Category Archives: Things That Amuse Me—

Last Night

I recently had my last ever night shift, I would have written abut it earlier but the effects of the shift work had basically knocked me on my arse and made me incapable of doing anything except sleeping and dozing on the sofa.

It was, ultimately, a not unusual shift – no jobs that leapt out as being anything out of the ordinary.

My first job was to a woman who was intensely isolated because of her being unable to speak English, the only person she knew was her daughter who has a full time job. We were called because the woman was 'behaving strangely'. We arrived with the police to find her crying on the floor. We did the only thing that we could do, take her to hospital to see a psychiatrist.

It was handy to have the police there, because initially the woman wanted to refuse to come, but as she was distraught and had threatened suicide it was important that she see a professional.

The next job was to someone who'd been minding their own business and then been punched in the face with a knuckleduster. Often you can tell when someone is hiding something (because, let's face it, a lot of assaults in my area have a reason behind them. Not a good reason mind you, but there is normally a reason). In this case he didn't seem the type to be in a gang, he didn't appear to be a drug dealer and I don't think that he was secretly sleeping with someone else's girlfriend.

We took him to hospital in order to rule out a fracture of his facial bones.

The next patient had been indulging in some cocaine, some cannabis and a lot or alcohol. So had his friend. We had been called because he was 'off his legs', or as it was described to us 'he had been on his hands and knees like a dog'. I may have resisted the urge to ask if he had taken to barking.

As he got to the doors of the ambulance he let forth a huge spew of vomit, simultaneously passing flatulence. 'Better out that in' goes the old saying, and truly it is better out than in, as in outside the ambulance and not inside it where I need to mop it up.

During this he had developed a bellyache, so we assessed him and took him to hospital where, a few hours later, he was feeling much better.

(Seriously, is Red Bull and whiskey a sensible drink?)

Our next patient. Oh dear, our next patient…

The short version is that she was faking a panic attack in a pub. Once more I'm left wondering why people think that they can fake medical conditions in front of people who've seen them all before. This patient was very trying as she refused to get onto the ambulance (until she realised that her audience were bored and going home), then she alternated between not telling me anything and telling me about everything.

At the hospital she refused to get out of the ambulance until I had sweet talked her, then she refused to enter the hospital, then she refused to go to the toilet while crying that she needed to pass urine.

She was put into the waiting room (eventually) where she then argued with one of the nicest nurses in the unit…

I'll be the first to admit that it was very hard for me to remain the consummate professional that I am.

The last I saw of her she started by telling her new audience that her four year old child had called the ambulance (rather than the bar manager who'd actually called us), and that everyone was against her. She then went on to try and damage a police car before drunkenly disappearing off to the local bus stop.

I think it's called 'personality disorder'.

A much simpler job followed – a man who was stuck in the bath. The FRU had got there before us and had already solved the problem. We didn't even see the patient, as he'd gone to bed, so we caught up on some gossip with the FRU responder and made ready for our next job.

A nightmare job. Not because of the patient (who was confusingly suffering from a mish-mash of symptoms that had us blue-lighting her into hospital). No, the nightmare was the spider on the wall of the staircase that was the size of my hand. Garden spider or escaped tarantula in disguise, who knows what it was?

One of the elderly relatives saw the look on my face and managed to dispose of the creature in a piece of kitchen roll – as he walked into the kitchen with the ferocious monster I listened out for any screaming as the spider broke free of the paper and tore the old man's throat out…

An interesting job as there was a mix of heart problems, probable sepsis and undiagnosed diabetes – the best thing for the patient was for us to treat her symptoms as best we could and get her into hospital as quickly as possible so that the doctors could sort things out.

And a nice family, adept at dealing with the sorts of giant spiders only seen in horror movies.

Then I had a nap for twenty minutes in the passenger seat of the ambulance as, for a few minutes at 5 a.m, it seemed that people were getting some sleep and not filling their time calling ambulances.

Our final job was a transfer of a patient from our local hospital to the heart specialist unit. A nice patient, a nice family member and an uneventful journey finished the night off lovely.


