Tomorrow I'll be flying off to Egypt for a week stay in an all inclusive hotel. Once there I shall be mostly hiding from the heat (35ºC or more), reading, drinking and relaxing. It will be a chance for me to forget everything and just put my feet up and think. I don't think that the hotel has internet access - which strangely pleases me.

Of course, this means that I will be flying for around five hours, something that fills me with dread.

It's not a fear of flying - there are certainly worse ways to die than by dropping out the sky from six miles up. Sure, I don't want to die, and there are so many tiny components on a plane, any of which can go wrong, especially if one of the mechanics has had an off day.

(Our ambulances are much simpler machines, yet they break down a lot more than airplanes - I'm sure there is a lesson there somewhere).

No, it's not fear - for I understand mathematics, and chance, and realise that I'm more likely to die crossing the street, falling off a ladder or sitting in bed hoping that the chest pain that I've suddenly developed is indigestion.

And besides, plummeting from the sky to have my heart separate from my aorta and my brain try to exit through my nose as I explode on hitting the water at terminal velocity is unlikely to cause much in the way of suffering.

So it's much less a fear and more of an intense dislike of flying, on one hand you have the whole security theatre that you have to go through in order to prove that you aren't carrying explosive shoes, the worry that your carry-on will be one inch outside the allowed size, and the pathological fear that I'm going to lose my passport, my boarding pass, or both.

No, the main reason why I dislike flying is that I am nearly 6'2" tall and I fly economy.

I also hate children.

And I get 'jumpy' legs.

My arms are quite long as well - although thankfully on this flight we haven't paid extra for a 'meal' that requires me to become a contortionist to try and eat. In two mouthfuls.

I honestly don't know how people can take flights that last longer than eight hours. Certainly not if you are my size. Eight hours is my maximum and even then, as the plane lands, I'm pawing at the doors to let me out. How my crewmate deals with 12+ hour flights to New Zealand is beyond me - although being 5'4" probably helps.

Thank goodness I'm not a nicotine addict as well.

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All of which is to say that I'll be out of contact for the next week, although there should be some blogposts going up automatically should everything work out as intended. And then, after the holiday, I should be back fully revitalised and ready for a flurry of activity including a new project...

There are a couple of reasons why the public like us - the biggest reason is that when they call us they are the centre of attention - they are sick and now two people have turned up and are giving them their undivided attention. We don't have more patients to look after, we don't have to run off to bed three to give someone a bedpan, we don't have to drop everything for a drugs round. Instead that person is focused on 100%, no distractions.

Of course, when they hit hospital they take their place behind all the other 'generally unwell for two weeks' patients that found the idea of a GP appointment just too much effort. Certainly more effort than dialling 999.

And really, it was your choice to wait four hours for treatment in A&E rather than get a GP appointment, so don't blame me for taking you out to the waiting room to burn some hours with the multitudes who think the same as you.

This, in my eyes, was common knowledge - however a recent article by Professor Richard Ashcroft has shown another reason why us ambulance types rock your world.

Patients and families seeking help on how to live with long-term conditions such as autism do not always get the clear advice they seek.

Any diagnosis of a serious medical condition or impairment is hard to take in at first.

What you need after that is reliable information, and co-ordinated clinical care and social support.

Co-ordination is not what you get.

'Hints and clues'

Professionals are trained to be "non-directive" when they advise or counsel parents.

n my work, I teach current future doctors and lawyers about medical ethics and law. I teach them about informed consent.

I think empowering patients to make decisions in the light of their own values and interests is really important.

But I don't think "non-directiveness" achieves this.

Essentially, nurses and doctors are told to be 'non-directive', to not tell people what to do as that would be seen as taking away the other person's independence and right to self determination. That to be 'prescriptive' is some sort of abuse of the power relationship that folk in uniform have over the general public.

When I was training to be a nurse I suggested that perhaps we should be directive, as after all we hopefully have the full facts of a person's illness and the skills to deal with it.

I was told by my lecturer that by saying that I was acting like a Serbian war criminal. A badge I wear with bizarre pride.

That's something that us traditionally educated ambulance staff have never been told (I have a horrible suspicion that this is not the case for the new training regime) - in our training we are told that we are to take control of a situation as everyone else will be looking to us for direction (normally followed by a few unkind words about brickheads, dripstands, Trumpton, our firefighting colleagues).

No - what we do is direct. We turn up and make the chaos into calm, the fear into peace and the uncertain become certain. We tell people what to do, we tell them what we are going to do and we can often explain what the hospital is going to do. People surrender into our loving embrace and feel better because we are there to help and the other people present can abrogate responsibility to us.

That is what we do, and people are happy for us to do it.

