received as being serious or immediately life-threatening).
Of these, 79 per cent were reached within eight minutes, which represented the Service’s best ever performance against the Government’s national target of 75 per cent and was helped by improvements in the time taken to answer calls in the control room.
The news caps a very successful year for the capital’s ambulance staff. The Service was named the highest-rated in the country by the Healthcare Commission in October and the survival rate of people suffering out-of-hospital cardiac arrests in London has more than trebled in the last five years.
The improved speed in responding to patients was made all the more notable by the fact that November and December 2007 were the busiest months in the Service’s history, and that demand has also remained comparatively high since then.
Now, in an effort to remind the public of the other healthcare options available before calling 999, the Service has produced a newspaper advert to appear in a range of publications across the capital.
Chief Executive Peter Bradley CBE said: “Staff from every department in the organisation have played their part in what has been our most successful year ever, and we can be confident that the high-quality care and treatment we are providing to our patients is continuing to improve all the time.
“Londoners can also help us to help them by using us wisely and only calling us in an emergency, so that we can really focus on those people who genuinely need our help.”
The way in which ambulance response times across the country are measured changed at the beginning of this month, meaning that the ‘clock’ now starts as soon as a call is connected to the control room, rather than after key information has been obtained from the caller.
This new system – along with continued high numbers of calls from patients who do not really require emergency medical help – means that the Service will face a very challenging 12 months ahead.
Peter added: “The new way of measuring our response times is very good news for patients as it will require us to respond even more quickly to calls, and this should help save even more lives.
“What it does mean, though, is that more than ever we are urging those people who are not seriously ill or injured to consider other ways of getting help before dialling 999. This can include looking after themselves at home, calling NHS Direct on 0845 4647, or even making their own way to hospital, as arriving in an ambulance does not mean that they will be seen more quickly.”
The Service is now in the second year of an improvement programme running up to 2013 and which aims to move right away from a one-size fits all way of responding to patients.
Peter said: “We are planning to increase both our number of frontline staff and vehicles over the next year, and are looking to ensure that we can provide the most appropriate care for our each and every patient – whether that means caring for them in their own home, taking them to hospital or an urgent care centre, or to a specialist centre best placed to treat them for their particular condition.”

• In 2006/07, the Service reached 75 per cent of Category A calls within eight minutes
• Until the beginning of April this year, the clock started after the caller’s telephone number and the patient’s location and nature of their illness or injury had been established

I've just had two weeks off work, two glorious weeks where I could maintain a reasonable body clock, could sleep and could be normal for a change.

The constant nausea that has crept up on me vanished and tension drained from my shoulders.

Then on my first shift back at work I suddenly get insomnia and that familiar nausea returns. I'm making an effort to eat some decent food and to get some good rest. Perhaps I may even have an attempt at exercise.

---

We were called to a ten year old who'd fallen down some stairs, nothing serious and on further discussion, the sort of thing my crewmate and I used to do for fun. Would we take the happy, healthy and fundamentally unhurt child to hospital?

Well yes, you see the mother was conviced that the child stopped breathing for three minutes.

Apparently the child was fully awake and looking at her mother during this 'respiratory arrest'.

It's one of those weird things, that parents will often state that their child stopped breathing - now, given my medical training, I find this hard to believe.

But the trick is never to mock the parent, they were there and witnessed the accident, so we take the child into hospital and let them sort it out. While I'm sure that it's the parent panicking, no-one ever lost their ambulance job by taking someone to hospital.

And besides, the family were nice, so it wasn't a hardship to keep them happy.

You may be interested to know that you can now get my book in the colonies without having to pay huge amounts of postage and packaging. My publishers over there are Andrews McMeel Publishing who I like a lot even if they won't pay for me to fly out and publicise it.

It should also be available in shops, so feel free to ask them to order them for you. While you are there ask them to order a few extra to put on the shelves.

It is also freely available under a Creative Commons License at Archive.orgThis lets you remix the book in any way you can think of as long as you don't charge for it and as long as you credit me.

So please, go and buy it so that I might retire to a beach somewhere to drink fruit based cocktails until I go mad with boredom. Also to give these lovely publishers some profits as well.

The boiler in my place is knackered, so I'm typing this wrapped up and hoping that the laptop heat will warm my legs. Once I get going it'll be fine (for I am completely cleaning and rejigging my flat). Any typos are due to me not being able to feel my fingers.

On our data terminals we have a 'special information' section, often this causes more problems than it solves.

"Elderly woman, unwell, called by relative not on scene, ring three times so she thinks it's her relative calling or she won't open the door".

