A lack of energy from these winter hours, night shifts and a feeling that no matter how hard I shout about things nothing is going to change has meant that I've been lacking the will to write. I keep thinking 'no-one listens', or at least nobody who has any power to change anything.*

What I should be writing about is the private ambulance companies that are being contracted to do our A&E emergency work, which is an incredibly bad idea. I should be writing about the utter tosh calls I've been going on of late. I could even be moaning about how our training day was 'postponed' because there is no-one to train us, and even if there was they have no idea how to train us, or what to train us in.

I'm sure it's just the season and that, come spring and a bit more energy, I will once more be waving my fist at the sky and shouting 'all Gods are bastards', albeit with the same effect that doing that always has**.

—–

When I get angry I find myself doing two things. First I wave my arms around like an epileptic chicken. There is a simple reason why I do this, it's because I keep raising my hands to hit someone, but then realise that, while enjoyable, it probably wouldn't do much good. I also have worked far too long in emergency medicine to be doing anything stupid like punching a wall.

The second thing that I do is I vibrate. I get filled up with energy and start shaking – first on the inside and then as I get angry the shaking spreads to my limbs.

I also shout a lot. Well… not so much shout as 'talk loudly and firmly'.

I have a long fuse, but a huge explosion.

—–

Why do I mention this? Well the other night I ended my shift an incredibly angry person.

We had picked up a young woman who was alternating between rolling around the floor and pretending to be unconscious. Her problem was apparently 'abdominal pain', but it turned out to be period pain.

Who am I to judge? Besides, it was nearing the end of the shift so if she wanted to go to hospital we were more than happy to take her.

We should have walked her out, but when dealing with someone suffering from Status Dramaticus it can sometimes be easier to just pop them on the carry chair and wheel them out – especially if they are light. So we did this and as we were about to load her into the ambulance she decided that she didn't want to go to hospital – so this poor flower, who moments earlier was 'unresponsive', undid the seat belt and started walking back towards the house.

I was just about to wave her goodbye when the FRU stepped in and convinced her to go to hospital. I can see the FRU's point, if our patient were to go back home and overdose on painkillers it'd be our fault.

So the patient agreed to come to hospital and I jumped into the driver seat while my crewmate did the things that we do in the back of ambulances.

We were halfway to hospital when the patient took off her seatbelt, threw herself on the floor and pretended to be unconscious again.

—–

We got to the hospital and, expecting the patient to continue the dramatics, I went and got a wheelchair so that she wouldn't have to walk. She stepped down from the ambulance, looked at the wheelchair and, once more, threw herself on the floor. I say 'threw', what I actually mean to say is 'died like an extra in the original Star Trek or Dr. Who series'. You know, 'collapsing' without hurting yourself.

“Why did you do that?”, I asked.

“Fuck off”, she told me, then stood up and threw herself into the paediatric waiting room where she, once again, threw herself on the floor and acted like she were struggling with death itself.

There then followed a long ten minutes where myself and two nurses persuaded herself to sit her arse in the chair so we could take her around and put her on a trolley. This was accompanied by both swearing and drooling***.

—–

I washed my hands while my crewmate booked the patient in onto the hospital system, and then went to leave.

One of the nurses then turned to me and asked me my name – I know the nurse's face but haven't really spoken to her.

“Why is that?”, I asked.

“Because she told me that you called her a nigger”, the nurse said – and the way she said it made me think that she believed the patient.

—–

Oh yeah, the patient was black. Didn't really give it much thought until then. After all I can go days at work without seeing a patient that is to be recorded in the great UK ethnic coding database as 'White British', so different skin colours don't hugely register on me.

There are three points I would like to make at this moment in time.

1) I've marched against the BNP. Several times.

2) I don't hate people due to their race or colour or however you want to slice it. I hate everyone. Equally.

