The sun is going down behind the horizon, thick clouds overhead. I can feel the first drops of rain.

My knees, my back are screaming in pain, but I can't move, I have to hold my patient's head still.

Blood runs from his head pooling beneath my boots mixing with the puddles from that afternoons rain. The blood is red but as twilight approaches it gets darker in colour before fading to a sticky black.

Beneath my hands the patient twitches, I wonder if it is because he is cold and drunk or if it is because of a serious head injury.

Not for the first time I wish for eyes that could peer into his skull to see the damage. Instead I stare at his face, his eyes closed only sometimes opening to my shouts of his name.

We enlist the help of bystanders to help roll his body onto the stretcher. We bind him to it using straps that were designed for other equipment.

We make do and mend.

Finally he is in the ambulance, on the stretcher he holds his arms in a position that I hope means that his brain is largely undamaged.

We head for the hospital, lights and sirens blazing, weaving through traffic. I keep looking at him, checking and rechecking to make sure that he hasn't taken a turn for the worse. I hold my breath that he doesn't start fitting.

At the hospital the resuscitation room is a place of noise and light, full of doctors and nurses and radiographers, all in lead aprons. They listen to me tell the story of the last hour of this man's life. Numbers roll from my mouth, the mechanism of the injury, my findings and things that I didn't find. They hear me hope that it is the alcohol causing this.

We go back to the ambulance, in the center of the floor is a perfect bootprint.

Mine.

Formed from his blood.

Maverick ambulance service managers risked patients' lives in an over-zealous drive to achieve the quickest 999 response times in England, the government's health watchdog disclosed yesterday.

The Healthcare Commission said Staffordshire ambulance NHS trust used poorly trained volunteers to act as "community first responders" to get to emergencies ahead of paramedics. They were authorised to drive at speed, using blue lights and sirens, without the necessary advanced driving training.

The trust supplied ambulance staff and volunteers with controlled drugs that they were not legally allowed to possess, including the sedatives diazepam and midazolam. It also failed to keep proper records of medicines, which regularly went missing from ambulance stations. Patients were sometimes given larger packs of controlled drugs than they needed and told to dispose of the excess themselves.

It's not the London ambulance service, but it just goes to show what lengths trusts will go to in order to hit these targets. A strange first sentence though, "Maverick". Will the police be looking into whoever illegally supplied the Controlled Drugs?

It said Thayne, a former army officer, was described by senior staff at the trust as "a benevolent dictator".

From what I hear, that's not what the ambulance crews on the road called him...

The commission blamed regional and local NHS managers for not asking searching questions. "This complacency was brought about by the trust's ability to exceed the Department of Health's targets," it said.

In other words, "They were hitting their targets, so we didn't look too closely at how they were doing it".

I think that community first responders are a good idea, out in the country every little town can't have an ambulance sitting waiting for someone to become ill. However, they shouldn't be whizzing around on blue lights, not without training. And with blue-light training you may as well train them to ambulance technician standards - but, oh, that would cost money.

(Although as far as I know the legislation about driving an emergency vehicle is a bit wishy-washy - any experts reading this, please do chip in).

The commission report has this to say,

Some of the problems may have arisen because the trust perpetuated the belief that the role of a CFR was broadly equivalent to that of an ambulance technician. Although the trust, when compared with other ambulance trusts, provided more training for CFRs, this was not comparable to the training given to ambulance technicians.

From the Healthcare commission themselves,

The Commission points out that the trust was a good performer in terms of response times for emergency calls. It was considered to be innovative in its introduction of new equipment and services and had good relationships with patients and the public.

But, the investigation found that these achievements were undermined by a culture and approach that did not prioritise safety and that put patients at risk.

So once more, evidence that the ORCON target puts patients lives at risk,

I've yet to look after a celebrity in this job - while the chances aren't that high, we do occasionally find ourselves in the more central parts of London. There is also a rather famous heroin user who lives on the edge of our patch, although I suspect that they do most of their 'partying' in rather more salubrious establishments than can be found in my patch of East London.

The closest to celebrity that I have dealt with is the daughter of one of our 'pillars of the community'.

She was with her friend, working as a prostitute and had been hit when the punter had expected more or his £20 than a quick 'hand shandy' behind the bushes.

Lots of foul language in the back of the ambulance, none of which directed at me or my crewmate while various bits of anatomy were nearly falling out of the clothes.

There were no serious injuries and the girls just wanted to return home, just down the road from where I was bought up as a child. They didn't want the police involved and to be honest I suspect that the police officers present were more amused by the protestations on innocence by the man and the complete and frank disclosure by the women.

Such are the high social circles I move in.

Today's blogpost is elsewhere.

Little does the crew know that the woman has just told the call-taker that she has a knife and is going to kill the paramedic about to come through her door.

-----

The Guardian asked me yesterday to write about violence on ambulance staff, this was a strange coincidence as that was the exact subject I was going to write about today.

Here is another example of how Call connect is a danger to ambulance crews that wouldn't fit into the article.

It's nine a.m. in the morning, we have been sent to a young male with a 'head injury' in a residential property. WE have no details of how this occurred so I ask Control if they know anything.

They have to ring the patient up again to ask him. He's been assaulted and the assailant is still with him. The caller promises that the person who inflicted the injury is not going to be a danger to us.

What makes this dangerous is that Control had to ring the patient back, they didn't note that the injury was caused by an assault when the call first came in.

All in an effort to get us to the scene to stop that all important ORCON clock.

It would not surprise me if some time this year an ambulance person is killed because of there not being enough information gathered before they arrive on scene. I'll also predict that the trust involved will use the phrase 'Lessons have been learned'.

