Category Archives: From Random Acts Of Reality

From my old blog, Random Acts of Reality


To whom it may concern,

I wish to resign from my post as an EMT-3 in the London Ambulance Service. If possible I would like to go onto a bank contract so that I may work the occasional shift.

I would appreciate it if you could tell me my last working day as soon as possible as I am moving elsewhere in the NHS and they would like to know the earliest date that I can start.

Many thanks in advance.

Brian Kellett


I handed this letter to my immediate boss today.

People who follow me on Twitter will have already heard that I have a new job, one that I'm due to start in approximately one month. In one month's time I shall be going back to nursing where I am taking a post as an Urgent Care Nurse Practitioner at Newham hospital.

I've been led to this by a number of factors, a majority of things that have pulled me towards a career change as well as more than a few things that have pushed me away from the LAS.

My AOM described it best when she gave me my reference, she said that I was bored and that I needed new challenges. We both agree that in most cases the job that we do turns our brain to mush.

So, I'm going back to nursing because I want to develop my clinical skills, I want to learn new things, I want to be more responsible for providing people with the best healthcare that I can.

It's pretty much impossible to do this within the LAS because, for example, our ECP (Emergency Care Practitioner – our top clinically trained people) programme is effectively being shut down. There is nowhere to progress to and… well… you have been reading all about it on this blog for the past few years.


So, some big changes – one of which being that I'm going to go to writing under my real name, Brian Kellett, rather than the helpful pseudonym of Tom Reynolds. At the moment I'm in the process of changing this on all the social network profiles that I can remember belonging to.

If you take a look at the top of this very blogpost you should see that it no longer says 'By Reynolds'.

As for this blog… well… I'm unsure of what form it's going to take in the future. WIll I be still writing about ambulance stuff? Will I be documenting my journey into urgent care? Will I just natter about whatever interests me at that moment in time? I'm not quite sure. Certainly I'm not going to stop writing and in fact, later today, I'm heading into town to have drinks and a chat with a friend about something we are planning together.

So I'll keep blogging, but I'll no longer be the 'ambulance blogger', I'll be 'that annoyingly nerdy blogger', which I think puts me in good company.


So there you go, a change in career, a change in direction, a change (of sorts) of name. I'm looking forward to it and will be writing about it in the coming weeks.

It would be a lie to say that I'm not at least a little bit nervous about this, but nervousness is just a form of excitement – and while this is a big step for me it's one I'm looking forward to taking.

An Indulgence

The monster, who was once a man, sat on the bonnet of the burnt out car and looked out across the London night.

He was deciding what to do, after all immortality could get boring after a while. So he sat on the car and tried to decide whether he should let himself die.

The problem, he thought, was that with endless years the space in your mind would fill up – forgotten names, faces without names, memories blurring into one another.

It wasn't that long ago he had London in the palm of his hand, ruler of the night court. Taken through fair means and foul, politics and violence, from the one who came before. And he couldn't remember her name.

He remembered other things though, the massacre at Osbourne house – trading on his survival at that bloodbath gave him his first footstep on the ladder of power. He'd risen through the ranks, slowly at first, then ever faster – his comrades at his side. One he would trust, the others could only be trusted in a well lit room.

Then the one he trusted returned to his homeland, the monster smiled at the thought of him now, probably dancing around burning orthodox churches.

He thought of the reward he had received for waging war against the other half of the city, the reward that ended in his near assassination.

But his survival fed his fame even more.

He remembered the lord of the undercity, he remembered him from when that lord was still a man and not the twisted but honourable monster he became. That lord had met his final death not too long ago from monsters older and nastier than he.

The things he had seen, the monstrosities in Norwich, the art gallery filled with elephant dung somewhere on the south coast, the things that flew invisibly in the air and invaded your thoughts.

The friends he had made, sitting around swapping war stories, insulting those who had not truly lived before they died and became monsters together.

The people he had killed to slake his thirst for blood. The murders he had planned, the murderers he had sent off to do his bidding.

The sky was lightening, too slight for human eyes, but easy to discern with his predators eyes. His decision would have to come soon.

Those of his kind that he called friends were largely no more, he had outlived most of them. The humans he had cultivated were now all moved on, taking roles that were of no consequence to him. Those enemies that still lived, to smart to fall to his blades, he could not count them all.

