I wasn't going to write about this subject but I think I've got to get it off my chest.

The Ambulance service(s) are undergoing changes at the moment. They affect me and my colleagues and they will also affect you as our - customers- if you like.

And I am worried.

I'll explain why I'm worried, then I'll explain why you should be worried.

To start with there is "Agenda for change". This was introduced as a new pay deal for everyone who works for the health service. What was supposed to happen was that everybodies skills were measured against a national framework so that theoretically everybody should be paid the same amount for doing the same sort of job. It didn't work out like that though. The money paid to a lot of people was and still is being disputed. The problem was that the whole agreement was pushed through with great speed so that any wrinkles in the system weren't able to be worked out.
 One of our biggest problems is an unsocial hours allowance. The government decided that we should have a pay rise. Very nice. But what they actually did was cut our basic pay and give us a 25% allowance. Now they want to cut the hours for which it is paid. This will give us all a pay cut of between £300 and £3000 pounds a year. Add to that a pay rise well under the rate of inflation and people will begin to leave. 
 Mealbreaks are another problem. Agenda for change decreed that we would no longer be paid for mealbreaks. The management were quite surprised that not many of us wanted to work and not be paid for it. This had also a big impact on responce times which the management of the various trusts care about a great deal. The answer they came up with was firstly trying to moral blackmail us into working. Now they want to pay us if we work through our mealbreak but how they plan to do this when the European working time directive says we aren't allowed to is anybodies guess. This seems a bit selfish I know but my point is that people will leave. Experienced people will leave, theyre leaving already but there will be more. So what is the governments responce?

 The Government has decided that in the near future all paramedics will be working on cars and technicians will be working on ambulances. The theory is that a if you dial 999 you will first get a Paramedic on a car and an ambulance will follow up when one becomes available. Now bear in mind that as soon as somebody(anybody) reaches you the 8 minute clock stops. The pressure is then off the service to get to you as someone is allready there. If you need to go to hospital in an ambulance you could be waiting for a long time.
 So if all the paramedics are on cars who is going to be on Ambulances. The answer is Emergency Care Assistants. First I want to say that I mean no disrespect to any ECAs reading this as they are skilled people in their own right. But they don't have as much training as technicians or indeed paramedics.
 So whereas now if you dial 999 you will probably get an ambulance staffed with a paramedic and a technician or at the very least two technicians in the future you will get a car with a paramedic who will assess you then a wait for an ambulance with a technician and an ECA.
 How is this cost effective? There are illnesses when you need to be in hospital very quickly so how is waiting for an ambulance better for patient care?
 It strikes me that the influx of ECAs are to man ambulances quickly and, more importantly, cheaply.
 
 So that's why I'm worried. I'm worried because my colleagues and I are being done over financially by the Government, again.

 You should be worried because I think that this will adversly affect the care that you will receive from us. You should be worried because it is inevitable that people will die because of these reforms and you should be worried because I am pretty sure that, for the first time in over a decade, the ambulance services will be involved in some sort of industrial action.     
      

The day started with a man with a drippy leg and sort of stayed at that level all day really.

We went to the address given and having been buzzed in to the building let ourselves into the flat. We had to climb over a two foot high pile of dirty washing to get to where the patient was. The flat was littered with the standard detritus of the alchoholic/drug addict.

He told us that he had been beaten up about 3 days earlier and his arm really hurt. It hurt so much in fact that he couldn't move it. He demonstrated this by waving it at us. So why had he called us now then? Because he had run out of codeine.
 
Ah!

Oh yes and he said he had an infection in his leg. This was shown to us as well. A hole in his shin was oozing green, um, gunk.

Any comments about guacamole and tortilla chips at this point will be brushed aside.

We took him in because of the leg more than anything but he made the fatal mistake of getting stroppy with the receptionists at casualty

Which was a BIG mistake.

Then off to a woman who had called the out of hours doctors saying that she wanted to kill herself. They were due to go home so they didn't want to see her and passed it to us.

It turns out she was an alchoholic and was desperate to get some help to stop drinking. Now there was no medical reason that she needed to be taken to hospital but as with so many of outr patients we took her to hospital because we couldn't get anybody to take any responsibility for her.

I doubt very much whether they did anything for her but I hope they got her to someone who could help.

Then to a chap having a nose bleed. Doesn't sound like much I know but it was his second today and his eigth in the last week. And he had had it cauterised last friday. Obviously hadn't worked.

