I understand that there is a job going in a government advisory agency.

All you have to do is call yourself a scientist, and then agree with everything the government and the newspapers say - ignore all evidence and keep your mouth shut.

Seriously, is there any political party that understands science, that makes decisions based on evidence rather than on what Paul Dacre or Dominic Mohan publishes?

Anyone fancy starting said political party?

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So, the decision is made - NaNoWriMo, here I come - 1,667 or so words starting tomorrow in an effort to (a) get down a first draft, and (b) get me back into the habit of writing regularly. There may be ambulance based posts dotted here and there depending on how aggrieved I feel...

You may have noticed blogging being a bit light of late - due in part, I suspect, to SAD (again) and due in other parts to the ambulance service not getting any better.

I write about things here in the hopes that someone will read it, about the crap targets, the time-wasting calls, the poor state of our ambulances and all the other things that stop me from doing the job that I'd like to do.

So my blogging has me feeling a bit burnt out.

I need something to excite me, to interest me, to keep me posting here.

NaNoWriMo

I don't think it's a secret that if I want to write another book I'd have to do more than collect and polish posts from here - I think that two books have well and truly saturated that market. So I thought I'd give fiction writing a go.

NaNoWriMo is a month long event where people are encouraged to write 50,000 words over the duration of November - and to do it at the same time as others.

Which sounds like a good idea to get me typing again, to get me writing about things that aren't necessarily ambulance related and to spark some sort of enthusiasm in me.

So I'd like to give this crazy exercise a chance - but I thought I'd check with you folks first. I don't want to drive you all off for a month, never to return...

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I'm running a quick straw poll in the comments of this post as to what I do over November.

Do I,

A) Keep writing about ambulance stuff the same as normal, but probably with a bit less frequency.

B) Undertake NaNoWriMo with a story that is about infectious dementia and the possible end of the world as a metaphor for our ageing population.

C) Undertake NaNoWriMo with a story about magic and magical creatures in the modern world. (Basically this extended into a proper novel)

D) Take a month off blogging. Maybe never to return.

Neither of the NaNoWriMo options preclude me writing about ambulance stuff if I get fired up enough about something.

YOU the public DECIDE!

It's really simple - I hate forced overtime.

I know that it's just part of my mental make up, but if I'm forced to stay longer in work than I'm contracted to be there I start to get itchy and fed up.

It can't be helped though - sometimes we just get that 'late job' which means that we are dealing with a patient after we should have clocked off. I'm somewhat more used to that, it is one of those things that just happens, and we get paid overtime to make up for it.

(I think it's flat rate overtime mind).

The one thing that really annoys me though is when the clocks go back.

All because our ancestors were afraid of demons that might attack them after the sun goes down (or some such, I don't really care) the clocks go forward in Spring and go backwards in autumn.

Which is fine if you work normal hours - it means you get an extra hour in bed.

Lovely.

However if you are one of those stupid <illegitimate child>'s that work shift work it means so much more...

It means that if you are working a twelve hour shift, suddenly you find yourself working a thirteen hour shift - and that's not counting any extra you have to work if you are unlucky to get stuck with a late job.

I'm working night shifts this weekend...

Some time ago my crewmate told me that the clocks go back on Sunday.

I thought I would be a cunning swine and book annual leave. I really despise working that extra hour (oh, it might not make sense, but in my head it does).

So I booked Sunday night off.

Because that's when the clocks go back.

Isn't it?

No - of course they <copulation>ing don't. They <copulation>ing go back on <turf>ing Sunday morning.

Which means the <female genitalia>ing Saturday night shift.

Like a dozy <male genitalia> I took the wrong <illegitimate child> shift off.

<Male genitalia>.

So - because I'm a daft <person who copulates>, who takes his crewmate at her word, I get to work a thirteen hour shift on Saturday night.

<Copulate> it!

I may not be in the best mood.

The patients had better need an ambulance - or I may well be educating some of them as to the best use of an ambulance service.

£5.4 million pounds. For artwork to showcase 'British Culture'.

With £5.4 million pounds spent on the ambulance service I might not be left looking for a spare ambulance on my late starts.

We might have enough blankets for the coming winter.

I might have a fully kitted ambulance.

