I've just spent longer than I'd like to think in deleting spam from this blog. While I do like the simplicity of the Blogware system, it isn't the world's best at filtering out spam. I wish there were a way of turning off the comments to an article automatically after a month or so.

As it is I've turned on moderation for comments that the Blogware system thinks is spam and decided to not allow HTML in comments any more. Sorry if this annoys you but I have better things to be doing with my time than clicking through and deleting spam.


I've been utterly fed up for the past week or so – I shouldn't have, because I've been busy for much of my five days off work. I took my mum to see 'Priscilla – the musical' for her birthday, and it was superb. The day day we dragged her around London Zoo, which again was nice but spoiled by both her, and my, inability to walk around slowly for hours without getting crippling back pain.

Then I went to the Fymfyg bar to watch some comics and drink entirely too much as part of a friends 'stag do', then the day after that we went paintballing at the London paintball centre. All good fun and I do indeed have the bruises to show for it.


So why so fed up? In part it was the Digital Economy Bill going through parliament, it wasn't just that it went through, it's the manner in which it went through. 6% of MPs sat and debated it, then, when the time for the votes came a load of unknowing members came shuffling in at their Whip's behest. I watched the debate and the complete lies that were bandied about had me grinding my teeth and having to resist the rather strong urge to but something heavy through my TV screen.

But I'll write more on this later…


Essentially all I want to do of late is close my front door and ignore the world – which isn't that healthy I admit, but especially during a run up to the election I think it's a perfectly reasoned insane response.


On to the questions that I got from you folks –

First up, the most common question.

How do I get a job working for the ambulance service, what is the best way to pass the interview and do you recommend it?

When it comes to recommending the job, it depends on what sort of person you are – if you like the idea of helping people, if you like the idea of working either on your own or as part of a two-person crew and if you aren't bothered by icky stuff and time-wasters then I might recommend it. Saying that, all ambulance services are going through a lot of changes, but then they always are, so be prepared to have the ways in which you work change under your feet.

As for how to join – well I wrote about it a bit here (and talked about the sorts of tests that I had to go through, including the interview) – however it keeps changing.

My suggestion is to talk to the ambulance trust that you want to join – they all have websites and their contact details are there. See if you can have a chat with someone already in the job where you work, for example – when London has new recruits they go onto what is called the 'B Relief rota', which is lots of nights and weekends – that might put you off.

Each service is different so you are better off talking to someone who has just been through it.

My personal views on the current ways of training people is that it is all either up in the air, or a bit poo. But I only get second hand reports – however the people that we do get tend to be fine people despite all that.

As for the different routes – if you can manage a degree level course then go for that, otherwise your chances of getting anywhere in this job will be pretty slim.


I'm wondering whether to do St John training for voluntary ambulance work.

While I am contractually obliged to pour scorn on St John ambulance service by my fellow LAS staff, it's actually not a bad idea. Firstly they teach a fair few useful skills, you can get into gigs for free as long as you are working them…

As other commenters have mentioned it also helps you with your 'patient contact' skills, in other words how to calm someone who is scared or in pain – which is probably 90% of 'proper' ambulance work.

And if worse comes to worse you'll know CPR – and bystander CPR is a large part of what saves people. I know that one of my 'saves' was only because a St John fellow was doing excellent CPR.

So yes, while it may cause me some mockery – the Johnnies are alright.


So, what brought you to the LAS and what is keeping you there?

What brought me to the LAS was that I was a nurse in an A&E department, and the fact that I was basically locked in a windowless building for twelve hours a day dealing with an endless rush of drunks while people dying of cancer were packed two to a bay without pillows to put their heads on because there were no beds in the hospital was driving me a little… actually, a lot, crazy. I realised that I needed fresh air and a bit of sunshine – so as I enjoy medicine it seemed like an obvious choice.

What is keeping me here? I have rent to pay and a lack of transferrable skills. Nursing and EMS is pretty much all I have, on paper at least, my computing skills have atrophied since we stopped needing people to program 6800 processors in assembly.


Roughly how many 'managers' are there within the LAS between e.g. the Chief Executive and someone who works on the front line such as yourself?