He gobbed on my crewmates arm (by accident) but he wasn't impressed.

Then to a little old lady with a suspected broken ankle. In common with most old ladies she had a grip that could bend steel as I found to my cost when she grabbed my finger.

And finally we were called to back up the welsh bird on a response car. A lady who was VEERRYY drunk had fallen down stairs and had hit her head on the bottom. We arrived to find the woman shouting at the top of her voice. She had broken her wrist and was waving it at us saying that it hurt. Her daughter was there and she was shouting at her. She was drunk too, by the way. There was also a man standing around mumbling. He was drunk as well.

So we descended into this happy throng. Because the lady had fallen down stairs and was complaining of pain in the middle of her neck we needed to get her onto a spinal board. Which was going to be fun.

I was dispatched to hold her head still. I spent the next fifteen minutes looking up her nose and reeling under her beery breath.

We got her strapped to the board eventually,although at one point she did try and wrap her legs round my crewmates neck. She was quite limber for an old girl. He was very scared though.

So that was that. The surreal level was quite low today although the freak index was high.

More tommorrow

So there we were back in the carpark of the super duper hyper market. Quite early in the morning.
We were parked up and were watching all the early morning shoppers lumber up to the main doors and wait for them to go open.

And then I had one of my cinema flights of fantasy (as I am prone to do when I'm bored). Suddenly it reminded me of the film "Dawn of the dead" http://www.imdb.com/title/tt0363547/ 

All the shoppers looked like Zombies besieging a group of the living in a shopping mall. Quite a good film if you get the chance to see it.

Then a strange thing happened. We were parked up, not moving and the windows were closed. Both fold up seats crashed down on their own and a gust of wind blew through the communication hatch into the cab. 

I don't know why or what caused the gust of wind. Then my crewmate remembered that this was the very ambulance where somebody we work with was having a sleep on the stretcher. She woke to find ten or so people looking at her.

Make of it what you will 

Sometimes it just goes wrong. Not for us so much today but for the people in control. I think we were a bit short staffed which may have had something to do with it but still.

Spent most of the early morning sat in the carpark of a local super-duper hyper market. There didn't appear to be a lot going on so we people watched.

Then we got sent back to base

And the town woke up.

We didn't get to base, we got a job three junctions down on the motorway. This would have taken us at least half an hour to get there so things must have been quite busy. We didn't get there though; a nearer ambulance became available so they went.We were diverted to a lady with breathing problems. We didn't get there though; we were diverted to a cardiac arrest on the other side of town. More information became available and they discovered that the chap was cold so a car was sent instead. Obviously he had been dead for a long time so no CPR could be done. We were sent back to the original lady with breathing problems.

This suggested it was busy.
 
We got to her and to be honest she was  in a bad way. In her '60's and on chemo-therapy she had had a session the day before and it had knocked the stuffing out of her. We did the usual tests and looked for any abnormalities. She didn't have a blood pressure. Not one I could read anyway.

Oxygen on. It's funny, there are certain things that scare me. She scared me. I don't know why but she wasn't right. There was something in her eyes and her manner that told me that she wasn't long for this world. I can't describe it any better than that i'm afraid. Instinct I suppose

We got her to the ambulance and got her lying down again. Still no readable Blood Pressure. My crewmate stuck a needle in her arm and we put a drip up. The fluid comes in litre bags. We used two and only managed to get her pressure up to 75 systolic. 

Bare in mind that your systolic BP should be 100 plus your age (roughly).

Then after dropping her off we went off to see a chap who had tripped up some stairs. Hit his head and his glasses had hurt his nose. We dressed the scrapes and then he went off on his way.

It had quietened down by know and the last job we did was a chap who is developing into one of our "Frequent Flyers". He said he had been assaulted, which is what he said when we saw him last week. The wounds looked more self inflicted than anything but he didn't want to go anywhere with us so he didn't

8 am till 4 pm. Very civilised.   

Sometimes you just know what you are going to as soon as you know where it is.

We got the address.
 
"Bet he's an alchoholic", said my crewmate.

Dead Right

Nice day again today.

We get a call to the middle of nowhere to a woman who had had a seizure. This is all fairly routine and shouldn't present too many problems. I was driving and we made quite good time considering where it was. Three or so very straight roads and there.

