I've had a crappy day and I get home to find a couple of people have sent this story to me. (And thanks to all those people, I would have missed it otherwise).

A paramedic has been criticised for not cutting short a break to help a woman who had suffered a heart attack.
Catherine Cowie, 50, died two days after collapsing in Fraserburgh.
An ambulance technician was on the scene within four minutes, but a paramedic did not attend with him because he was on a lunch break.
Some cardiac drugs can only be administered by a paramedic. The Scottish Ambulance Service said staff could not be disturbed during breaks.
However, it said staff could choose whether or not to attend calls during break periods.

Well.

Can someone please explain how 'staff could not be disturbed during breaks.' and 'staff could choose whether or not to attend calls during break periods.' can both be in effect?

In London it's quite simple if you get a break* then the first part of it is sacrosanct, with a 45 minute break that's the first half an hour. Then the last third of the break is interruptible. If a high priority call comes in during this time then Control can choose to end your break early. Unless Control chose to do this, the crew having the break have no idea that a call is waiting for them.

There is a lot of other weird stuff in this story that just doesn't sound correct - but then, few people understand the bizarre workings of an ambulance trust, and that includes some of the staff**

And of course I'd like to see the person who wrote this article work without a break for twelve hours while dealing with some of the awful things we have to do. And that means no cups of tea and no hot meals, or if you are lucky then you can get a dodgy takeaway while dodging Control. And having to use the toilets at hospital that patients with infectious diarrhoea have been using. And doing that every day of your working life.

If this story were really as written then I suspect that the Paramedic involved would be thrown to the wolves for 'denying a member of the public an ambulance'.

What next? 'My relative died because Paramedic was off duty'?

Remember people - if you are picked up by an ambulance and die two days afterwards while in hospital then it's all the fault of the ambulance service...

I'm sadly getting used to this attitude that ambulance staff aren't actually human.

*And really, I'm not convinced that the LAS aren't breaking the law by not enforcing break periods, instead paying us an extra £10 if we don't get a break.

**...And all the managers...

It's funny how, when you are used to working twelve hours (without a break), a run of eight hour shifts feels like a holiday.

Eight hours, that's like a 9-5 work day, even if you do start at 6:30am.

I do like going home at 14:30.

It's great to see the discussion going on in the comment section of the last post. I love the fact that people here can disagree politely.

This story is a little segment from the LAS internal 'magazine' that I've scanned in direct. IT just highlights the sorts of jobs that we can find ourselves going on. I've written before about my call to a dead dog.

Finally, and perhaps a little cryptically, 'Moab Is My Washpot', thank you very much.

The last blogpost has started up a bit of a discussion about the pros and cons of the NHS database, so I thought that it wold be an idea to make my thoughts on such a system clear.

While it might make the retrieval of notes simpler and more convenient, the security risks are frankly too great. The cost will spiral and *********

We can first look at the cost, going on previous history the UK government seems to have an almost pathological aversion to being able to bring IT project in on either budget, or time. The cost has already spiralled beyond the initial estimates.

Discussion point - find governmental IT projects that have come in on time and budget.

The people who would be using the system don't particularly want it. The BMA think that it should be an opt-in system with each patient choosing to be put on the database rather than automatically being assumed to give consent. This is a fine compromise as long as the people opting in are fully informed as to the risks of being on the database. There is a way to 'opt out' of the database, but there are rumours that people who are refusing to go on the spine are having their names recorded by the government.

Discussion point - given the technical knowledge needed to understand databases and security as well as the way the NHS runs, will anyone be fully 'informed' beyond us computer geeks. Also, is the recording of opt out names just paranoid rambling.

The proposed benefit is that medical notes will no longer get lost, or that if you are unable to communicate there will be easy retrieval of your notes enabling allergies to be avoided, pre-existing medical conditions to be taken into account and next of kin to be contacted. There is an easy way in which a more secure system can be created, and that is one that points to where a person's paper medical notes are physically stored. That way the database is just a pointer to a more secure system.

As for treatment for people who present while unconscious - most causes of unconsciousness are well know and are tested for and treated, if a person has a rare condition then they will often carry such information on them. They are the protectors of their data, not a third party.

Discussion point - if someone is without a form of ID, how will this database help them? Will this tie in with a national ID database scheme.

Just looking at the security issues is enough to make someone paranoid. In more than one hospital I've seen passwords and user names stuck to mobile computers - a cleaner could 'borrow' a computer easily and in the privacy of a cupboard log onto the system and gain access to your details. Even if the log-in is tied to staff ID cards the system will not be secure, cards will be lost, or lent and borrowed. I can't imagine any ward sister sending home a nurse who is unable to do their job because of a lack of an ID card - they'd lend them their own.

Extend this to clerical staff.

Discussion point - this doesn't even include pure malicious attacks, agency nurses entering and leaving hospitals, patients stealing a glance at unattended computer screens or social manipulation attacks.

It would be trivial for me to socially hack the system and leave no trace of wrongdoing. I could sell your data on to nefarious parties for a tidy little profit.

But this is nothing more than we can do at the moment anyway - notes are lost, or looked over by people who have no right to do so. The problem is in the scale of the breach. I might have a friend in the notes section of the local hospital who can look up details for me - but that information is limited to people who have gone to that hospital. With the NHS database that 'local' become the whole of the UK.

Discussion point - part of risk analysis is how disastrous the consequences of a breach of security could be, having access to the entirety of the UK population's medical notes is pretty disastrous if you ask me.

Then there is 'function creep', we've seen this already in the use of anti-terrorism legislation enabling local councils to 'snoop' on people. What is to say that some government later on down the line decides to start selling the data to insurance companies, or to other government agencies like the census department. Even if you trust this government, do you trust every government that comes after them?