Looking wider - we might be able to look after our returning soldiers without needing charity.

We might be able to get some people out of poverty - thus saving lives.

Instead we'll have,

'LED panels on the roofs of bus stops aim to provide Londoners with a new way to display their creativity, express what is special about their London and to talk to one another.'

Oh well.

Neenaw has written recently of 'banana man', in that post she mentioned someone dribbling on my arm...

There is a person on my patch who takes great pleasure in calling out an ambulance - I suspect that he likes the attention that he gets from us. The other night we were sent to him on four separate occasions.

For the first call he'd already left the scene, which was perhaps unsurprising as the call was over an hour old.

The second call was made from outside a pub - we rolled up and he wandered over to us to have a chat. The complaint was one of his regular reasons for calling us - 'feeling suicidal'. He never appears suicidal with me, laughing and joking, telling me how he is a trained scientist and therefore is a genius.

I suspect that he doesn't actually have a mental illness, although he is an alcoholic with liver failure.

It was this call that had him dribbling and spitting over my arm. Not good, as I understand that he has hepatitis.

While talking to him another one of our regulars staggered over and started shouting at him for wasting the ambulance service time, which made me laugh as he's used up more than an average number of ambulances himself.

Our 'scientist' decided not to go to hospital and instead head back into the pub - so we drove off into the night.

Two hours later we were back at his house, this time saying that he was bleeding from his anus. We arrived and, once more, he decided not to go to hospital.

I'm fully aware that one of these days an unlucky crew will go to him, he'll refuse to go to hospital, and then he will die - dropping the last crew to see him in the brown sticky, smelly stuff.

It's like a game of Russian roulette.

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Our final call to him came down the MDT as this.

You will notice that the 'Determinant' - the thing that is used to triage the call says that he does have a weapon.

A nuclear weapon.

(I know that calltakers have to put down what the person calling says - although I'd like to know if the calltaker was serious, or having a joke).

Needless to say, I cancelled the police who would have attended due to weapons being used - told Control to look out for the mushroom cloud in the East and trotted around there again.

After a bit of an argument he finally agreed to go to the hospital - with him now in the A&E waiting room we know that he is...

a) Safe, and

b) Not going to call us for the next few hours, thereby letting us deal with actual genuine calls.

As we dropped him off at the hospital his 'friend', who had berated him earlier for his misuse of ambulance resources was pissing up the wall of the A&E waiting area - having called an ambulance himself.

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The thing is - he has been known to be violent in the past. While he has been nothing but nice to me (except of course the dribbling on me) he has been nasty to nurses and other ambulance crews. I'm happy to go to him without wasting the police's time, but there are some crews who - more wisely - ask for a police escort.

I've written about him before.

Currently I think that there is a team looking at him to try and reduce his calls to the LAS and his attendances at hospital - it's a process that has worked in the past, so I'm keeping my fingers crossed.

...along with the lovely Scott Pack and the Friday project.

This is a post about how chasing government targets impacts directly on patient care.

I've often written about our chasing of our 'Cat A' targets - that we are tasked by the government to reach 75% of these calls within eight minutes. I've also written about how I think our senior management have put this priority above many others.

There is another target that we should be hitting - calls that are given 'Cat B' (serious but not immediately life threatening), we should be reaching these calls within 19 minutes.

In my part of the LAS we have been failing in this second 'Cat B' target.

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One of the things that really surprises me is that someone having a CVA, also known as a stroke is normally given a 'Cat B' priority. Given that the move is for better treatment for strokes - going so far as to rename them 'brain attacks' to put them on a par with 'heart attacks'.

It is a good thing that we are starting to treat strokes more seriously - I can remember when I was a nurse that we would essentially put people who had just had a stroke into a bed and arrange for physiotherapy - there was no treatment then, only rehabilitation.

Things have changed a little but there is still an amazingly long journey before we can start offering the same level of treatment as we do to people having heart attacks.

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Due to our poor performance in 'Cat B' our senior managers have decided that we should have 'Amber Ambulances', these are ambulances that are to be tasked with bringing our 'Cat B' response times up.

These are extra ambulances that are staffed with the same skill level as our 'regular' ambulances, but they are only supposed to attend to 'Cat B' calls.