Back before he was made the monster he was just a man, a soldier, endless battles across Europe, fought for King and country. Different kings but the same country. He didn't care for the cause, but he cared for his brothers in arms. When he was a man he belonged to a family, now he was the monster any family he'd built had scattered to the winds, under their own steam or as ash, it didn't matter.

Perhaps, he thought, the choice to be made wasn't so black and white as to be a choice between life or death.

Once, when he was a man, the choice had been simple – to avenge his fallen comrades, hunting the monster through the alleys of London until cornered the creature that he thought a man turned bared it's fangs, and leapt for his throat. Life or death, it didn't matter, he would die for his family.

Now he couldn't, for he had no family.

So, if not life and if not death, then what should he choose?

Perhaps rest, a slumber for a decade or so, buried beneath the earth where his dreams could wipe away the last fifteen years. What changes would he see when he woke?

The bluing of the sky was more pronounced, his skin starting to itch from the sun's power. His choice would have to be made soon. To stay on the banks of the river and turn to ash, or to hide in the shadows and continue for one more night into the endless stretch of time.

He was bored. He'd won his game and kept his prize. But the boredom was his undoing, he'd would take more and more risks just to spice up each night. Seizing the praxis of the neighbouring counties, returning the power when he was bored.

And one night that boredom led to him losing the power in London. He'd tried to go it alone, but knew that it would not last, so one night he stood up and left – and didn't return.

Since then he travelled, looking for something to keep him interested, but the same old fights were repeated everywhere.

So now he sat on the bank of the river waiting for the first rays of the sun to appear over the horizon. To burn his flesh and blacken his bones.

The moment was approaching – to choose. Life, death or something else.

'I think a nice rest', he said quietly to himself, 'one day I might be wanted again. And besides, I wonder what will happen next.'

He strode out into the river and, picking a spot no different from any other spot, buried himself deep in the silt. Feeling the cold of the water and the slickness of the riverbed he thought that this would be a good place for a sleep of a few decades.

'I wonder how interesting the future will be', was the vampire's last thought before he slipped into the torpor of ages.


An indulgence, an inside joke and a banishing with laughter. Tomorrow a big step to be taken and a line to be drawn under the past.

My Intial Thoughts On the NHS White Paper.

The NHS White Paper is out and I've read pages and pages of analysis, although I'm yet to read the White Paper myself. It's sitting in my reading queue waiting to be read.

The big change is the PCTs who currently 'purchase' healthcare will go the way of the dodo to be replaced by 'consortia' of GPs. The thought being that GPs know better the needs of their community.

While I am sure that there are plenty of conscientious, well trained, thoughtful and management minded GPs out there, certainly in my part of London they seem a bit few and far between.

As an example, my crewmate and I were sent to a patient who had seen the GP who had thought that she might need hospital treatment. The patient was described as 'ambulant'.

She was 'ambulant', in that she had walked to the GP surgery – at least one mile away, and the GP had sent her home to await the ambulance.

As soon as I walked into the room I knew that we would be wheeling the patient out on our chair. She was so short of breath she was breathing forty times a minute, her oxygen levels were way below what they should have been (86% – even with someone with chronic lung disease, this would be a worry), her pulse was racing at over 120 beats per minute.

She was a very sick lady – and yet the GP had sent her to walk home.

Similarly I've been to patients in the later stages of shock who have been sat out in the waiting room for the ambulance and I've had patients who the doctor has, correctly, diagnosed a heart attack sitting on the wall outside the surgery.


Now, I understand that not every GP is like this and that I only tend to go to the patients that are seen by these worryingly poor GPs, but how many of them will be holding onto the public's purse strings in the future.

In some places they can't even arrange decent out-of-hours coverage with GPs who are able to speak English.


The other worry is what happens if a GP consortia decide that they don't want the LAS handling emergency calls in a certain postcode? Will we be refusing calls because privateambulanceservicecompany will hold that contract? Will we no longer be London-wide, but tasked to only cover certain areas.

Given yesterday's announcement about 'Big Society', will the ambulance service be broken up to be replaced by volunteer services? I heard rumours that the Olympic planning people wanted LAS staff to volunteer to cover the Olympics as they didn't want to pay them, was that just the start of this?