3) I may call you a moron, an idiot, a fuckwit, a wanker or an utter… well, you know. I would never use colour or nationality to insult someone – much as I hate hearing kids using 'gay' as an insult. You are what you are and you don't make that choice, so why would I insult you based on that? If I insult you, I'll insult you because of what you do.

What really riled me us was that the nurse seemed to believe the patient.

—–

I think I said something in reply along the lines of, “Excellent – tell her to write a complaint, maybe I'll get suspended with pay, I could do with a holiday”. But inside I seethed with anger.

I phoned the on duty Station Officer for advice. He told me that I should go to the police, that I should have a cup of tea, and that there was nothing he could do about it.

What. The. Hell.

No, “Let me come down and see you and chat about it”. No, “Let me go and talk to the patient and see if we can sort things out”. No, “Don't worry, I'll take a statement from you while it is fresh in the memory”.

Nope – cup of tea and call the police if I feel that bothered about it. Oh, and the implied suggestion that I get back on the road within the next 15 minutes.

Thanks for that.

—–

So there I was, stalking up and down the messroom before having to fill out the 'incident report' paperwork with my crewmate.

Knowing, full well, that this is the sort of thing that ends careers, after all remember, I was investigated for a complaint after I told a patient that he slaps like a bitch after he assaulted me.

Racism is, quite rightly, not tolerated in the ambulance service – but is the proof on me to prove my innocence in a 'my word against hers' complaint'? I just don't know.

—–

As I write this I don't know if a complaint has gone in. Has this malicious liar decided to put pen to paper and complain? Or pick up a phone and ring our 'patient experience' line? I just don't know.

What I do know is that I found it very hard to sleep for the next two nights – not so much because of a fear of losing my job, but because I've put a lot into this job and the people who live where I work. My health is shot to shit because of the rota I work and the patient lifting I have to do. My social life is pretty much non-existant because of those shifts.

And yet – one of the people who I serve, and yes, it is serve, called me one of the things that I hate the most – a racist.

And she did it without thinking, as an easy way to try and get me into trouble.

—–

My thanks are due to my station mates who were there that morning, firstly for giving me advice about what to do next, and secondly for making fun of me by suggesting that it was obvious that I'd soon be wearing a white hood while erecting burning crosses across East London…

—–

I almost forgot – the lovely Kal writes a very insightful piece on 'Race Relations' in medicine. Go and read it.

—–

*Brought about, in part by the testimony that Tony Blair gave at the Chilcott inquiry and how he seems to avoid arrest for war crimes. That and if I performed as poorly in my job as many of the people I come into contact with there would be a lot more dead people in London.

**i.e. none whatsoever.

*** Not attractive, and a reason to be wearing gloves.

When the last chairman of the London Ambulance Service left earlier this year he gave an exit interview in our internal newsletter, he said, “We are not an emergency service any more, we are a problem solving service”.

Which is kind of the root of our problem.

For my last four night shifts I'd spent my time going to people who really didn't need an ambulance. They fell into one (or more) of a number of categories.

The 'I want treatment now'.

This group of people really have no idea what an ambulance is for – they've had a pain in your arm for four days, haven't taken any painkillers, haven't seen a GP and now at 3am in the morning decide that now is the perfect time to pick up a phone and dial 999.

Explaining to these people that this is not what the ambulance service is for will only result in them whining “but it really huuuurts”. Which means a trip to the hospital if I want to keep my job. Explaining that if they'd made an appointment to see their GP they'd be better by now rather than sitting in A&E for four hours also falls on deaf ears.

The 'I want my problem solved'.

I was sent, under blue lights, to a woman who wanted a cup of tea.

'Patient wants cup of tea' written as large as life on my computer terminal. Which in my mind doesn't really make her a 'patient'.

Sure enough, nothing wrong with her – but her carer was running ten minutes late and she wanted her cup of tea right then and there. I found myself standing there in the kitchen watching her make it herself.

The 'I can't hold my drink'.