She was upstairs and still in a fairly unresponsive state after the fit. After people fit all they really want is to be left alone. They can be quite nasty to that end but thats ok because its not really them. If you see what I mean. We did the usual tests and the all came out ok. I put some oxygen on her and she ripped it straight off. In a way this is quite a good sign because it means that they are responding, although on a very basic level. Her daughter gave us her history which indicated that she hadn't had a fit for a very long time if at all. 

The fact that this was an unusual occurance and that she wasn't coming round properly said to us that she needed to be in hospital.

Stretcher by the front door and we get her onto our chair that we use for transporting people downstairs if they can't make it under their own steam. My crewmate had stuck a needle in her arm by this time just in case he needed to give her any drugs.

Carried her downstairs and got her onto the stretcher. Wheeled the stretcher to the back of the Ambulance and started loading her in. I heard a strange noise, looked round to find her having another full on, grand-mal seizure.

Oh Bugger.

We needed to get some drugs in her, quick. This we did. The fitting subsided.

Then she stopped breathing.

Oh Bloody hell.

It wasn't for long. 15 maybe 20 seconds, but to the two of us it seemed like years. She started again but became completely unresponsive.

This was all going horribly wrong.

I quickly explained to her daughter what had happened and that to the two of us it looked like she had had a stroke. We really needed to go to hospital

We pre-alerted them that we were coming so they would be ready and I put my foot down.

She came round a bit on the way but was still fairly out of it.

Talking about it afterward we both thought she was going to die on us. Luckily she didn't and even more luckily she hadn't had a stroke, just a few fits. Hopefully she should make a good recovery
 
As I've said before, sometimes its nice to be wrong.

The next job we did was to a road traffic accident. The discription was a female lying under a motorbike. We also got the road name and where the incident was near. The person who reported this hadn't actually stopped to help, or see what was actually happening but had phoned up while driving past at 30mph.
 
So we arrived and drove up the road. It's been a nice day and there was a young couple sitting by their motorbike snogging on the grass verge. We reached the end of the road and drove back again. Didn't find anything. The couple were still at it. As we drove past for the second time I said to my crewmate," I bet it was them that the bystander saw". We still couldn't see anything messy and where they were sitting was about right address wise. By this time two police cars had joined the hunt. They drove up and down a few times as well and didn't find anything either.

So we have a situation where somebody is sitting at home feeling pretty good about themselves not knowing that they have cost the tax payer upwards of a grand for this callout.

And two lovebirds who have absolutely no idea what their innocent sitting on the grass caused to happen.

And 4 coppers who had to go back and fill in lots of forms about it.

And me and my crewmate went for a drive in the sunshine

For those of you who saw "Tonight" with Trevor Mcdonald last week:

I am an Ambulance Technician and I haven't killed anyone yet

Its been a nice day today. Weatherwise and patient wise.

It started with an unexpected trip to Oxford. The first patient was a 3 year old who was prone to having fits. She had had one and her father had called us. Her consultant was in Oxford and as we are now one big trust.........

Then back again and the only actual ill person of the day. A 78 year old who was found by her family in a completely unresponsive condition. She had brought up a lot of blood in her vomit which covered the floor. I've often said that you can usually tell as soon as you enter the door whether someone is going to hospital. This was a case in point. My crewmate got busy cannulating her and I went to get the bits to get her out of the house. To cut a long story short we got her onto our carry chair and it looked like she had had a stroke. We got her to hospital quite quickly as you can imagine.

Then to a 92 year old who had been booked in by a doctor as a non-emergency admission. She had cellulitus. This is unpleasant and messy but not that serious in the grand scheme of things. Anyway we arrive on scene and buzz her flat to be let in to the buliding. Someone lets us in. We knock the door. We ring the bell. We knock the door. My crewmate shouts through the letterbox. We can hear voices inside, talking to each other. We ring the bell. After a while we start to think its us and go back to the ambulance to check we've got the right flat. We have. We buzz again and someone lets us in again. This time we actually get into the flat. She's under the hair dryer. Because of a mess up in communication between various parties she thought she had till 4 o'clock. Never mind we said. She wasn't that keen on coming then and we were quite happy to leave her to get ready in her own time. Because of one thing and another the doctor wanted her in straight away so it was rush to get her curlers out and and some dinner down her neck. She was a nice old dear and we didn't want to rush her but other people had decided.
 