What?

Now, we don't have extended contact with patients, but what we do is try to form some sort of relationship with them. Sometimes I take on a parent role while the patient is the child, sometimes it's a partnership and sometimes I'm the child and the patient is the parent. It all depends on what works with the patient. It's one of the skills that we ambulance people develop - to quickly determine the best way to approach the patient.*

What we don't do is start off with a deceit. It's never going to go well if the first contact that you have with the patient is to trick them.

Things tend to go downhill from there.

We were cancelled for a higher priority call (probably a twenty year old with the sniffles, so it goes) but I wondered what I would have done had I arrived on scene only to be greeted by a closed street door.

The options are simple assuming that the relative isn't nearby.

1. Knock normally and hope that the patient opens the door. It's unlikely that she would. Then shout through the letterbox that we are an ambulance who've been called by her relative. Lots of elderly people try to avoid going to hospital (they aren't daft - people die in hospital), so that wouldn't guarantee success.
2. Knock three times. The patient then opens the door expecting to see her relative and instead there is a 6'1" tall stranger in green asking if her can remove her from the house. I can't see anything possibly going wrong with that.
3. Knock normally, give up and wait for the relative to make their own way down to the house. This may take some time depending on how far away the relative is.
4. Knock normally and when she doesn't answer get the police to kick down her door. Hmmm I suspect (quite rightly) that the police might refuse to do this.
5. Be grateful I'm cancelled off the job and am on my way to do something far less stressful.

My job is simple - most folks could do it with the right bit of training - but it can get very complicated over the strangest detail.

*I used to know all the special names for this sort of thing, and much, much more. Now it's so soaked into the very fibre of my being and I've forgotten the 'proper' terminology because I use it unconsciously. I'll leave it to the experts to use the long and impressive words.

Only a quick post today as I'm in an extremely busy part of my life at the moment.

Reading the comments on my last post reminded me that I haven't really commented on comments. Here is a rough FAQ.

1. I like reading comments, it lets me know that people are reading this site as I don't pay much attention to site statistics any more.
2. I value almost every single comment.
3. All comments, no matter how far back into the archives they stretch get emailed to me. I read every single one.
4. I delete all spam, just as a matter of principle.
5. I don't delete comments with three exceptions - If the person who wrote the comment emails me and asks me, if it breaches patient confidentiality, or if they are nothing but abuse.
6. Feel free to disagree with me in the comments, I like having to change my mind about something I've written or having to defend myself. It gets what tiny spark of academia I still have burning again. Just try to be polite and if you can bring evidence to the discussion I'll thank you for teaching me something. (See my post on Home births for example). I may completely disagree with you, but we can still be civil. So far I am so incredibly happy and proud that almost every comment thread has been reasoned and calm, even when discussing quite controversial subjects.
7. If you write utter twoddle then other commenters will stamp on you. I tend to ignore the trolls but others won't. The verbal beating you get will make me laugh.
8. You cannot insult me in the comments, nor upset me, nor cause me harm. I spend my day job being verbally and physically abused. Words on a website do not bother me in the least. If I have a sleepless night it won't be because of something you've written. I have no dark secrets in my past that you can bring to light and embarrass me. If you are a fool I will laugh at you.
9. I may use comments as inspiration for further posts. Sometimes far in the future.
10. If comments get silly (like calling other commenters Nazis) I will shut that thread down.
11. I try to answer direct questions, if I seem to have forgotten and it's important do feel free to send me an email - I'm awful at answering emails but I will get to it eventually. The timing depends on what shifts I'm working. Likewise if there is a good comment thread I'll get involved, but unfortunately I have little free time so please don't feel I'm ignoring you.
12. I love comments, I really do.
13. If you want to leave a comment you need to 'create a reader account'. This was put in place to stop the frankly astounding amount of spam I was getting (over 500 a day).
14. If you have a long comment to make and a blog of your own, post a précis of it here and direct me to your own site - we can continue the conversation between the two blogs, just like the good old days of blogging. I like getting comments of all sorts, but this means I can send some linky-love your way.
15. Keep commenting I really do love it. When I was promoting the book a lot of people asked me my favourite thing about blogging, and each time I answered, "my commenters". Really, each time I get even the slightest glimmer about packing in this blogging lark it's you folks that keep me going.

Yes, pretty much most of that list can be boiled down to, "I like comments and read them all, but don't be an arse", but it sometimes needs stating.

All comments gratefully received.

UPDATE: And then I hit my Bloglines subscriptions ands see that Diamond Geezer has posted a much more entertaining view on the same subject.