Still, lets wait and see what happens in the consultations before we start panicking. After all it's not like consultations in the past have ignored all the good points in opposition to what the government want to do…


You would think that it is pretty obvious what us ambulance people do; pick up sick people, treat them and then take them to hospital.

If you've read this blog over the last few years you will have realised that we do much more than that.

It's why I carry a Swiss army knife, because more than once I've been called to fix something.

The other day I had one of the weirder calls, it was sent to us as 'Having heart attack because of two boxes'.

Needless to say this piqued our interest.

We arrived as scene quickly, after all it was a 'Cat A' call and so be there in eight minutes or be a failure – but we were also the quickly as the address was just around the corner to the station.

Once the patient opened the door we recognised her, I'd say all LAS and half of the Police force in the area would have recognised her as well…

She is elderly and lives alone. She is also probably schizophrenic, or at least has some form of dementia. She has daily carers who are good, but they aren't there all day so she gets worried and scared easily.

The last time I was sent there was because she hadn't had her morning cup of tea and was worried that she would faint.

This time we were there because some delivery pillock had picked her address, out of all possible addresses to mis-deliver two large boxes.

These boxes turning up on her doorstep had, as she described it, 'given her a heart attack'. She'd phoned the police, and they had directed her to us.

And here we were.

The two boxes were lurking in the corner of her living room, staring at her with malicious intent.

Well, not really, but she was acting as if they were the most evil things in existence. There was no way that we could leave the boxes here because she would just keep phoning us, or the police, back.

So it was time for our problem solving skills to get a bit of exercise.

I phoned Control to get the phone number of the address on the box. This was not that easy as our radio kept cutting out, I would guess that we were in a b it of a dead spot as there wasn't any rain…

Control then looked up the p-hone number and relayed the number to me – I then phoned the person who was supposed to have the boxes (he only lived around the corner).

He was greatly surprised to hear from the ambulance service about his mislaid parcels, but was more than happy to come and pick up the bosses himself.

I suggested that this wasn't a good idea, and that we would come and drop the boxes up to him – after all if he turned up after we left our patient would probably call out the coastguard as well as us and the police.

So, as I knew the address I threw (ahem, rather I 'placed carefully') the parcels in the back of the ambulance and drove them around to him.

He was both exceptionally happy and very grateful.

Parcels delivered I returned to my cremate (and FRU, did I mention they were sent as well?) and picked her up after she finished assessing the patient.

Problem solved, and no need to drag our woman off to hospital.


It would appear that the radio system that the LAS uses has been in the news of late – claims that it doesn't work in the rain, or that vehicles are without radios.

Or vehicles use the 'Airwave' standard, a digital network shared by, amongst others, the police. We have a main set that is fixed to the ambulance and should have two handsets that we carry everywhere with us.

I can only talk personally, but in my experience the radios are often a bit flaky (but remember that this is a system that was forced on us by the government), but not any flakier than any digital phone network.

The problem is that they are digital, if they have a poor signal then they just refuse to work, unlike the old VHF analogue radios that would transmit, although over a load of static. With analogue though the human brain is a great signal filter, and so you could make yourself understood. With a digital system you just have silence.

So it's not perfect, but it's not bad – at least we have handsets now, it's been something we've been wanting for crew safety for quite some time.

As for not having radios on vehicles – I suspect that the spokesperson for the LAS is counting the main set in the vehicle as a radio (quite rightly as that is all we have had for years), but the HSE are also counting the portable handsets.

These do go missing, but there is normally at least one handset on a vehicle. When we were trained in the use of the radios we were told about the system for replacing them if one should go missing – sadly this seems to have gone out of the window.

Oh well, no change there.

The switch to digital has meant some changes. For example you can no longer hear everyone on the radio talk group, so you have no idea where your workmates are or what they are doing – this results in much less awareness at street level of the situation across your sector. I can't tell if a hospital is full or not just by listening to the radio, nor can I hear if any crew needs assistance. This makes you feel a lot more isolated on the road.

The other side effect of not hearing the rest of the talk group is that, when it is busy, you 'buzz in' to talk to Control, but you don't get an answer, all you have is what seems like an empty channel while Control seemingly ignore you. With the old system you would hear them talking to the other crews, and so you would know that they were busy so you knew you weren't being ignored.