While we were sitting waiting my crewmate picked up a video box. It was Pink Floyde greatest hits. I'm not sure whether it belonged to her but it conjours up a lovely mental picture

Then off to a supermarket for a a chap having a diabetic hypo. His first in ten years, which is good going. We fed him Mars Bars and coke until he felt better and he went home.

No Mars Bars found their way into our Ambulance and we didn't eat them afterwards

That was about it really. Nice day. 

Machinery has been a bit of a problem these last few nights.

So, the new ambulances we've got, well, I say new. They're about a year old now and starting to show their age. They have a snazzy feature which means that when you open the fuel cap lid it reminds you not to use petrol.

This handy feature was slightly broken on the ambulance we've been using. I'll give you an example:

So there we were in the wee small hours. We've pulled up outside a block of flats. All is quiet. All is dark. We are there to pick up a woman who a GP wants in Hospital. We leave the vehicle and ring the bell to get in the flat.

And the Ambulance shouts "Caution. Diesel fuel only."

Twice

Lights come on in the flats.

As we drive along it takes to shouting at passers by. But it doesn't get it all out. So there are people walking along the road, minding their own business. An ambulance drives past and a voice shouts "K-K-K."
 
If you don't hear it properly it sounds a bit rude.

Back in the garage it starts rapping to itself.

We have sat-nav in the vehicles but the local toe-rags have realized this and decided to help them selves when they can. As they are very stupid all they steal are the display units as the rest is built in. So now most of the vehicles don't have sat-nav anymore.

They are being put back in slowly. Our vehicle had the display put back in however the engineer hadn't put the new remote in, and for some reason the display didn't work.

The voice was american. "Have a nice day"

And she wouldn't shut up.

And to finish everything off We were loading in an old lady with breathing difficulties and my phone started singing "Mr Hanky- the Christmas Poo"

It's been wierd.

Oh yes. I have discovered something I didn't know. Its called the Bristol Stool Scale. And, yes, thats what it sounds like. Someone has calibrated different  forms of poo into 7 different varieties. Google it if you don't belive me

I'm going to bed. Night        

Ok, so picture the scene.

Quite well to do house, middle class suburbia, tidy and well maintained.

The front door is open. A couple in their seventies, she is sitting on the stairs with her head in her hands, he is lieing on the floor with a pool of blood forming round his head.

That's what we were met with. So whats going on then?

I went to see to him. I shook him gently and he opened his eyes and took a swing at me. My Matrix-style reflexes moved me out of the way and he missed.

Well, he was concious. Thats a start.

I talked to him. He was confused but talkative. We gave him some oxygen and did some observations and all seemed fine.
 
My crewmate tried to talk to his wife but she wasn't saying anything.

Looking round, there was some debris in the corner of the hall. An idea was starting to form.

There was a faint but unmistakeable odour in the room. We examined the wound on his head and it was not huge. Head cuts bleed a lot which would explain the puddle on the floor.
 
I asked him if he had had a drink. He denied it, but his wife, who had also had a few, said he had.

Aha. That was the answer. They were both bladdered.

We took him in because the problem was you can't tell if they're confused because of the head injury or the alchohol.

But they get the award for the oldest drunks I've seen this year.   

Ok, so picture the scene.

Quite well to do house, middle class suburbia, tidy and well maintained.

The front door is open. A couple in their seventies, she is sitting on the stairs with her head in her hands, he is lieing on the floor with a pool of blood forming round his head.

That's what we were met with. So whats going on then?

I went to see to him. I shook him gently and he opened his eyes and took a swing at me. My Matrix-style reflexes moved me out of the way and he missed.

Well, he was concious. Thats a start.

I talked to him. He was confused but talkative. We gave him some oxygen and did some observations and all seemed fine.
 
My crewmate tried to talk to his wife but she wasn't saying anything.

There was some debris in the corner of the hall. An idea was starting to form.

I'm starting to think its me.

First job was to a man who had set light to himself. But, as per normal, it wasn't quite that simple. We arrived at the address, or rather next door to the address, to find the chap in question kneeling on the floor. He said that he had had an accident and his shirt had caught fire. It turns out that he had a history of harming his self and had been in hospital earlier that day after cutting himself. After some questioning I discovered that he had set himself alight deliberately. However he was wearing a nylon shirt and it had gone "Woof". This scared him and he'd pulled it off. We took him into hospital, not because he was injured - he was totally untouched- but we weren't sure he wouldn't try again.