In the LAS we have a thing called the 'high risk address' register - it's where we make note of any houses where an ambulance staff has been abused or attacked. We put addresses on it ourselves after the fact. It's something that will be part of a larger post sometime this week.

It was no surprise to see our current call tripping the alarm, I'd put it on there myself.

The woman who lives in the flat suffers from some pretty severe mental health problems, the flat is always a tip and she calls us for some rather strange reasons. I'd been to her when she had thought she was pregnant, about twelve months pregnant. I'd done nothing to provoke her, but her and her boyfriend had started shouting and screaming at us, so we'd retired to a safe distance; then called the police who calmed the situation down. I'd then filed the paperwork and the address was duly marked.

So we found ourselves parked up the road waiting for the police to come. We'd been called because she was 'hearing voices', then she'd told the calltaker that she had knives in the house.

Yeah - I'm brave, but I'm not stupid.

So we waited for the police, for they are braver than me and have much more experience in dealing with aggressive people in a 'physical' manner than myself.

They soon arrived, two officers, both about the same size as me. I may not have much of an ego, but even so it can be a bit bruised if I find myself hiding behind two female officers who are five foot nothing. Especially considering that they could probably 'take me out' in short order.

The police knocked on the door, I cowered behind them. Our patient opened the door with a smile.

"Come in, sit down", she said joyfully.

We walked into the flat - you couldn't pay me to sit down, it was a little tidier than before, but not by much.

"I'm fine now, I found my pills".

A little chat and we filed out of the house.

It's embarrassing when you ask for the police and don't need them - though they never moan about being used unnecessarily, it just feels like you are wasting their time.

But in this case it saw the officers off duty without having to fill in reams of paperwork, so it wasn't all bad.

I wonder how she'll be the next time I see her?

So.

Unlike the things that normally make me angry, this particular episode was because of something that happened to me.

I had my formal interview for my sickness record. Five periods of sickness in the last twelve months has led to this, for I am only 'allowed'

• Three periods of absence in a rolling twelve month period.
• or, two periods of absence resulting in eight or more days being lost, in a rolling twelve month period.

I noticed that I was getting on to breaching this rule so I asked for counselling a to how to improve my sickness (as obviously I must be doing something wrong to be breaching such reasonable guidelines) - I'm still waiting to get such counselling.

I'm also waiting for an occupational health appointment for my foot injury which was aggravated by slipping on some oil at work.

I found myself sitting across the table from two members of my local management team (neither of whom know me) and some Human Resources person in a suit. I'm just in time having done our Control a favour by taking a transfer from one hospital to another.

I asked why the sickness policy is the same for those of us out on the road as for those who sit in an office from 9-5 Monday to Friday. There was a mumbled 'we are looking into it'.

I do rotating shift work - there is plenty of research that points to this having an effect on your immune system as well as making you much more likely to get various cancers (mostly breast, prostate and colon) and increasing your chance of heart disease. I also have the pleasure of sitting in the back of the ambulance with infectious patients who insist on coughing, sneezing, spluttering and sneezing all over me.

"Eat well and do some exercise" was the advice I was given.

I accept what they said, that my absences are more than those of my peers, although if I were a little quicker witted I may have asked by how much. If I were really thinking I would have asked if I fell outside the standard deviation of my peer set, and if so, by how much. Or I could start wittering on about p-values, and is my sickness really that unusual?

If only I weren't the embodiment of esprit d’escalier. Instead I left the room waving goodbye when they have led me up to the hangman's platform.

If I have one period of sickness in the next eight months then I'm up before people several pay-scales above me for a Capability Hearing - am I capable to continue working in the service.

This came as a bit of a shock considering that the local management team have repeatedly missed meeting with me to discuss my absence despite their own policy.

I asked what would happen if I had a case of rampant diarrhoea, should I shove a cork up my backside? I was told that they would 'look into it'.

They did at least have the humanity to tell me that if I were sick because someone assaulted me then it wouldn't count.

Jolly nice.

The next time I'm at the hospital I'm going to get some of their adult nappies - so that should I have diarrhoea I can still work. I look forward to coming to work with 'flu, being sicker than my patients and giving it to them for a change. I just hope I don't come across any patient with a compromised immune system.

I look forward to coming into work and showing my manager a sample of my stool in order to prove that I do have diarrhoea - it may even still be in the uniform I was wearing at the time.

It does make e angry - that I work hard when I'm on duty, I offer up to help out Control, I put myself in front of violent, infectious patients. I wreck my health and social life with shift work for very little reward. I don't get complaints made against me and I don't consider myself a person who 'rocks the boat'. And yet, because my sickness is higher than those who work in an office I'm threatened with the sack.

If I were paranoid I'd say that they are trying to get rid of me.

It makes me...

...ah...but that's a post for another day.

It's gone up on the BBC Radio Four Website - you can listen to the radio play based on my book just by following this link.

UPDATE: After reading the comments, I'd just like people to be aware that I had very little to do with the play, it was written by Richard Monks, not me - I just gave them the idea to set a play in the ambulance service.

To Whom It May Concern

Our Mr. Reynolds is unable to write his usual blogpost due to him being peeved, annoyed and occasionally downright angry. This will pass, but in the interests of public safety, as well as not writing something that he will regret, there will be no blogposts here until Monday; when he hopes that he will have calmed down enough to unclench his fists and provide his normal balanced reportage.

Until then he shall content himself with the making of Molotov cocktails and trebuchets, and by shaving his head and walking around his flat naked and screaming.

The MGMT.