For the past four or five months I have been coasting at work. It's not really my fault, it's just that none of my patients have been... challenging.

I've been going to a seemingly endless supply of patients who either do not need an ambulance because their 'illness' is so minor, or have had such simple problems that helping them doesn't require much in the way of thought.

I haven't had to 'blue light' a patient into hospital for this period.

And so I find myself settling into a fug of relaxed 'easy jobs'. Nothing much requires thought and, for many of my calls all I need to do is a set of basic observations and write down a name and date of birth.

It seems to last forever, being able to walk through my workday without having to think, without having any worry.

It makes the days go very slowly.

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And then...

Then I turn up to a patient, one who, to start with, doesn't seem too unwell.

But then he begins to get worse, he's getting a lot worse.

He starts sweating, he starts edging around collapsing, he asks me if he's going to die.

Suddenly, after months of sleepwalking through my day, I'm having to make decisions. I'm throwing drugs into him. Hell, I'm giving him drugs and I can't remember the last time I gave them.

We blue light to hospital and I'm eyeing up the ventilator, wondering if I'm going to have to use it when he stops breathing.

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We get to the hospital and the doctor there does a stunning save. No faffing about, just straight in there with the best treatment.

By the time I've completed my paperwork, cleaned and restocked the ambulance and washed my hands, the patient has turned the corner - we part company with him shaking my hand and thanking me.

Which, you know, is not a bad way to end the day.

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The trick is to be prepared for that worrying call. To not let the nearly endless stream of simple stuff blind you to the occasional, but important, serious job. You must not let yourself be caught out by it.

And lets face it, that's a lesson that works outside of the medical field.

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Now, I have a serious question for any ambulance people who read this blog, and I think the answer will say a lot about the state of the ambulance services in the UK.

Who is the top EMS educator in the UK?

Someone tried to assault me on Sunday - an alcoholic who was brought into hospital drunk, then sat outside to continue her drinking. She then decided to wander off home while still attached to and IV, IV bag and drip stand.

Another crew came across her and were trying to deal with her but already had a patient in the back of their ambulance, so we decided to help out and take the 'patient' back to the A&E department to have the IV removed.

As I was waiting to chat to the nurses about her she because louder and aggressive and I told her to behave - she then threw her mobile phone at me. I call that 'refusing treatment', so I removed the IV and, in an armlock, marched her out of the department and told her to 'go away'.

There is paperwork to be filled in, but honestly - what is the point? I've never had any feedback on the other times I've been assaulted, never been to court, never heard of anyone being prosecuted.

And then you hear this story,

Ann Sumner had much of her hair pulled out of her head, she was punched and scratched and left with a form of whiplash in her shoulder.All because she had stopped her rapid response vehicle to attend to a drunken girl in a Manchester city centre street.

The student, 20-year-old Melissa Massey, was jailed for eight weeks on Monday after she pleaded guilty to assaulting the paramedic in the early hours of New Years Day.

Excellent - a custodial sentence for someone who has assaulted a medic who was sent to help her.

But then a few days later,

A high-flying student jailed for viciously attacking a paramedic has been freed after just four days of her sentence.

Melissa Massey, 20, was slumped in a drunken stupor on Princess Street in Manchester when ambulance worker Ann Sumner went to her aid on New Year's Eve. But the Oxford Brookes undergraduate, who is expected to gain a first class business degree this summer, responded by punching Miss Sumner in the face and pulling out clumps of her hair.

Before sentencing, she said she had no memory of the ten-minute attack because she was so drunk and that she was mortified by what she had done.

Of course, it's not her fault - she is just a victim,

Alistair Reid, representing Massey, said prison had been a 'short, sharp shock' for the student.

He said she had 'absolute sympathy' for the victim because she had been run over by a drunk-driver as a child. This experience, he claimed, had left her 'particularly apprehensive around medical staff'. 'That was the only possible explanation she can give why she lashed out and reacted in such an appalling manner,' he added

So you can see why, for reasons unconnected with any assault that I have received, why 'filling in the paperwork' feels like a complete waste of time.

If an alcoholic throws a phone at me, tries to punch me, spits at me, kicks me or is at all aggressive towards me then the chances of them ending up in court are slim - and if they do end up in court they just show how they are the victim because of their illness (and for 'illness', read 'poor life choices') and in doing so, even if found guilty, receive a tiny sentence.