Discussion point - would legislation allay this fear, or just require a change in legislation later on down the line?

So, the NHS database would, in my view and the views of people much smarter than me, be expensive, unfit for it's purpose, horribly insecure to both technological and social attack and prone to function creep. In return there would be little benefit for most people.

Sure, have it as an opt-in system for those people who are willing to put their faith in a government system and local hospital and their ability to keep such data secure. But make it a fully informed choice, one where people are aware that it is being run by the same people that 'mislay' their normal paper notes on a regular basis.

I have a source who has let me know how insecure the proposed system is - I fully intend to opt out, and I work for the NHS.

More data lost from the NHS.

"Discs containing personal information on almost 18,000 NHS staff have gone missing from a north London hospital.
Whittington Hospital NHS Trust admitted the discs were lost when they were put in the post by mistake in late July."

I've worked at the Whittington A&E department in my nursing days and it's worrying to think that there is enough data now floating out there, lost, to comprehensively steal people's identity.

These details could be used to impersonate a nurse. A nurse that might have access to vulnerable patients.

Of course, when the NHS has all your details on a centralised system there will be 'policies and procedures' in place to prevent this sort of data loss happening. Just as the policies in place managed to prevent this data loss.

Oh wait, they didn't.

On a technical side, it would be much more secure to encrypt the data and send it via the internet than to burn it to media and send it by post or courier.

Related somewhat to yesterdays post.

I attended to a young lady with a slightly unusual and complicated complaint. She sat in my ambulance wearing a top with a plunging neckline - not a problem, I always do my best to look people in the eye and not at the level of the breasts.

I was getting the medical history and asked her if she was fasting.

'No', she told me fishing around in her cleavage and pulling out a cross, 'didn't you see I was a Christian?'.

'Erm', I blushed, 'I try not to stare down there...'

As far as religious dates go, Ramadan isn't too bad of an idea as part of the fasting is to have sympathy for those less fortunate than yourself. Of course that all goes out the window when you start stuffing your face as soon as the sun goes down.

This year it has seemed to 'sneak up' on us ambulance people, there was no memo or announcement that we'd have a month of Muslims falling over and collapsing. You would think that, in my area of London where there are many Muslims, the ambulance service would think to let their workers know.

The first I knew about it was from a patient who kept changing her story. She'd collapsed at work with abdominal pain and one of her workmates said that she was fasting. I was a bit surprised as Ramadan is normally later in the year and I'd heard nothing about it being this early. I asked if she was fasting because of Ramadan and she told me no.

Then, as we were rolling into hospital I asked her why she was fasting and she told me that it was because it was Ramadan.

Oh well.

It wasn't the only time that day that a patient changed their story, sometimes in front of the nurse that I was handing them over to.

The problem with Ramadan is when, as a friend of mine puts it, adherents try to be 'more Muslim than you'.

The Koran says that you shouldn't fast if you are pregnant or have a medical condition that means fasting would be too hard or dangerous.

Unfortunately some folks want to prove what good Muslims they are and fast anyway.

Then you end up going to Muslims who've collapsed. I wold also suggest that we get more calls for 'chest pains' as well, when people with indigestion call us out. It doesn't help that for a lot of our Bangladeshi population indigestion and gastric reflux is a very common medical complaint.

On the other hand, you still find yourself going to Muslims who have hangovers...

I'd like to see if Ramadan really does increase call rates or if it's just the impression that us road staff get. Might be an idea to increase staffing in heavily Muslim areas for the month if it is true.

It would perhaps be churlish to point out that I go for twelve hours at work without food on a regular basis. I can tell you that it doesn't make me feel any more charitable.

I look at my patient and consider my choices, either I act outside the policies that the LAS have set me in the best interests of my patient, or I follow the rules and provide sub-standard care.

What do you do?

Our patient is a fiercely independent woman - well into her eighties every morning she walks to the shops, has a potter around to buy her papers, has a chat to the shopkeepers and then returns home.

She'd had a fall because the strong wind that day had blown a door into her, one of our first responders was already there and had patched her up. We took her to the ambulance and completed the assessment. She had a cut like half of a 50p piece on her shin. Sometimes you can get quite nasty skin tears, but in this case it was more of a gouge, and therefore easier to fix up.

There was one problem, our patient didn't want to go to hospital and after she told us why, I cold only agree with her.

No problem, it would be a simple job to steristrip the wound closed, something our ECPs are well equipped to do.

Except there wasn't one working on this shift.

Now, as long time readers will be aware, I used to be an A&E nurse. Wound closure of this sort is something that I would do regularly when working in the minor injuries department. I could easily do ten such closures a day, all without supervision. Our doctors would tell me to clean, close and dress the wound and the choice of how to do this was down to me.

But with this lady, if I were to follow our policy, she'd be left with a cut that would be left open with little more than a bandage over it. This would not only cause scarring, but would also have a higher chance of becoming infected.

It just so happens that I carry some steristrips in my personal bag.

So, of course, I used my nursing knowledge and closed the wound using my steristrips. It is a low risk, high outcome intervention that I am competent in. At the end of the day I can justify taking this course of action to anyone who questions me, and more importantly, to myself. I can guarantee that I've done more wound closures of this sort than any of our ECPs.

Us ambulance staff work under guidelines rather than the more restrictive protocols these days and this means that we can do pretty much anything, just so long as we can justify it. While I've been been told that I shouldn't use my nursing skills (like cannulation) I can't see anyone having a problem with my course of action.

I sure that my patient was happy.