Please Sir, can I have some more?

Dear David

I'd like to start by wishing you and your family well in these tough economic times. You and Samantha's combined salaries of £400,000 plus shares and bonuses must be really getting spread thin. I empathise, I really do. Like you, I seem to work all the hours god sends yet that £25,000 seems to just disappears! Still waiting for my mileage expenses to come through though, so that will be an extra £42 in the piggy bank! I love expenses! Anyway, the point of this letter is one of a more serious nature. 

I have waited a long time to write this too you. Let me draw your mind back to your first assault on the Police service. In case you'd forgotten you cut 16,000 officers. Less is more! Quality over quantity! Needs must! Look at the bigger picture! We will all feel the pinch! No one is immune from cuts! All very very true. We must indeed all pay the price for the bankers and politicians sticking our country in the economical dark ages. But, there are consequences to your ill advised cuts. Let me share a story. A story that brings back painful memories. A story that still bears real scars. 

As a paramedic, one who has been through years of training and sacrificed friends and family for such a fulfilling salary, I understand that part of my job, in fact, part of my salary is danger money. Well, not officially, but being abused is part of the job, right? As the Right Honourable Ann Widecombe, recently said, "Public servants worry more about their own safety than that of the public, Britain has sunk to a new low". I'm guessing by your lack of condemnation of these comments you must agree wholeheartedly. So, as an 'ambulance driver' (yes, we are that low in the food chain), a bit of danger comes with the territory. One afternoon, I was called to a residential address to a man who had 'passed out'. 

When I arrived that man was lying on the grass. I approached him, on my own, and he appeared drunk. I went about my business, checking him over, when the ambulance crew arrived. We began to get the bed off the ambulance all the while making sure the member of the public was OK. We are public servants after all and serve we shall. Without warning the patient stood up and swayed a little, then staggered into a fence. Poor guy eh?!

He then beat me with a fence post. He also beat the other members of the ambulance service. Three of us in all. Do you know what it feels like to be helpless against a man beating you with a lump of wood? Despite all of our broken bones we managed to press our emergency button. Let me share a conversation with you.

Me: "Red base red base, urgent police, we are being attac......." I stop because the lump of wood has been broken over the back of my head and then broke my hand.

Crew 1: "Red base, my crew mate has been hit over the head, urgent police" he says with 3 broken ribs.

Red Base: "Getting the police for you now, are you all OK, can you get to safety."

Crew 2: "I'm now locked in the car, I think my wrist is broken, he's still attacking us."

Crew 1: "We are away from him but he's coming after us. Are the police on way?"

Red Base: "The police have no units to send, try and maintain a safe distance."

Crew 2: "He's trying to get in the car, he's hitting it with the wood"

Crew 1: "I think he's stopped, he's lying in the road but we can't drive off."

Crazy stuff isn't Dave! No units to send?! But aren't the police supposed to be there to protect us? Surely in a real emergency they have someone to send. Surely you didn't cut too many? It's OK, 9 minutes later two undercover officers arrived. Part of their job is getting abused too. I should probably mention now that in their efforts to protect us from the patient they too both got broken bones. They were struggling to restrain him on their own so much, that we all helped. We all restrained him for 10 more minutes until more help arrived. Guess what we did then Dave? We all took the patient to hospital for treatment. With our broken bones and bleeding wounds, we checked his blood pressure, he even got to travel on the bed. He is of course a member of the public and we are all their servants.

Now, do you still think less police is the right answer? What if you or your beloved family were trapped somewhere in real fear for your life? What if you called for help? What thoughts would go through your mind when you heard those terrifying words "No units to send." The officer who came to my aid told me that it used to be a team of 25 to police the borough on this shift. Today it was a team of 7. No doubt they got complaints from the public for not coming to their aid quick enough whilst 2 of the 7 were sat in A & E with me and my colleagues. Tut tut. We really must all work harder.