I wish I knew – I suspect that this is a problem that would tax the finest minds. Certainly I've never seen an organisational chart – I don't think one exists. There are at least three levels between me and the CEO – Station Level, Complex Level, Sector Level and then Overall management. And that doesn't include the non-executive people.

While I joke that there is a 'Director in charge of blankets, an assistant director in charge of blankets, two staff officers an assistant staff officer and a handful of civilian staff' (and we still run out of blankets) I suspect I'm not far from the truth….

I know that we have a director of handwashing – he used to be my AOM.


What do you plan on doing with yourself once you are too old to lift drunks off the pavement?

Kick them until they get up on their own?

More seriously there are people doing this job well into their sixties – I don't think I'll last that long to be honest. I have a feeling I'll be 'passed unfit' long before I hit sixty.

So, suicide or a return to nursing. Probably a return to nursing as I feel the need to start stretching my brain cells again – they tend to atrophy when a large part of what you are doing each day is ferrying healthy people to hospital.

Or maybe I'll get myself promoted to a nice desk job – 'Officer in charge of toilet paper' seems like a decent job.


With flat cash funding in place for the coming 5 years, where do you see the service heading?

With an ever increasing call rate and a limit to the number of patients that we can refuse to send ambulances to I suspect that we will have a lot more solo responders going along to see if you really are in the 10% of our calls that really need an ambulance. I'm guessing that there won't be that much money spent on training staff on this new role, so expect to see a few 'Paramedic left my baby at home to die' type stories, a few sackings of road staff and a hiring of cheap recruits.

It's a plan I really need to expand upon. Remind me some day…

It's not looking good to be honest.


Is Newham really as bad as you make out or are some bits a lot rougher than others.

The majority of Newham is fine – full of decent people trying to make their way in the world, unfortunately I tend to see the nastier sides of things, the assaults, the stabbings and the abuse.

Let me put it like this – I would happily walk around the streets of Newham at night without fear (In fact I do – night shifts tonight). I'd say that Romford was much nastier…

To be honest I don't think that I paint Newham in that bad of a light. Do I?


As someone who rides a motorcycle every day through town I often have people tell me how I am going to 'die' and they always 'have a friend' (or rather 'had a friend') who was injured/killed on a bike.. I've been going 7 years without a incident. Do you see a lot of bikers in your work day? What are the factors that separate the 'bad injuries' and the ones that are relatively minor?

Speed and driving like a prat. Riding with sandals on. Alcohol.

I don't see much in the way of road fatalities, those that I do see are mostly cars with young men in them and with bottles of cider rolling around in the shell of the vehicle. I think the last M/C fatal on my patch was some drunks racing their bikes. That or someone who forgets that large, high, vehicles have nasty blind spots.

Certainly I don't think that motorcycling is any more or less dangerous in my area.

I think the worst injury I've seen with respect to motorcycling is a fellow whose bike fell on his ankle. While stationary.

(My crewmate is currently doing her MC course – her test is next week and I've got my fingers crossed for her)


I live in the US, how hard would it be for me to become certified in the UK? I am graduating soon with my medic?

As above, I think the best thing is to talk to the ambulance trust in the area that you are moving to. you may be surprised by some of the differences in the ways we work.


What would be your “death row meal”?

Something with large amounts of heroin in it so I can cheat the system and kill myself? Probably one of my mum's stews, that or a Wetherspoon's mixed grill.


Can you still remember your first call?

Not really – I remember my first drive to a job, because I crashed. I think my first attendance call was a kid who'd been hit by a bus. Nothing seriously wrong with him, but loads of precautions taken.

I can remember the first baby delivered though – it was in the back of a car in an unlit street, no-one spoke English and they weren't booked into any maternity department. Fun…


Hey, do you know Luke Eastwood?

Never heard of him.

(At least I don't think so)


My students would like to know whether patients or collegues of yours have ever recognised themselves and become annoyed about being in your blogs? How much, therefore, is there censorship of what you write?

I have been recognised once – I wrote about it here, and then the people involved left some comments to the post.

I do a lot of censoring – primarily for the reasons of patient confidentiality, I'm often either changing details or writing about something in such a generic fashion that it could apply to any number of calls or ambulance staff.

I still live by these rules.