Then off to the mad old woman of the evening. She had fallen and pulled her cord. We arrived to find her sat in the doorway of her flat. She was very very deaf but didn't have a hearing aid. The only way to communicate was to shout in her ear. We picked her up, she hadn't injured herself. She then regaled us with details of her bowels (times, consistancy, etc) and the fact that her husband had TB when he came back from the war. We didn't take her anywhere although I did make her a cup of tea

She didn't say thank you though.
 
Then no Saturday night would be complete without a fight. Into town to a man who had been punched and was now lying, sparko, on the road. Police were everywhere.

So there he was lying on the road, hysterical girlfriend lying across him. We peeled her off and woke him up. He had a nasty bump so he needed to go in. I spoke to his girlfriend to find out what had been going on and I must say she had a chest so awesome that I wanted to give it a round of applause. She insisted that she was coming with us but after we had sorted the chap out and I went to get her she was in the arms of someone else. Hey Ho.

Then off to two drunk young men whose car had had an arguement with the central reservation. the car had come off worse and was upside down when we got there. They both had small cuts to their hands and that was all. The firebrigade were there being heroes.

Then off to a woman who had had a few drinks at home and had collapsed with stomach pain. She wasn't talking to us but was concious. The rest of the family were very lubricated as well. We got her on the Ambulance and she decided to talk to us.

Oh well. Watch Dr Who and then bed I think

The infiltration of the world by batty old ladies continues.

She called us out after calling the out of hours GP service 6 times. We turned up at one of those warden controlled flat complexes that seem to exist in another dimension to the real world. They really are quite surreal. I don't know what drugs the architects take but they must be good. I'll give you an example: We pull up outside the front door and let ourselves in. We're looking for a flat number and guess (wrongly) that it was on the first floor. We get in a lift, because we can't find the stairs. The lift doesn't go to the first floor, only the second. We go to the second and at the other end of the corridor is another lift. Which goe's down to the first floor. The floor between them seemed to slope and I'm sure I saw a fire escape on the second floor that seemed to be below gound level with outside steps going up.

And no, it wasn't built on a hill.

Anyway, I digress. We found the flat. And knocked the door. And knocked the door. And knocked the door. I was a bit reluctant to look through the letter box after what happened to a colleague of ours on saturday night so knocked again. Movement.

We entered and were met by the lady concerned and her husband. She told us that she couldn't breath which was patently untrue. We went through the checks anyway. Blood pressure, fine. Pulse, fine. Blood sugar, fine. Breathing, fine. My colleague listened to both lungs and air was going in and out as it should. She was a good colour. There didn't appear to be a lot wrong with her.

So we all got talking and it transpired that she didn't want to go to hospital and didn't really want a doctor to see her. Her husband had nodded off by this point.

Her breathing had sorted itself out by this point and she talked and talked and talked and talked and talked and talked.

Sweat started to break out on my crewmates forehead. He managed to steer her conversation back round to what she wanted from us and she wasn't sure. He said he would phone the out of hours GP and see if they would come out. At this point we didn't know she had called them six times.

He left to make the call so I got full force of the talking pointed at me. We ranged from the bombing of Portsmouth to a relative of theirs seeing the Duke of Edinburgh.

I was about to chew my foot off when my crewmate reappeared. By this time it was about 5.30am so it was agreed that she would ring her own GP in a few hours.

We were there for an hour and a half. I think she just wanted someone to talk to.

There comes a time in most night shifts when you and your colleagues finally get back to base. Usually about 0330-400am. You are all sat around, very tired, the caffeine and adrenaline that has kept you going through the earlier part of the evening is wearing off and you just talk.

The conversations at that time can become quite surreal, very un-pc and absolutely hilarious. I'm not sure that if anybody was listening in they would find it at all funny but the conversation had us on the floor last night. I don't think I can repeat it here but you get the idea.

Vomit featured quite heavily last night. After the obligatory drunk teenager (covered in vomit) there were a couple of small children who were being sick. Now for some reason their parents thought it was nessessary to get them out of bed and call us. Neither were particularly unwell but I'm not a parent so what do I know.

And then a woman in the local hotel who called us because blood was coming out of her ears. Needless to say it wasn't. She was very drunk though. We offered to take her to hospital but she decided to sleep it off when she discovered that we wouldn't give her a lift back.

One more to go