More on the last post - a new memo has appeared on the notice board that boils down to 'if you have swineflu, the advice is to not come in to work, it will be counted as an absence' - which to be fair is only reasonable. After all the coughing pig death virus is a fairly mild flu - and we don't have special circumstances for normal 'flu.

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The job was sent to us as 'man - bitten by dog two days ago' which figures high on the 'rolling your eyes' scale, but not too high on the 'completely unexpected' chart. What was unusual was that in the special instructions part of the dispatch notes was that the patient needed to police to look after his dog.

When a job like this comes down the wire it is only traditional to share the news with any other ambulance personnel within earshot. It's a game of one-upmanship that we play with each other, seeing who can get the most ridiculous call.

"Hold up", one of my station mates says, "what address is that?"

I tell him.

"You'd better take the police along with you, I was listening to them talking about that patient yesterday - he's apparently violent".

I could see that he wasn't joking.

As the job was obviously not going to be anything too serious we decided to ask for the police to arrive, after all the patient had asked for the police himself to look after his dog.

We were waiting only a few minutes before two response officers and a dog handler arrived. The dog handler got the kit out of his car - a loop on a stick and a fire extinguisher.

Fully prepared we approached the front door and rang the bell.

"Come on in", said the man who opened the door - a man with obvious alcoholism and mental health problems*.

We entered to be greeted by what is perhaps the most energetic dog I've ever met.

This dog, that apparently needed the police to look after, ran over to my crewmate looked her square in the eye and rolled over to have his belly rubbed.

My crewmate and I are both dog lovers and when we get to a job where a dog is loose whoever isn't dealing with the patient is normally found playing with the dog.

And that is what happened - while I tried to persuade the patient that, no, his finger wasn't going to drop off, my crewmate sat playing with the dog while the police, seeing that we were fine, disappeared off to their next job.

A bit of a waste of all those resources, but what can you do except shrug and keep going?

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*Don't ask - after a while you start to develop an 'eye' for such things.

My apologies for not blogging very much last week, unfortunately my mind was occupied by some rather important things...

It started with one of my station officers handing me an envelope, in it was an appointment to see my immediate boss and a human resources manager to talk about my current level of sickness.

At the time I was on a 'Formal warning', essentially I was ordered not to be sick otherwise I could face disciplinary procedures that could end up with me being fired.

In the letter detailing the appointment it told me that I could bring a union rep (I don't belong to any union as the main one seems about as much good as a chocolate teapot and I refuse to fund them) or a friend, and whatever paperwork I deemed necessary.

I phoned my boss and asked her if the meeting would be a friendly little chat or if I should be worried - I was told that I should bring a union rep along with me and any paperwork.

This led me to worry somewhat about my future with the London Ambulance Service.

So last week was spent either preparing for the meeting, or stretched out on my sofa just plain worrying about it, jotting down logical arguments about why I should keep my job.

I thought that it wouldn't be too hard to fight my corner - in the last eighteen months I'd had four periods of sickness, however two of those were work related. One of which was when I was assaulted by a patient for around half an hour, the other caused by doing CPR in an enclosed space for forty minutes or so.

Then there was apparently a 'back pain' that I couldn't remember and of course my recent epididymitis.

If you were to take out the two work related injuries you'd realise that I'd been sick twice in eighteen months, which in my opinion is pretty good.

On the appointed day I found myself in the office being told that, depending on the meeting, I could end up being sent to Waterloo to have my sickness 'handled' by upper management (which I suspect would have me out looking or another job), I could be kept on the formal warning, or I could be removed from any warning.

The thing that surprised me about the meeting was that the people present seemed to blame me for the assault (I was wrestling with a potentially brain injured patient, and the 'urgent police' we called for didn't turn up), that if I were to be assaulted again I could be further disciplined for that sickness. I assured them that I wasn't planing on being assaulted again.

I explained that an ambulance officer had already told me not to wrestle patients, so the next head injury patient that wants to wander off into traffic can do so.

Then, concerning the other workplace caused sickness, I was asked if it were really necessary for me to undertake an extended CPR in an enclosed space - I explained that the patient was heavy and 'stuck' and so, no, I couldn't move them to a place where it would be easier to do CPR. I continued to remind them that once I start CPR, according to LAS policy, I'm not supposed to stop.

I reassured them that my epididmytis was unlikely to return, and even if it were I'd be able to recognise the grumbling early signs and start on the antibiotics a lot quicker.

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I was sent out of the room while they discussed what to do with me.

It didn't take long - I would be kept on a formal warning until December, so all I have to do is not be sick until then. At which point I could well be taken off my disciplinary sanction.