Those people who would be angry about my writing wouldn't recognise themselves in my writing. I take confidentiality very seriously, and there have been a number of things that I just can't write about because they are just too identifiable.

My colleagues tend to like my writing on the whole (quite a few have bought my books), because I do only speak the truth and they recognise that.


It seems that the ambulance service is pretty badly run, with less equipment that you need, stupid management targets, and lack of support for staff. And your union doesn't seem effective in backing you up either. After British Airways and Rail management have successfully used legal action to prevent strikes it strikes me that with our current health and safefy leglisation that the unions could use legal action to punish the worst management thinking.

Let's just say that there is a reason that I don't belong to a union. The current staff-side representative was kept in his seat by around 5% of the LAS workforce, so you can see what an important mandate he has…

My personal opinion of the union (which is Unison) is that why our local rep is very good, when there is a larger issue the union management seem unwilling to rock the boat. As I say my information about such things is limited.

Personally I think that we should set up an internal LAS only union with minimal fees to represent staff in these larger issues.


Also, I know you yourself say you are quite shy away from the job and I am also quite shy. How did you get through your interview process to get into the service?, what have you found most challenging about being shy and getting into the ambulance service?

I am quite shy, but when I'm wearing a uniform everything changes – and let's face it, an interview suit is just another uniform.

Besides, the 'rules' and social mores of interviewing are pretty solid, so both sides know what to expect. They expect you to be a bit nervous, and you expect the familiar questions to be asked.


What has been the best/worst moment of your career so far?

The best? Going home at the end of a shift.

Seriously – it's whenever you make that bit of a difference, be it saving a life or hearing about a vulnerable adult referral to social services going well.

The worst? – Just the constant lack of kit, support and training. It's sad really, we could be really good, but a lot of decisions are 'quick fixes' and not too well thought our. We are far more reactive than proactive.

Personally – the worst bit was fighting to keep my job after being sick following an assault. But I did have tranquil fury and logic to keep me going.


Is overtime available?

It depends on the balancing of hitting the targets and keeping funding under control. At there moment there isn't that much overtime.


How are shifts arranged, do you work say 3 13hr shifts a week, or 5 13 hr shifts one week and then less next week?

We tend to work in bursts, so I'm working four 12 hour night shifts, then I have sic days off, then I'm working another four with three days off, then two on, two off and so on and so forth. The nice bit about this rota is that you do get a week off which can turn into two weeks by taking 24 hours worth of leave.

In other words, sometimes I'm worked like a dog, other times I can be incredibly lazy.


Do you feel valued by management ?

HAHAHAHAHAhahahahahahaaaaaa….. *chortle*

No, not really – I'm employed to get to somewhere in eight minutes and that is about it. Sadly I don't expect anything different.


What made you choose LAS over says SECAMB ?

Location – I live in London and it's the bit of the world I know – working 12 hour shifts means that the shorter the commute the better.


Are there any private companies you or your staff work for to earn some extra money?

There are one or two – but I'm no expert on that as I like my days off to be as much like days off as I can.


I have often wondered if you've thought about moving countries or trying another area of emergency medical service?

My problem is that I really like London, while I like travelling, I like being able to come back to London. In your larger question you mention Toronto, which I have visited – while it is a really lovely place, it feels a little 'small' compared to London. I guess I'm not feeling at home unless I can chew the air and get crushed to death on Oxford Circus.

I don't know, maybe I'll change my mind one day, but I'm not too sure how my qualifications would translate – and I don't have the money to emigrate anyway.


Also I hear you talk about paperwork, doe this take up a lot of your time and is it hard to fill out?

Nope – the paperwork is an A3 sized bit of paper with a lot of tick boxes. It's annoying to fill it out for a 'nothing job', but it's certainly not hard. I'll show you all the paperwork in an upcoming blogpost. Compared to some jobs it's surprisingly little to be honest.


Well you did ask for our questions! I’m just wondering of your personal opinion of Newham Trust (acute, not PCT). I used to work there but hindsight tells me it ain’t so grand in the scheme of things. How do you view it as a professional? Are they getting better, worse or just plodding along? What could they do that would make you a happy ambo? (apart from not putting the treatment centre and mental health on the same site that requires a big white taxi to take them to emergency?)