The good news from all of this, was our patient was treated professionally by us and the hospital. He was arrested and charged. He was sent to prison. However, because of your cuts to the prison service he has already been released and I could bump into him anytime of any day.  Oh wait....in fact, only last week, I was sent on a job to his house. Can you imagine the fear Dave, can you? Luckily he wasn't there. 

I am proud to say that in this country we have by far the best police service in the world. The things they do and the dangers they face without a gun on their belt. The professionalism they show at all times is nothing short of amazing. That is in the face of your assault on their salary, their pensions and their working conditions. Now you are making a career in the police as unappealing as possible by slashing the starting salary and rushing through the 'Eton Old Boys' to top ranking jobs without ever having to be spat at, kicked, punched, stabbed, shot, sworn at, had missiles through at them and put their lives on the line. It is plain and simple Dave. There are not enough of them any more. Not enough by a long shot. So, in the words of Oliver Twist, 'Please Sir, can I have some more?'

Just a thought, you know that publicly owned bank, RBS? You know, the one we all bailed out with our taxes. Well they are paying their staff £950,000,000 in bonuses this year. As they are PUBLICLY owned, why not use the money to fund the salaries for 38,000 new police officers on £25,000 a year. I think my maths is right. There are other banks to you know. Other ones we all helped fix. How about they now help fix us? I know, I know, I'm probably not looking at the bigger picture, but in that big picture I just see the words 'No Units To Send'. Silly me.

By the way Dave, this wasn't a work of fiction for effect. This actually happened. To me. Have a read. http://www.barnettoday.co.uk/news.cfmid=3449&headline=Man%20in%20court%20for%20paramedic%20assault

Good luck with the economy Dave, there are tough times ahead.

Your Sincerely

Ella Shaw (Public Servant)

Dial 999... & wait?

"A country in apparent shock at having to wait for an ambulance"

On Monday 3rd September the BBC aired a programme called 'Dial 999...& wait?' detailing the failings of the emergency services in this country. It's shocking isn't it; having to wait for something? Just terrible. Like with most documentaries, articles and reports about the emergency services, we all come under attack. I say all, as per usual the PR department for the Fire service has been working overtime so they came away unscathed. There was no such escape for the Police and Ambulance services. The culture of targets and response times was what the programme was about and, rather than talk about the real causes, it just highlighted the failings of the services using some well-placed stories about people suffering due to waiting times. 

First in the firing line was the police; the shocking statistic that out of 1 in 5 calls made, the police take more than 15 minutes to arrive. Outrageous. We surely expect more from our police?! I wonder what the government had to say about it... oh yeah, they declined an interview. Obviously the cuts are to blame, there is no denying that; a 20% budget cut is huge, but instead of doing a programme blaming the government they blame the police for basically being greedy. The short interview with Andrew Haldenby from the "think-tank" Reform showed only the attitudes of those not directly involved in working with or in the police. The police have 'never had more money than they have now' and 'for far to long, forces have rested on their laurels'. If cuts are being made, services will be affected. The reason the police have more money now than ever before is because year-on-year the call volume goes up. Don't for one minute believe isolated statistics of a decrease in crime; it is simply that the type of crime is changing. The police still require resources to deal with the 100's of 1000's of daily calls. This call volume will not change, yet somehow, on skeleton staff, they are expected to arrive anywhere within minutes of a call.

The example they used of peoples' suffering was a shop owner who had been burgled. She was 'shocked' at the police not arriving for 20 minutes. How many shop alarms are triggered each night? How many violent assaults are there? How many domestics? How many hoaxes? How many RTCs? How many requests from the ambulance service? How many raids are being done? How many criminals are being hunted? That is just a fraction of the work our police force is doing. In the London borough where I live there are about 330,000 residents. The borough covers 87 square kilometers and is the second largest in London. While chatting to an officer a few weeks ago on a Sunday morning, he told me there were only 13 front line officers responding to calls. He also told me he remembers when there were 30+. It's no surprise that with such huge cuts low priority calls like a shop alarm are getting a delayed response. To be perfectly honest I'm 'shocked' that the police got there so quickly.