I promised them that even if I were to catch the dreaded swine 'flu I'd still be in for work - at which they said nothing.

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I mention this, not to have a dig at the people in the meeting - they have the rules that they have to follow and ultimately they treated me fairly. I mention this just to show the sorts of rules that govern road staff, people who are placed in danger, are often in close proximity to infectious patients and who work long rotating shifts with no break while having to carry heavy patients downstairs.

I mention this because the same rules apply to those in the LAS who work in the offices 9-5 Monday to Friday dealing with paperwork and going to meetings, walking around with clipboards and drawing up policy documents.

I mention it because I've heard that around half of road staff are on an 'informal warning' - and that if this is the case, either there is something wrong with half your staff, or there is something wrong with the sickness policy.

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I have a nice little holiday next week - to say that I am really rather looking forward to it would be the understatement of the century. A week in an all inclusive hotel in Egypt doing very little but reading and lazing by the pool. I'm counting down the hours I've left to work before I fly out.

32.

It's the usual job.

We are led into the police cell / magistrates court holding area / place in the supermarket where they keep shoplifters*

The patient is there, having collapsed with difficulty in breathing / chest pain / asthma attack / drug reaction / withdrawal / claustrophobic panic attack / catatonia*

My crewmate and I assess the patient, we try not to touch the walls of the cell because they are often...icky.

I notice that there is nothing wrong with the patient/ unusually something actually wrong with them*

I talk to the custody officer / police officer / security guard*

I tell them that, while there is nothing wrong with the patient, and it is likely a waste of everyone's time I'll take them to hospital.

The reason for this is to cover my back, just like they have in calling me. After all, a death in custody, while rare, is no fun for anyone.

So off we trot with the criminal / suspected criminal / illegal immigrant / drunk* in tow, in handcuffs and accompanied by an escort.

They'll be back in their police cell / magistrates court holding area* soon enough, but not before wasting everyone's time / money / patience / goodwill*

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*Delete as applicable.

While I'm at it, can anyone recommend a cheap tele-convertor for my Nikon D40X? It doesn't have to be anything special, just so that I know it fits.

A school has installed CCTV cameras in classrooms in a bid to avoid disputes between teachers and pupils and to tackle theft, the deputy head has said.

Mr Rush said that the reaction from staff, children and parents had been entirely supportive.

"The children are very happy here because they know they are on a school site where they are safe.

And this is the problem, that children 'feel safe' because they are under the watchful eye of a CCTV camera. They are being trained to believe that.

Likewise they are being trained that it is only right that your fingerprints can be taken so that you can borrow books from a library, that carrying ID cards is the norm and that you should feel safe now that you are put on a database as soon as you are born.

State control of your data is increasing and they people concerned have realised that 'getting them while they are young' seems to be the easiest way to slip these databases and surveillance systems in to place.

Seriously, look at the responses to the library fingerprints link - shouldn't we be concerned that we are creating children who will accept anything for the sake of 'safety'?

The question therefore is what can we do to educate children about the flaws in such systems?

My immediate thought is to make Orwell's '1984' and Doctorow's 'Little Brother' compulsory English texts. But what else? Perhaps ORG/FIPR/No2ID should start setting out their stalls at school fetes, and town shows, or start making child friendly websites?

But what else can we do?

I'm open for suggestions.

(And the first person to say that 'if you've nothing to hide then you've nothing to fear' will have their net curtains removed, their walls replaced with glass and be made to sign a declaration stating that they trust this, and all other future governments, as well as every soul that works for the civil service, the NHS, social services, transport your local council etc...)

We walk up the stairs to the teenager who has 'fallen, swollen arm', to be greeted by a fourteen year old girl with her arm in a tubigrip.

I start with my usual opening gambit, "Hello, what seems to be the problem?"

"I fell over yesterday innit", she says, "now my arm hurts and it's swollen innit".

('Innit' is how a full stop is pronounced in my part of the world).

"Let's have a look then", I say and she pulls the tubigrip off her arm, "so, how did you fall?"

"Dunno just fell over, and it hurts now innit".

I take one look at the injury, the bruising and swelling around the hand in a rather specific place.

"So, you didn't fall over did you? What did you punch, a wall, a door or a window?"

She looked at me as if I'd grown another head.

"You can't fool me, for I have fearsome psychic powers", I tell her, "Also it's a classic Boxer's fracture, so, wall or door?"

"Yeah, alright", she admits, "I was having a row, right, and I punched the wall."

"Fair enough, you'll need to go to hospital for an x-ray and treatment - and in the future don't try lying to ambulance staff, for we are wise in the ways of the world".

I wiggled my fingers like an old-time psychic, "We. know. all."

She looked at me with an open mouth.