Overall, the provision of handsets has made crews safer, although I can't comment on the panic button as I've never had to use it. Some things are better, some things are worse. But at least the LAS has made the effort and the problems are with the design of the system rather than with the LAS.


Can I also take a moment to mention one thing that I forget to write about in the last 'Transplant' post – that you should also discuss your being on the donor list with your family, so that they are prepared should the worst happen and that they know your wishes and don't overturn them. You might also be able to persuade some of them to sign up as well.


Finally, big changes coming up, but it's something that I need to sit and write with plenty of time, not fire out in the half hour before I leave for work. And I'm not just talking about the NHS White Paper.


A lot of the people I follow on Twitter have been talking about #transplantweek, a way to get everyone aware of the need for organ donors.

In my years as an A&E nurse I only knew of two people passing through my doors that went on to be organ donors, helping people that they never met. Two people in many years is simply not good enough.

In my ambulance work I find myself going to dialysis wards, people who desperately need kidneys. The chairs are always full – people connected to machines that clean their blood and keep them alive.

I've been to people who need liver transplants, waiting for someone to donate their liver to them so that they can live. These patients are swollen, yellow and in pain, and all I can do is take them to hospital where they can be 'managed' for a little while longer.

There was a child on my patch who needed a heart and lung transplant. She was lucky and got one, and I don't see her any more.

Once upon a time, when I would go to people who had suffered trauma, we would rush them into hospital where they would get blood transfusions that would save their lives. As a nurse I can't even guess at the amount of blood products I've given people. I used to be the one sent for the blood because the storage was halfway across the hospital and it never bothered me walking the hospital grounds late at night.

Organ donation saves lives – of that there is no doubt.


There are myths that doctors will 'let you die' so that they can get their hands on your innards – I can tell you that this is completely untrue.

I've been on the organ donor list for as long as I can remember. I wouldn't be on it if I thought there was anything 'dodgy' about it.

You'd accept a kidney if you needed it to survive, why wouldn't you donate one when you no longer need it?


Why don't you sign up today – help someone out when you pop your clogs. It's the ultimate in green recycling.

Register as an organ donor.

Self Promotion

Di you know that both my books are still available in shops and on Amazon?

Blood, Sweat and Tea

More Blood, More Sweat and Another Cup of Tea.

But did you also know you can download them for free for pretty much every platform under the sun. (And here for the sequel)

They are also now on the Apple iBook store, also for free, so if you have an iPhone or iPad you can read them on that platform as well. (And it has been downloaded quite a lot from there – a few more and I might make the top twenty free downloads chart). For some reason you can't like directly to an iBook store page. Which is a bit daft – do try and fix that Apple.

And finally – 'Blood, Sweat and Tea' is now available as an audiobook. Huzzah!

iTunes link

Amazon link to CDs.


Feel free to download the free editions, and then, if you like it, buy a physical copy for your loved ones (from the emails I get, it would appear that mothers really like them). That way both my publishers and I get some lovely, lovely money.

OK, self-pimpage over.

On How Targets Directly Screw Patient Care

So… What is it that makes an ambulance?

What sort of equipment do you think needs to be on a vehicle for it to be classed as an 'ambulance'.

You'd probably think that it would need a stretcher, a carry chair and some sort of medical equipment. Perhaps something to take blood sugars, blood pressures and tracings of your heart.

Maybe it would need something to deal with broken limbs, a board to strap you to if the crew thought that you had a broken neck and maybe even some drugs to treat conditions such as asthma, heart problems and allergic reactions.

You might also expect bandages.

You would, of course, be wrong.

We have had the official memo from one of our Assistant Director of Operations.

To be a working ambulance you need…

1) A vehicle which passes the legal requirement of basic roadworthiness – decent tyres, has a windscreen, has working lights and is taxed.

2) A Bag-valve-mask and a defibrillator.

3) That is all.

That is all you need to have a working ambulance – or rather an ambulance that will stop that all 'important' (and utterly bloody pointless) ORCON target.

This level of equipment means that you can perform pretty basic life-support – no drugs, no clever airway management.

If you have asthma, you will be wheezing like a wheezy thing with not a thing I can give you.

If you are having a heart attack I won't be giving you the aspirin that vastly increases your survival rate.