And that was it, my last night shift. I drove home with a huge smile on my face – no more would I need to feel sick in the stomach after a long night shift, nor would I need to batter my body clock into submission any more.

No more night shifts means that I will be able to rejoin the human race, no longer will I have the constant feeling of jetlag dragging me back.

As I write this I have another stupidly big grin on my face and an urge to dance a little jig around the room.


Sorry folks, another crosspost from Paper Not Included, my mea culpa this time is that I'm recuperating from a pair of nightshifts that were less that smooth. Something ambulance based tomorrow though.

Windowing makes ebooks more like DVDs than CDs

I got into a discussion on Twitter last night with someone who I respect about ebooks, made slightly difficult by constraining myself to 140 characters and by fitting my tweets around work. And it being silly o'clock in the morning when my brain turns, not so slowly, to mush.

He was suggesting that when you buy a hardback book there is within it a 'scratch panel' with a code for the ebook version. While I completely agree with the idea, and it has been one I've suggested in the past, I was trying to make the point that, especially when ebooks are concerned, the publishing industry isn't exactly the most sane creature.

For the record, I don't think that publishers will want to do this because it is too easy to buy the book and then email the code to someone else – or put it on a 'book swap' website where such codes could change hands. The publishers would then see this as a 'lost sale' and therefore 'lost profit' rather than as a marketing tool.

Our brief discussion then turned to whether ebooks are to MP3s as physical books are to CDs.

I maintain that ebooks are to DVDs as physical books are to films at the cinema.

You see, the publishing industry, like the film industry has long had a point of 'windowing' releases. That is, a film is released in the cinema – stays around for a few weeks and then only after a few months does the film get released as a DVD or digital download.

On the other hand, CDs are normally released at the same time as MP3 downloads.

Turning to publishing, like films at the cinema – hardback books are released first and it is only much later they are released as a paperback book.

This is known as 'windowing', and it is used to ensure that one section of the market, the section that is willing to pay more for first access, or for the 'experience', don't instead decide to turn to a less profitable product.

In the publishing world the profit margin on a hardback is much more than that on a paperback (although the risks are greater), it is a poorly held secret that while hardbacks cost three times that of a paperback they do not cost three times as much money to make and distribute.

This then is why many publishers are looking at a distribution scheme where the hardback is released first, and the ebook is held back until the paperback version is released, or even held back until later.


Is this sane?

Without the figures available I can only speculate – but I would imagine that the algorithm that the publishing house comes up with is perhaps lagging behind the real social change that the internet and social media has wrought.

I would guess that most people who buy hardcover books are those that simply cannot wait until the paperback to read the book by an author, or are huge fans of the experience of reading a book – the sheer physicality of a hardcover. These people will pay triple the price of a paperback for the same 'content' in order to read it as soon as possible – I know I have been that person in the past.

Then you have the second market – those that will wait until the paperback is released. This section are more wary of spending a lot of money and will happily put off that instant gratification in order to get a bargain.

The third market are those that will wait until they can borrow the book from the library, or will buy the book when it appears in a second hand bookshop. Publishers get no money from these people and so they are ignored, or marketed at in order to become members of the first or second market.

Where we stand now we have a new 'fourth market' with ebooks – people who don't care about the physicality of books and who want instant gratification. The jury is still out on how much money that they want to pay (this returns to the argument of 'how much should you pay for an ebook', do you pay near hardback prices for that instant gratification, or do you pay less because you are buying a product with less functionality?).

So, how do you window ebooks so that they don't gouge your physical books sales? Can you make the ebook price enough that you recoup any hardback sales lost, yet don't discourage people from paying that amount for a non-physical product?

One key question is 'how is the first market who buy hardbacks split?', Those who want the experience, the pure artifact of owning a hardcover will never buy that as an ebook as it doesn't have anything that they want. It's those that want that instant gratification that may start switching to ebooks, and publishers want to keep the profit that those people bring them.