Drink, drink, drink, drink. Fall over, fall asleep, wake up. become abusive. The police aren't interested, to be honest neither am I, but I can't leave someone laying on the pavement in case they get mugged and it'll all be my fault, not the fault of the person who drank so much they couldn't walk.

Lather, rinse, repeat for the majority of the night.

The 'Worried well'.

Your baby cried? Your child vomited once after taking it's milk? You choked on a glass of water? People who have nothing wrong with them – well, just dial 999 for an ambulance and you too can have someone sit there and say, “There, there, it'll all be alright”.

Then we'll take you to hospital because you want to go to 'get checked out'.

The 'Mad'

Not the people with a genuine mental illness – after all they are genuine patients. No, I'm talking about the people who have an argument and then have a hissy fit – roll around the floor, pretend to be unconscious, pretend to fit.

In toddlers, having a temper tantrum is to be expected. In adults it apparently needs a 999 emergency ambulance.

The 'Bad'

So, you've been run over by a stolen car – driven by your underage cousin who has since driven off and has torched the car. You then sit in the back of the ambulance with your minor leg injury whinging that 'the hospital will make me wait for ages'. Then when the triage nurse sits you out in the waiting room you throw a strop and say you are going to walk home.

Then when I show you the way out, you get angry at me for helping you out.

Yeah – screw you too buster.

The 'Sad'

Those who have, through bad life choices, ended up unable to look after themselves – the alcoholics, the lonely, the drug addicts. Of all the groups these are those that I have most sympathy for and have less problem being sent to, they phone us up for a chat, they call us for the long running illnesses that they have. The only number they know is 999 during those lonely hours of the morning. We turn up, we take them to hospital, they sit in the waiting room to talk to a psychiatrist – then they leave and do it all again tomorrow.

The 'Complete and utter misunderstanding of what an ambulance does'.

No, we will not deliver condoms to you. Even if you do want to 'shag that bitch but don't want to catch a disease'.

'Innit'.

We do not prescribe painkillers. Nor are we (despite the best attempts of our managers) an out of hours, to your doorstep, immediate GP service. Call us if you want to go to hospital, not if you want to stay at home with tablets for your self diagnosed 'swine flu'.

We do not fix stairlifts, beds, sinks or windows.

If you go into hospital via an ambulance you will not get seen quicker.

Let me repeat that.

If you go into hospital via an ambulance you will not get seen quicker.

I can't help you pay off your debts either, nor settle an argument about something that was just on TV.

Each of these people have picked up the phone, dialled 999 and when asked what emergency service they require have asked for an ambulance. What they should do is ask for the fire service – they have more plumbers working for them and they are a lot less busy than us.

—–

I don't hate these people, well, maybe 'The Bad', but at the end of the day the reason why we can't get to that heart attack in time, the reason why your gran lays on the floor for hours with a broken hip is because we are spending more and more of our time chasing after people who think that '999' is the only number that can solve their problems.

As our ex-chairman says, we are no longer an 'emergency' service, much like the police who are called to deal with couples arguing over control of the TV remote, we are being used more and more as someone to whom responsibility is handed.

'Look after me', they say – forgetting that they are adults who should have some idea of how to keep their body and mind working in some sort of reasonable fashion without needing an emergency response.

Education, of course is the answer, my solution would be to remove 'Hole in the wall' from the TV schedules and replace it with an hour of 'How to look after yourself'. Then make every TV channel have to show it at the same time so that there is no getting away from it.

Meanwhile I'm off to scrape the word 'Emergency' from all our ambulances.

—–

For those that worry that I'm on the verge of burning out – I'm not. When I was nursing I got burnt out, and I can recognise the signs.

If you have ever done a health and safety course of fires, you'll probably know about the 'triangle of fire', where the three sides of the triangle are made up by 'heat', 'fuel' and 'oxygen'.

At the moment I have the 'triangle of whinging', it's three sides made up by 'Seasonal Affective Depression', 'Too many nightshifts with a stinking cold', and 'going far too long without meeting anyone who actually needs an emergency ambulance'.