Let's face it, this isn't an uncommon situation.

However, I do think that this video from the Netherlands is really rather good - although I wonder how long the billboard was paid for before being taken over by a drinks company...

Thanks to everyone who sent me links to the BBC/Mail articles, and special thanks to Ed who sent me the link to the video.

As is my wont, I often find myself moaning about social care, or rather the lack thereof.

We were sent to an elderly man who had fallen over, the police had already arrived and had gained entry to the address and by the time we go there they had already picked him up and sat him on the end of the bed.

We did our usual checks, and a few things were a little 'off'. For example his ECG showed a chronic heart condition that may have been the cause for him to collapse.

The patient didn't want to go to hospital, he'd only recently returned home after an extended stay there. As I've mentioned in the past, I'm not actually allowed to kidnap people against their will.

So, I made sure he understood the risks of remaining at home - "You could die", I told him. "That's fine by me", he replied.

But we couldn't just leave him there, for a start his mobility was so poor it seemed inevitable that he would fall again.

So, what to do?

What he really needed was a referral to a frequent falls team, some occupational therapy, some physical therapy and for the GP to check on the patient's medications.

Unfortunately, while we can recognise this, us rank and file 'stretcher monkeys' don't have to tools to make these referrals.

However, our ECPs do have the 'pathways' for referring people to various teams designed to keep them out of hospital. Of course, this only works if there is an ECP on duty.

We were lucky, one of the ECPs on our station was working that day, so we rang through to Control and asked if they could send him.

I'll spare you the hoops that we had to jump through in order to get the ECP to visit us - apparently Control won't let you 'book up' an ECP for a patient.

Our ECP arrived and listened to all that we had to say. Then he found out the postcode that the patient lives in.

The problem is this - our ECPs can only refer patients who live in certain postcodes - if they live outside of the designated areas then the funding isn't there and the 'keep 'em out of hospital team' aren't interested.

(Having ended up in North London, far from my patch, on my final job the other night I wish I could refuse calls outside of certain postcodes).

There was nothing that we could do - it was a weekend so all the regular services had shut up shop, any GP that we would ring would be a locum, and the patient was still refusing to go to hospital.

The list of the patient's problems continued - he was supposed to have carers, but he often locked the door so that they couldn't come in, sometimes the carers 'forgot' to turn up. He was also refusing to take his medication - in my inexpert opinion he is suffering from depression. He had wounds from previous falls that weren't being dressed properly.

The list goes on.

His son, who'd arrived during our assessment, had been trying to 'get things sorted' for the last month but he'd been getting nowhere.

At the end of the day, all we could do was write a letter to the patient's regular GP explaining all that we found and hoping that the GP would take the required action. Now, you must understand that we aren't trained to write referral letters to GPs, we aren't expected to do this, and it would probably surprise a lot of people in both our management and government to realise that we do these sorts of things off our own backs.

I'm a poorly paid multi-drop delivery driver with bandages, a defibrillator, and extended social skills. Yet I could see where this man was being failed, and was ultimately powerless to help, and all because of him living in the wrong postcode.

Jobs like that are frustrating and depressing - because with the right input he could continue to live at home. At the moment his future will probably consist of frequent falls until he breaks his hip and dies.

Unless the GP acts on the letter we wrote. The letter that we aren't supposed to write.

Fingers crossed.

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If this reads a little fragmented and wobbly, it is purely because I'm fragmented and wobbly - I've just finished my third night shift and am yet to sleep.

I've been doing a fair amount of transfers between hospitals of late. Which is why this article on the BBC news site struck me a particularly timely.

Unnecessary risks are being taken when transferring seriously ill people from hospital to hospital, doctors say.

But British Medical Association doctors said medics often had to rely on batteries to power vital equipment - and these were prone to failing.

Most ambulances do not have sockets for standard three-pin plugs. Instead, they have cigarette lighter-style sockets, which means hospital equipment such as ventilators, blood pressure monitoring and intravenous drug equipment cannot be plugged into the vehicle's power supply.

Doctors transferring patients are therefore required to connect the equipment to batteries. Newer ambulances are being brought in which do have three-pin plug sockets but, because many of the older vehicles will be on the roads for another five years, doctors believe action is need now.

Dr Dharmarajah, who works as an anaesthetist in London and as such is often involved in patient transfers, said a "simple solution" would be for ambulances to start using adaptors that would take the three-pin plug. The devices, known as inverters, can be bought for less than £100. But only a handful of NHS trusts are using them.