It is simplistic to say that ebooks 'cost nothing'. Sure, the 'per unit' cost of an ebook is next to zero – once you have an ebook format you can sell a million copies for the same cost as selling a hundred copies – but the real cost is in getting to that finished ebook format. This means copyediting, author's advances, marketing and the myriad of other costs that go into making a book. It is this initial outlay that publishers look to recoup with those initial sales of hardbacks (because remember, the profit margin is higher on them).


So, what for the future?

I see publishers continuing to do one of two things, they will either 'window' their sales – making ebooks available only after the paperback version of a book is released, or they will embrace the 'variable pricing' model initially releasing an ebook at the same time as the hardback for hardback like prices. Then when the paperback is released they cut the price of the ebook for something more like a paperback price and then finally, after selling the majority of their paperback sales, they will lower the cost of the ebook even more in order to make the last bit of money from those who are only willing to pay secondhand book market prices.

This, in part, is why publishers are embracing the 'agency' model of ebook pricing that came to a head with the fight between MacMillan and Amazon, brought on in some part by the imminent release of the iPad.

Is this sane? Well it makes sense in some part – but then it ignores in part the influence of social media in book buying – and that is a subject for a later date.

Unwarranted Uncharitable Thoughts

The first job of the day was to 'female slipped on ice – police on scene'.

I'll admit that, at half past six in the morning my thoughts towards people, actually towards anything, are often less than charitable.

'It's not that cold', I said to my crewmate – although years of working in all weathers mean that I'm perhaps not best placed to judge, 'I bet she's found the one tiny patch of ice in Newham and fell on that'.

It's the end of the financial year, and so there are roadworks and temporary traffic lights everywhere, unbeknownst to us there was also a 'fun run' in the area – no-one had told us road staff about it. So it took a fair bit longer than normal to get to the patient.

She was stretched out on the pavement and there were four police officers standing around her. As she was partway in the road they had parked their vehicle to 'fend off' the oncoming traffic.

As we pulled up one of the police officers knocked on our window, 'be careful – it's like an icerink out here'.

Well, I have nice boots, they tend to be alright on ice, so I suspected the police officer was being a bit dramatic.

I stepped out of the vehicle and instantly felt my feet sliding under me. The officer was right – it was treacherous.

I decided to forgive our patient for falling over.

My crewmate started to assess the patient – she had a painful knee and with one gentle feel from my crewmate through the patient's jeans she knew she'd done something serious and crunchy to her knee.

Time for a stretcher then.

So, being the driver, I pulled the stretcher out and started towards the patient.

My crewmate describes the next few moments as her seeing the stretcher flying towards her, and her putting herself between the careening stretcher and the patient.

From my point of view, while moving the heavy and awkward stretcher both of my feet slipped and took off skywards. The horizon disappeared and I found myself admiring the beautiful blue sky. Then there was a crunch as I hit the floor and skidded a few inches to a halt.

I knew I hadn't hurt myself so I found myself laying there laughing.

The police officers ran over to me to make sure I was alright – I'm heavy after all and I have a lot of things in my pocket that made an awful noise as I fell on my arse.


The rest of the job went quite smoothly, our patient was very brave despite being in a lot of pain – pain that we controlled the best we could with immobilisation of the knee and some nitrous-oxide. Further examination in the ambulance revealed something rather wrong with our patient's knee, so she needed a trip to the hospital.

My crewmate's insta-diagnosis was proven right as our patient's kneecap – normally one bone had decided to become at least six separate bones…


As for the road, the police had got in contact with the council to come and grit this small section of road. What had happened was that the was a large puddle in a bus lane, as the night buses had gone past they had each laid a thin layer of water onto the road, these layers had then frozen, aided perhaps by the nearby river. This wasn't helped by being essentially invisible against the black of the road.

Unforeseeable and unfortunate, it was no-one's fault and it'll teach me to think ill thoughts at the crack of sparrow's fart in the morning.


Please Don’t

As I am a complete nerd, I have email alerts set up for various topics spoken about in government. Often I don't have the chance to read them but, being stuck alone on station last night, I had the time and the good luck to read on such discussion.