If you have a broken leg, I'll have no way to splint it. And I may not even have a stretcher to put you on anyway.

But I will have 'stopped the ORCON clock', and so the job will be a 'success'.


And this is happening – a friend of mine was sent out on an ambulance with this level of equipment. He was concerned by this and wrote a letter to our medical director who replied that this is a good policy.

Over 50% of the time I'm sent out on a vehicle without a blood sugar kit, and without other equipment like Scissors or a Paediatric Advanced Life Support Kit.

The London Ambulance Service calls itself a 'world class service' – but I think it's a bit rich to refer to yourself as this when ambulances are being sent out with this level of kit.

But who am I to complain that I don't have the right amount of kit? After all, the people who make these decisions are paid a heck of a lot more than me, so they must be smarter.


It is, as regular readers will no doubt have guessed, all because of the frankly dangerous ORCON target – dangerous because our ceaseless chasing of this clinically worthless target means that patient care is suffering.

The government has decreed that a number of targets will be dropped – the four hour A&E wait, the Police Pledge, Literacy (well… they haven't specifically said that literacy must be cut, but if you are cutting the education budget by 25% then that is the sort of thing you are going to get).

Sadly, no, tragically, it would seem that the ORCON target will remain. And so resources that could be spent on, oh I don't know, fully equipped ambulances, are instead being spent on beating that damn clock.

However I think that there are those in management who probably like this – after all they can understand how to chase this target as opposed to being capable of setting a standard of excellent patient care.

The Bitch Is Dead

The mosquito is dead, killed by chemical warfare. The only side effect being my new understanding that spraying insecticide into your eyes tends to sting a little.

Loads of good ideas in the comments although I am somewhat disappointed that no-one suggested this…

It brings a warm fuzzy glow to me – and a desire to see a similar, but larger, system strapped to the top of my ambulance for destroying the tyres of drivers who pull out on me while I'm driving on blue lights.


2:00 AM


2:30 AM

3:00 AM

3:30 AM

4:00 AM

4:30 AM

Every thirty minutes.

Every. Damn. Night.


I've not been sleeping well, in fact I've hardly been sleeping at all. The best I can manage is a half doze before the bitch wakes me up.

For the past few nights there has been a mosquito in my flat. Every half hour she has been buzz bombing my face, looking to land in order to suck my blood.

Try as I might I can't catch her.

So every half hour I slam on the bedside lamp, grab my glasses and rolled up copy of Wired Magazine and dance futilely around my bedroom trying to track her down.

But she always seems to vanish, only to return half an hour later as I've just dropped off to sleep.

If I could I'd just sleep and let her feed – I've been bitten so many times the bites don't bother me so much now. But there is something in my animal brain that wakes me up, instantly, when a mosquito buzzes past.


Female mosquitos are the only ones that bite – they use the blood to build their eggs. Male mosquitos are harmless and eat nectar and fruit juices.

Female mosquitos track their prey by body heat, scent and by sensing the carbon dioxide given off by breathing.


I try to breathe quietly, to form a pool of carbon dioxide to act as bait. But she doesn't come.

I turn on every light in my flat, my eyes scan the walls for silhouettes, but to no avail.

Every half hour I wake.

I'm trying to shift from night shifts to early starts. It's hard enough for me at the best of times, but to have my sleep disturbed in such a fundamental manner is making it painful for me.

I want to sleep during the day and hunt at night – just like her.


You can tell a male from a female mosquito because the males have larger and bushier antenna.

The base 'buzz' of a mosquito's flight is around 400 Hz.


Every half hour I wake.

My eyes snap open and I look around the room. My attention is drawn by 'floaters', retinal cells floating in the fluid of my eye. That's when I can open my eyes – without sleep they start to fail after around twelve hours of use.

I want to cry. I probably will today – lack of sleep has that effect on me.

I feel like I'm in an Edgar Allen Poe story – 'The Telltale Mosquito Buzz'

Later today, when the shops have opened I'm going to buy the nastiest, evilist, most enviromentally unfriendly spray that I can find – then at the half hour point I shan't look, I shan't open my eyes.

I'll just listen to her approach and empty the contents of the can into the air above my face.

'Do not inhale' the can will say – but It will do it's job, because either that bitch will die, or I will.

And at least then I won't be woken by her again.