A Department of Health spokeswoman said: "It is for ambulance trusts locally to ensure they have the right equipment for the job. "Ambulance fleets are constantly being updated and new ambulances are able to support additional equipment."

First I'd take slight offence to the suggestion that we cannot power equipment such as 'ventilators, blood pressure monitoring and intravenous drug equipment', ventilators are powered by the oxygen cylinder and we have our own blood pressure measurement machines.

What traditionally fails is the intravenous drug equipment - or as we call them, syringe pumps.

When you need to give a medication through a vein over a period of time the best way to do this is via a syringe driver - this machine essentially pushes the plunger of a syringe over a set period of time. Where we most often see these is when you are giving anaesthetic drugs to an intubated patient.

For as long as I've been ambulancing (yes, it's a word, I just made it up) I've been telling staff that if the patient is connected to one of these machines, then we need to take a spare as the internal battery will probably run out before we leave the gates of the hospital.

I was looking at the product sheet for the sort of equipment that we most often come across - the battery life on these is around three hours. Or rather it should be.

This is why this story annoys me, the hospitals, who should be looking after their equipment and servicing them and replacing the battery when it can no longer hold a charge, are blaming the ambulances for not spending the money to cover up the fact that this servicing isn't being done.

Like a laptop battery, these drivers need to have their batteries looked after or replaced. The hospitals aren't doing this because they are plugged into the wall at all times. Consequently the battery holds less and less of a charge, and so once you remove it from the mains supply it no longer has the advertised three hour battery life. More like a fifteen minute battery life.

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The 'simple solution' of ambulance trusts having inverters for ambulances, is not that simple at all because it would have to come from our bank balance. We'd be paying for the failure of hospitals to maintain their own equipment.

You must remember that ambulance trusts are not connected to hospital trusts, and the way we are both funded means that, should I replace a syringe I've used with a fresh one from the A&E department, I am actually 'stealing'.

Remember also that the hospital trusts were very quick to drop the London ambulance service from their patient transport services as soon as private companies offered lower costs. Of course, those private companies can't transport critically ill patients, so the hospitals have to use us.

I laughed when I read that it costs 'less than £100' for the equipment to be able to plug in a mains three-pin plug. I'm riding around on ambulances with incomplete equipment, with cupboard doors held together with medical tape and with electrical systems that often have trouble powering all the normal things that ambulances need.

There is nothing stopping the hospital from investing 'just' £100 in an inverter for their transfer pack in order to power the equipment that they should be maintaining.

Heck, if I were that concerned an anaesthetist I'd buy my own - certainly I'm personally using equipment that I have bought myself on my ambulance, and I'm paid a fair bit less than a doctor.

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Oh, and those 'newer ambulances'? Don't ask my boss about them, as the company that we were contracting to provide them has gone bust, leaving us without vehicles and also taking a fair chunk of our money with them.

I wonder if the people responsible for selecting that company have been disciplined?

Does this sound a bit whingy? It's only because the ambulance service is easy to blame for everything. It's a shame we didn't have a representative of the ambulance service in that story say 'If correctly maintained by the hospital trust the equipment that is used on transfers has a battery life of three hours. There should be no need for an ambulance service to have to cover for this shortfall in essential equipment maintenance.'

Two police officers had to be cut free from a police car that was involved in an accident on its way to a 999 call this morning.

The car was going to an emergency call when it was involved in an accident with another vehicle at shortly after 5.05am. The accident happened at the junction of New City Road and Barking Road.

Police, fire and ambulance officers attended. The two officers in the police vehicle received leg injuries in the accident and were taken to Newham General Hospital. The driver of the other car was unhurt, said a Scotland Yard spokesman.

I hope that every involved makes a full and fast recovery. I would wager that I've been on more than one job with the officers involved.

We've had two FRU's have similar accidents at that corner, it's a blind junction with one stop line set some way back from the junction itself. I always warn new staff and students about it as given the... 'quality' of some Newham drivers, there are often people jumping the lights there.

I know that one of my colleagues had the green light and right of way when hit was hit.

I was nearly taken out by a fire truck also travelling on lights and sirens at that junction myself - it's only because I drive like a nervous granny and creep slowly across red lights that I'm still here today.