This was a discussion about encouraging people to 'self care' their minor ailments. There was no mention of ambulances, the discussion centred mostly on the role that Pharmacists, GPs and Practice Nurses have to play. After all the government has no idea what us ambulance people do – I'm sure they think we only go to car crashes, heart attacks and the sort of thing you see on 'Casualty'*.


Never mind, although I do have one comment to make on the discussion.

'It is worth listing the minor ailments that I mean. They are generally part of everyday life and include backaches, coughs and colds, headaches, toothache, indigestion, skin problems, allergies and some respiratory problems.'

Hold on! I've been to every single one of those minor complaints, normally as a 'Cat A', high speed response. Around 80% of calls to us via 999 are for these very things.

The discussion continues,

'In many cases people manage these minor ailments already through self-care using an over-the-counter, or OTC, product, but research conducted by the Proprietary Association of Great Britain indicates there is often a significant level of dependency on the doctor.'

By doctor they also mean 'Call 999 because they don't want to wait for a GP appointment, then moan when they reach A&E and have to wait for longer than five minutes'.

'But it's serious' they look up at me and whine when the nurse, quite rightly, puts the poor helpless little flower out in the waiting room while trying to deal with the people in majors who are genuinely sick.


Needless to say, reading this gave me a good laugh…

You can read the whole thing here.


*'Trauma' is being shown on British TV at the moment and the first episode was last night – I'm yet to watch it, but from the reaction of my American colleagues it should be entertainingly awful…

The Future

I know I moan a lot. It's one of the 'Yellow Card' symptoms of working in the NHS – not enough resources, too much in the way of demand, daft governmental interference, management who apparently have no idea what they are doing…

But, like many of us, I don't look at the good things – the things that floated on down from the future and snuck up on us.

I'm not talking about robots, space travel or meals in a pill – I'm talking about the future that has, like the water that is slowly boiling the frog, crept up on us so that we don't think it's the future any more.

I'm sitting at my desk playing World of Warcraft – I can play with potentially 10 million people. The music on my home server is reminding me of the 80's where such a thing would be impossible to imagine.

I blue light a patient to the angioplasty lab – when I started nursing the treatment for heart attacks was minimal – now we can pretty much cure them as they happen.

The reasons behind heart attacks – let's take some pills to mitigate some of the bigger causes.

The internet.


Seriously, I can talk to people from across the globe, i can collaborate with them, I can play games with them. Surely it's a measurement of triviality that I can play games with someone on another continent in real time.

Cars are safer, I can buy a TV rather than rent it – and it doesn't need repairing every year.

I can fit a library in my pocket. Seriously – an entire library.

With 3G networks I can talk to people while I'm on the move – who here remembers the first mobile phones? They were a status symbol, now they are something that ten year olds have,

If I can think of a bit of music I can stream it, or download it. How about a movie?

I don't have to wait for the 6pm news to come on after Newsround – I have news 24 hours a day.

Sure, it's not perfect, people are still dying in silly wars predicated on religion or greed – but less people have died in wars this year than any previous year – and that number is falling every year.

We haven't died in a cold war exchange.

People die, people are discriminated against, people are killed in pointless wars, people die because they don't have clean water, or midwives, or accessible, affordable medicine.

But taking all that into account, it's not a bad future – it's certainly better than the one I expected when I was twelve years old.

My New Favourite T-Shirt


From the excellent Warren Ellis and his T-Shirt of the week. I'm getting this on both T-Shirt and Hoodie.
It is only available for a week, so if you want one, I'd hurry up and order.
For those that are interested in Print On Demand (and I am) – Ariana Osbourne writes a wonderful little post about the design work on the POD 'Shivering Sands' that she and Ellis worked on together.

Gentle Mocking

Long term readers may have noticed that when I write about the London Fire Brigade I often indulge in some slight mocking. It's an attitude that is taught to you in training school and one that is continued by the 'old hands' of the service.

When you start in the ambulance service you find yourself asking why this is so, surely it can't just be because they often get to sleep all night while we get moaned at if we find ourselves blinking for longer than necessary?

After all, when dealing with an RTA, they are instrumental in turning a car into a convertible so we can safely get a patient out. Likewise, when something is on fire they are pretty good at throwing water at it.