Given what they have to work with, a large, sick and undereducated population, a building that needs to have a fair few more beds in it. A lack of status that means that they can't 'headhunt' the better staff unlike, say, the Royal London. I think that they do all right to be honest. When my mum was sick I took her there, rather than our local hospital because I do trust them more.

As to getting better – I think they are trying, but I'm not sure if they will succeed.

What would make me a happier ambo? A much larger and better staffed A&E department and Walk in Centre would be a start. Some patients have to be put out in the waiting room even if it's not really appropriate just because there aren't enough beds in the department (and they can't 'work faster' because some things do just take time).

A mental health unit that would take direct admissions from us, even if the person was a little tipsy. But that will never happen.

Find some way to have nurses come out on the road with us – a lot of them have absolutely no idea what we do, or what we are capable of. We did a transfer once and the nurse asked if we could do blood pressure measurements.

I think that the best thing they could do would be to employ me to stalk the halls and boardrooms with my big stick of learnin' to slap the slackers. Either that or handle their internet strategy.


Right – I think that's all those questions answered.

13 thoughts on “Answers”

  1. As a student para in the West Mids area, it'll be interesting to see the differing paperwork between west mids and las.There's quite a bit to fill out on the West Mids one, even with the “tickboxes” (including the obligatory 2 sets of obs to leave someone at home)…

  2. Link error. On the question about “My students would like to know whether patients or collegues of yours have ever recognised…” you have two links. The first is about the first time you were recognised, the second is about the confidentiality rules you apply to your blogging. But both links point to the same blogpost about the first time you were recognised.Yes, yes, nitpicky I know, but I'm sure I read the thing about confidentiality rules before and I thought it was a good one.

  3. Yep, fixed now, although it disturbs me a little that I'm remembering posts from 2005 when I can barely remember what I had for breakfast this morning.

  4. I do find myself paying more attention to ambulances when they go past these days, just in case I happen to recognise a certain face behind the wheel – and when my eldest was taken to Newham earlier this year with a concussion, I did quiz her afterwards to try and work out if perhaps you'd been the one who treated her. ;-)Haven't spotted you yet though!

  5. The digital thing was a wash out farce, had some good articles on it.Cheers for answering my question, after reading your blog for a few years now I have grown uneasy about wandering around canning town at night. It is an odd area with really expensive houses and blocks of “council” flats next to each other. The main road past the hotel I stay in always has people gunning the red lights.

    Hey maybe its because I live on the south coast in a non ethnic area.

    Around here you are more likely to go to hospital in the coastguard helicopter than by ambulance as in the season its a lot quicker. Also the coastguard often turn up quicker than an ambulance. They seem to have the knack of forcing the holidaymakers out the way.

  6. Many thanks will pass on the answer to my friend and let her make her choices at least she has some info to make a start on. 🙂

  7. “when there is a larger issue the union management seem unwilling to rock the boat” – That's interesting because I've always felt the same. In the public sector the Union rep (the ones I've known anyway) always seems to be able to spend a lot of work time doing Union stuff. If they upset management then they will find more real work and less time for the Union tasks, not an incentive to fight hard for anyone unless you are unusually helpful.Oh, and the first rep I met was a member of the Conservative club and a bit to the right politically of Maggie Thatcher. She only did the job to skive and poke her nose into peoples private stuff.


  8. I think that everyone in the country with a connection should should host an exit node for the TOR network. It'd render the entire bill pretty much useless/unenforceable.Of course, even this would have drawbacks.

  9. I crashed an ambulance on my first blue light drive too! They made me go to the police station to report it and they all laughed. I also recognised you at NGH! I'm a student at Newham and your books and blog have been priceless. Next time I see you I'll wave like a nutter x

  10. I just found your blog after picking up your book at Amazon. I ended up reading fully 3/4 of it aloud to my husband and children and will be passing it along to Meghan, the head of our barely there, volunteer EMS service. You've got an amazing voice and a hell of a way of putting reality, and I will never, -ever- quietly allow the IQ-impaired residents of our tiny little Nevada town to take the piss out of our EMTs again.I don't think I'll ever put my parents in a nursing home, either…Thank you. Thank you. Thank you.

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