Nice - Can me and my crewmate have a £10,000 budget please? I could do a study into why our ambulances rarely have a complete set of equipment on them. Or, you know, I could just spend the £10,000 on buying the kit.

An ambulance service has apologised after staff were asked to rate how "cool" Adolf Hitler was in a questionnaire.

The survey was sent out to 4,000 employees at West Midlands Ambulance Service (WMAS) as part of a £10,000 study to identify what made good leadership.

Respondents were asked to rate how "cool" 10 famous leaders were on a scale of one to five.

Besides Hitler, the list included Gordon Brown, Richard Branson, Winston Churchill and Fabio Capello.

A WMAS spokesman apologised for any offence caused.

He said: "At the end of the day, Hitler galvanised a nation into doing something quite unusual. Dreadful atrocities took place off the back of that.

"The staff involved were not trying to cause any offence to anybody."

The project, called Making Leadership Cool: How Emerging Leaders Wish to be Managed and Supported, is a year-long study being conducted by two members of staff at the ambulance service.

The aim was to identify the key characteristics of good leadership, to allow the organisation and the wider NHS to be more efficient and effective which, in turn, would have a direct and positive impact on improving patient care, WMAS said.

The questionnaire, sent out last month, had so far been completed by "several dozen" members of staff, the spokesman said.

"The project sought to discuss different styles of leadership and the characteristics of leadership to help staff at all levels develop their career," he said.

"In discussing different styles of leadership, a survey which is one small part of the project sought to include an analysis of the dictatorial style.

"With hindsight, it would have been better to have used a different example to illustrate this."

The funding for the project was provided by the West Midlands Strategic Health Authority, he added.

From Guardian.co.uk

What might be interesting would be to see what role those two staff normally fill, I'm guessing that they are on the upper end of the management structure.
More seriously, haven't there already been countless studies and research into good management styles? Would it be churlish to say that it doesn't surprise me that ambulance management types haven't heard of other studies? In fact if you want to see good leadership just cast your eye at my local complex management.

It's night and myself and a policeman are leaning against a front garden wall, my crewmate is in the ambulance cab doing some paperwork. If this were a TV drama one of us would be casually smoking a cigarette in order to show the audience how cynical and hardened we are.

We are outside a squat, opposite a school. The windows are boarded up and so was the door, but the people living inside managed to pry them off and sneak some mattresses into the building.

There were two people living inside, now there is only one.

He was found on the floor, laying on his mattress, nothing else in the room apart from a small vial of what appeared to be drugs.

The room is freezing and there is no electricity for lights. The other man who lives in the house called us because he found his friend unconscious and not breathing.

When we got there it was obvious that he had been dead quite some time.

It looks like a drug death, although I can't see any of the paraphernalia that goes with it, only the small vial with tiny little rocks in it. Is his pipe in his pocket, or did his friend remove it from the scene.

His friend speaks only a little English, and he can't even tell me the name of the dead man, only that he was his friend and that they would sometimes go drinking.

More police arrive to check to see if there is anything suspicious, we all greet each other. Like the friend and the dead man, we know each other's faces, but not the names.

Our job is easy, we turn up, recognise that the person is dead and then do an impression of a CSI and tell the police if we think it is a 'suspicious' death or not. I'm sure that in most cases they only ask out of politeness.

I'm waiting for my crewmate to finish writing, so I lean on the wall and talk to the police and I look at the schoolyard.

And I think - will any of the children that go to that school grow up to this? Will they reach their twenties and die in a squat, in filth, in squalor - dead from heroin, or crack, or something new?

I think of our dead man, once upon a time he was a schoolboy, his future stretching out in front of him - what would they say if I could travel in time and tell him, his teachers, his parents, of the way in which he dies. Would they believe me? Would he still make the same choices that lead him to becoming a cold lump of meat on the floor of an unlit squat?

Will the children who will be playing in that schoolyard in a few hours time ever know of the man who died here? Will the parents who drop off their children, full of hope for their future, ever realise how close the world of drugs and death came to impacting on their school run?

I'll never know the answer to those questions, and even if I did it wouldn't change what has happened - a sad, lonely death. The only witnesses after the fact being anonymous strangers who are paid to care and a drinking friend who didn't even know his name.

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Thankfully the election is over and I can start blogging properly again - the official advice was to stop blogging during the campaign.

A busy week this week, and by the end of it I'll be able to reveal one of the things I've been up to.