The less charitable amongst us might also say that they are also experts at blocking off roads with a multitude of unnecessary appliances and flooding the streets with fire-fighters who then stand around and do nothing.

Maybe it follows that there is this derision because they work less than us, get paid more than us and for some reason end up on calendars and are drooled over by otherwise sensible young ladies.

So, jealousy really.

My crewmate and I were sent to a 'fire call' in a residential street – we arrived to find that the fire had already been put out, three fire trucks and about 12 fire-fighters had successfully dealt with an electrical fire that had caught a mattress alight. Our patient had been laying on the mattress at the time.

Surprisingly, for someone with very much reduced mobility, he'd managed to get himself out of the burning bed and into another room. Relatives had then called for the fire-fighters but by the time they arrived the fire had gone out itself causing minimal damage.

Our patient was more 'shook up' than seriously ill. He was a large fellow with a number of long-standing medical problems, including lung disease and the aforementioned mobility problems. As it was a foam mattress that had burned we decided to take the patient to hospital.

Meanwhile the dozen fire-fighters milled around chatting to the extended family of the patient, or stood on the pavement taking in the sun.

Then I heard the head fire-fighter (the one wearing a white helmet) suggest to the family that they could all stand for a cup of tea. As she left to start brewing he confided in me that it 'keeps them busy, and takes their mind off the fire', which is fair enough.

We soon got to carrying our large patient to the stairs where his installed stair-lift could do some of the hard work of getting him down from the upper floor of the house. It was a real struggle – the patient was large as well as heavy, and despite having leapt from his bed before he torched himself, now seemed largely unable to move.

So we puffed and we sweated and we strained – getting him downstairs and back onto our carry chair.

Then we had to move out of the way so that one of the women of the house could carry a tray full of tea out to the heroic fire-fighters that were chatting in their garden.

We left the house with every fire-fighter having their own cup of tea – can you guess what poor bastards didn't get a cup of tea? Yes, that's right, those of us actually doing some work.

Not that we would have accepted, we were looking after a patient after all, but it would have been nice to have been offered.

As I say, pure jealousy.


It seems that whenever I'm not working I miss all the excitement. Actually, having been involved in a few riots in the past, I'm rather glad that I wasn't working – for one thing I don't think that my stab vest still fits me.

Who Am I?


Sometimes I help with delivering babies – but I'm not a midwife.

Sometimes I deal with drunks – but I'm not a barman.

Sometimes I deal with assaults – but I'm not a policeman.

Sometimes I deal with mental health problems – but I'm not a psychiatrist.

Sometimes I deal with other people's grief – but I'm not a counsellor.

Sometimes I leave sick people at home – but I'm not a GP.

Sometimes I fix stair-lifts – but I'm not a mechanic.

Sometimes I just sit and listen to other people's problems – but I'm not an agony aunt.

Sometimes I just move a person from one place to another – but I'm not a taxi driver.

Sometimes I drive an ambulance – but I'm not an ambulance driver.


It's that last one, 'ambulance driver' that I'm mostly called, that or 'Paramedic'. Yet 'ambulance driver' is the one that most annoys my boss.

“They call you an ambulance driver”, he tells me, “I thought we'd moved away from that?”

He's right of course, an 'ambulance driver' seems to just drive the ambulance, or at least that's what some people think. It's something that the ambulance service has been trying to stamp out for quite some time as we obviously do much more than that, something that I like to think that I show on this blog. The thought that one of the crew does nothing but drive the vehicle while all the medical work is done by the other is wrong, yet one I'm often met with.

So, what is my job title? It's 'EMT', or 'Emergency Medical Technician', which makes me sound like I fix ambulances or mend the medical machines that go 'beep'. When I deal with the media I call myself an EMT and they ask what that means, 'Is it the same as paramedic?' they ask, to which I reply that it is – except that Paramedics have a few more drugs and sharp things that they can play with, but that we ultimately do the same job.

I'm an EMT-3, or maybe an EMT-4 (I'm not sure, the difference is negligible), but there are EMT-2 ('probationers' who can't work alone or with another EMT-2) and EMT-1 (who have a lot less training and only go to the most minor of calls – which almost never turn out to be anything serious).