All in order to meet that government target.

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We were sent on a possible CVA/Stroke - a 'Cat B' call. So I put on our lights and sirens and headed off to the call.

Partway there were were canceled for a nearer vehicle, so I turned off the lights and sat in the normal traffic. I got stopped by a set of red lights.

As the house we were going to was on our way back to station We would drive past it and see who had been given the job.

As I drew up to the street it was obvious that there was no ambulance there.

I called up Control and let them know that we had beaten the 'nearer' ambulance and that we were more than happy to take the job. After all if someone had suffered a stroke they needed to be in hospital, not waiting for another ambulance.

I was told that I should continue driving and not attend to the patient as 'the amber ambulance is nearly there'.

Four minutes later the 'amber ambulance' arrived.

An identical ambulance, with an identical skill level, but four minutes behind us - even though we had travelled most of the way observing the speed limit.

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Needless to say, I was absolutely fuming. Here we were, already on scene and yet being told not to enter the house because it was more important that the target-busting 'amber ambulance' would do the call.

An identical ambulance, but one that is to be used to hit this other government target.

Why were we canceled? We were canceled because it is not good enough to have an ambulance, it has to be the right ambulance in order to reach that government target. Because they are only to go to 'Cat B' calls, and if we attended then what would happen if there was a 'Cat A' around the corner? They couldn't send the 'amber ambulance' because then they wouldn't be free to hit the target.

And the government would be unhappy.

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I reported this through our clinical incident reporting procedure.

We managed to return to station where I saw one of my Station Officers, I told him about the situation and he phoned the top person in Control for that day. Top person in Control agreed that it shouldn't have happened and would look into it.

To be fair , this was the first day that the 'amber ambulances' were being run and this was probably just teething problems, but I still think it highlights how fixated on chasing these targets we have become.

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Every person in the ambulance service who works out on the road understands the simple fact that, if you want to get ambulances to patients quicker you need more ambulances. It's not rocket science, there is no way that we are going to make any appreciable difference in the number of people calling for an ambulance, so we need more ambulances to deal with the year on year growth in demand.

What doesn't help is bringing in more ambulances (in itself a good idea), but then limiting the flexibility of those ambulances over an artificial target that, I suspect, has no basis in science.

This is one of the worst cases of government targets directly impacting patient care that I have personally witnessed. And it shames me to think that actual patient care comes after pleasing the government.

However, sadly, it doesn't surprise me.

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Thanks to Lordneil for reminding me that the 'Cat B' target is destined to be scrapped and that better clinical indicators are to be put in it's place. This was supposed to be done in 2009 but has been put back to April 2010 for some reason. (It's here on page 40). This is something that I suggested in this blogpost although I am yet to hear what clinical indicators will be put in it's place.

He has told me that he has taken a large overdose of tablets, that he wants to die.

He reclines on the ambulance trolley refusing to talk to me, of what he has taken we are not sure. We've done some detective work and from the empty packets it looks like it might be a lethal dose.

Luckily for him, this lethal dose can be treated in hospital.

I ask him why he wants to kill himself.

'I've got nothing', he tells me, 'nothing to live for'.

He's eighteen and already he thinks that his life isn't worth anything.

He lies there, hood drawn over his head, repeating how he has nothing and how he wants to die.

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We arrive at hospital and he is put into the resuscitation room.

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In the next bed over there is a ten year old girl. She has a lot of medical problems and one of them has gotten suddenly, severely worse.

She struggles for her next breath. The anaesthetist is called and they prepare to intubate her and take over her breathing.

Every breath she draws in is fought for, every moment is now a battle for her to stay alive - and she continues to fight.

Her parents want nothing more than for her to see tomorrow. They pray, her doctors and nurses work, she continues to fight.

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Across the world people die - they die because they don't have food, beccause they don't have clean water, because they aren't vaccinated against the childhood diseases that we in the developed world conquered years ago.

People in tin shacks struggle to make it through a life of crushing poverty, they take what joy they can in the little things in life.

And across the world, in a country where you are fed and clothed and housed, where you have access to good quality medical care a teenager who 'has nothing' takes a handful of pills and calls an ambulance.