While I normally feel crappy around this time of year there has been an unusually long stretch of time since I last went to a 'worthwhile' job. One where the pulse quickens a little and you actually have to think. Think, as opposed to ask them to walk onto the ambulance and then fill in some paperwork before leading them off the ambulance at the other end.

(As an example – we were sent to a 'stabbing'. He'd been punched and had a scrape to his buttock…)

He's ninety years old, ex-army.

He's slipped on the ice coming out of his house, we are sent to the call as 'Fallen over, leg is at a funny angle'.

We get there, he's broken his leg all right. He's lovely, the family are lovely.

He has waited one and a half hours for an ambulance.

I am furious. He has been laying on the ice for that long without an ambulance. I've just come from the hospital – the police have been bringing in patients with possibly broken ankles because there are not enough ambulances.

—–

Apparently it doesn't matter, as the 'public perception' of the service is high.

That doesn't mean we provide a good service – it just means that our PR department is good at making us look good.

—–

It's not a hard problem to solve, I can see what it is and I'm on the bottom rung of the ladder.

We do not have enough ambulances to meet demand

It's that simple.

We don't need 'initiatives' where a driver and an ECP go around to a house to see if the call really needs an ambulance.

We don't need 'smarter ways of working' – because it won't work, the reasons are many and varied – but it won't work.

What we need are more ambulances and more road staff.

You don't have to be a genius to work that out.

—–

Year on year the increase of our calls is around 12%.

Our Boss, Peter Bradley seems proud that we will soon be dealing with one million calls in a calendar year.

He's crazy.

The number of calls increase but the number of ambulances, the number of hospital beds don't.

“But there are 400 students being trained at the moment”, our PR department will say, “It will all be fine”.

Ask how many leave the course, ask how many finish the course and then leave because they are already disillusioned with the job, ask how many regular road staff are leaving the service, retiring, getting the sack, or changing careers?

Is it really a 'huge influx' of staff once you take all that into account?

—–

Even if we have the staff we don't have the vehicles.

The other day my colleagues at my station were waiting five hours for an ambulance. This is not unusual.

We've ordered more, but it takes too long – we spent too long without getting new ambulances.

There aren't enough ambulances on the road.

—–

The population of London is increasing, a large amount of this increase comes from immigration, or the expanding of immigrant populations.

Immigrant populations tend to be both poor and under-educated.

Can you tell what the two big causes of poor health are?

Poverty and a lack of education.

We aren't doing too well at getting these populations out of poverty, so it's no wonder that the number of people wanting an ambulance is increasing.

—–

We aren't going to get people not calling ambulances.

People want ambulances to take them to hospital for free, and no matter how much we tell people otherwise they will continue to call us when they should be using other modes of transport, or not going to hospital at all.

(Today a nurse made an announcement at one of our A&Es that the waiting time was four hours; more than a few people moaned that it was too long and went home – how much of an 'emergency' was their reason for being there in the first place?)

—–

It's simple – More Calls Need More Ambulances.

It's not rocket science.

—–

“Unusual weather conditions” the PR department will say, “Lessons will be learned” they will say when someone dies waiting for an ambulance.

Here is a lesson that seems to have escaped those way above my pay scale – In winter, demand for ambulances goes up. We should then provide more ambulances.

Not blokes on pushbikes, not community responders, not FRUs to stop the clock in order to keep the government happy.

More ambulances to take people to hospital.

—–

If I screw up, I could lose my job.

If I say the wrong thing I could lose my job.

If I'm sick too much I could lose my job.

Apparently if I can't produce enough ambulances, if I can't ensure that they are equipped properly, if I can't promise to get an ambulance to an elderly person with a broken leg in the ice within a reasonable time – well, my job is safe.

I'll probably even get a promotion.

—–

What is important? It's not the 'public perception' that management and the government go on about, it's not about meeting a pointless target.

It's about not leaving a ninety year old man freezing on ice for an hour and a half.

Simple.