Then there are ECAs – Emergency Care Assistants, that have such a poorly defined role I don't think that even they know what they are supposed to do.

My role – EMT, Emergency Medical Technician, is such a poor term I find myself having to explain it all the time. It's like calling nurses 'Pill Dispensing Technicians', the police 'Handcuffing and Paperwork Technicians' or someone who works on a film set making sure that the audio is right a 'Sound Technician'.

This is why people end up still calling me an 'Ambulance Driver', because more people have an idea what that means than EMT.

Let's face it, if this blog were described as an 'EMT blog' how many people would know how to search for it?

And this is why, when I turn up at a patient's house and the worried relatives turn around and look at me they say, “It's all right now, everything will be fine, the ambulance driver is here”.


For the last two days I have been avoiding blogging, email, twitter, going out, or entertaining friends; in fact anything that could even slightly be construed as 'work' (while though I enjoy all those things, it can wear you down a bit). My calendar has, for some time, had the past three days marked out as 'Get my feet back under me' because it is the first time in months I've had a few days to myself where I can get over the busiest part of my rota, conferences, PR, visiting friends and catching up on stuff like laundry and re-centre myself.

Three days where I did little other than watch TV, play 'Oblivion' (where I am now a master assassin), eat take-aways, and read a little. It's been absolutely lovely – but now it's back to work, including setting up my new project, which promises to have me even more preachy than normal. And of course, spending twelve hours at work staffing an ambulance.

(This is to say that, if I owe you an email or twitter, you'll be getting it in a day or two)

Something I’m Co-Chairing

I have the good fortune of being the co-chair of this.

They are currently looking for more good ideas to be discused on the day, so feel free to send your ideas to
NHS - Department of Health

Wednesday April 22, 2009

Wouldn't it be great if…. all problems had solutions?

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  • Is there a better way to cannulate a frightened child?
  • Could defibs work better in the dark?
  • How can we improve patient handling for bariatric patients?
  • How can we improve upon needle safety in a moving vehicle?
  • How can we safely restrain violent patients?
  • Can we have an HCAI-resistant multi-feed cannula?
  • Can we have a “sobering” injection?
  • Can we improve blood testing on the move?

Do you have any ideas for technology solutions that would make your day easier?

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Have your say in the NHS international seminar in London on 18 June

The NHS National Innovation Centre (N.I.C.) is working with Ambulance Today magazine to find out about your day-to-day issues, and help find new technology solutions that will shape the ambulance service of the future.

The N.IC. is holding a free seminar workshop in London on 18th June as part of the NHS International Expo. If you can define challenges in ambulance patient-care that are perhaps being overlooked, then you could be part of this exciting event!

Our “Wouldn't It Be Great If….” event adopts an open floor approach. It will be attended by a selection of paramedics, clinical leaders, invited spectators, industry leaders and academics, who will be there to discuss your problems and help innovate technology solutions. There are only 80 free places available so email now for a chance to book your place at this world-leading event!

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Act now to help the NHS help you!

We'd like to hear about any problems you may encounter in performing day-to-day ambulance service duties – whether these are related to equipment, clothing, vehicle design, patient handling, communication, drug administration or anything else.

Remember – it doesn't matter how wacky or obvious your ideas for a solution may seem. We just may be able to develop brand new technology that will improve patient care and/or make your life easier!

Please email by Tuesday 28th April with as many ideas as possible. We will then contact you within 14 days of the closing date if your suggestion has been taken through to the next stage! Please feel free to forward this email to any ambulance service colleagues who may also have a great idea!

Thank you very much for your help.

NHS N.I.C. team.

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It is traditional, when removing a beard, to take off portions at a time and admire the result. I have removed my beard.


It is a legal requirement that during this process you need to do your best impression of Ron Mael. Sadly my bathroom now looks like I've been holding badger baiting contests in it. And can I just say that, unlike Mr Matthew 'rough and tough' Fox, no shaving or skin care products were used apart from a razor, some water and a pair of scissors.