Avoiding the fire, ironically, was the Fire Service; no shock there. No talk of missed targets, only that they arrived at a fire within 6 minutes. To be fair, it is easy to arrive anywhere in 6 minutes if you are sitting and waiting for that call to come in and get to spend all day perfecting the art of getting into your vehicle quickly. Last year the London Fire Brigade had a budget of around £437 million compared to £288 million the Ambulance Service got. They received 230,000 calls compared to the 1.6 million the London Ambulance Service received. They attended only 138,385 calls compared to 1.2 million that LAS did. They did so with their 5800 operational staff (almost double that of the ambulance service) from their 112 fire stations (compared to the ambulance service's 70), and of their calls attended, only 29,215 were fires. That is about 80 a day across London. Considerably less than 1 per fire station. Is it any wonder that they are able to respond quickly?! What was highlighted by the programme though was the crippling cuts that they are now facing. A whopping 3% in their budget! Wow! How will they cope?! Maybe they will have to send less than 25 fire-fighters to rescue a seagull from a 3ft pond. Oh wait... they refused to go in; they just sat around and watched a member of the public go in. Yes, THIS happened. Click here. It's weird how all of these facts and figures were omitted from the programme, hmm?

Saving the best until last, the Ambulance Service came under attack for people having to wait. They opened with a tale of an elderly lady waiting on the floor for hours, with the addition of an interview from her daughter about how terrible this was. I agree. In an ideal world no one would have to wait for an ambulance, least of all our elderly population. Unfortunately, the medical world uses a triage system based on what the caller tells the call-taker. As horrible and uncomfortable as it is, an elderly lady with a knee injury is not a high priority and when there are only a handful of ambulances covering a large area priorities have to be made. In this instance it wasn't life or death. Who knows what other calls were in progress. Long have I banged on about the fact that time wasters and nonsense calls just need to be told 'NO'. Sadly, Panorama decided to interview Tony Hughes for the GMB union who decided to highlight the few calls that slip through the net and are wrongly triaged. SO WHAT?! Out of the millions of calls the services receive that is bound to happen every now and again. There are not enough ambulances and staff to send one to every single 999 call that comes in.  Fact.

What annoyed me most about the programme was the failure to highlight the cause of these delays and lack of ambulances. Yes, we have faced cuts like everyone else but as of yet it hasn't had a huge impact in the amount of ambulances working on the front-line. The problem is that the call volume is going up year on year. This wasn't mentioned once. Nor was the massively high proportion of calls that we go to that are a complete waste of time and resources. No mention of the alcohol related calls we go to, the hoaxes, the split nails, the stubbed toes, the headaches, the colds, the can't sleeps, the noise in ear, the finger injuries, the needing a lifts to hospitals; basically 80% of the work we do. No mention at all that the delays people are facing are caused by the public's misuse of its ambulance service. Despite all of that though, for the first time all of the services met the category A target of reaching 75% of life threatening calls within 8 minutes. Instead of leaving it there and heaping praise on the service they interview people to highlight the apparent cheating that is going on. Calls being downgraded to meet the target? Calls being upgraded to meet the target? Is there any proof that this goes on? All ambulance staff, myself included, moan about the conspiracies, the stitch ups and mis-categorising of calls, but personally I don't think this is done to meet targets. The categories of calls change as new information comes in and I think it's highly irresponsible of Panorama to throw out accusations without a scrap of evidence. Then again, who ever said investigative journalists were supposed to research...?!

In the presenter's introduction he said 'What happens when the ambulance service decides you're not sick enough to get an ambulance?' Well as far as I'm concerned the answer is pretty simple; you don't get an ambulance because you are not sick enough. If the public and the media want an ambulance immediately then give us a budget proportional to the calls we attend. Based on the London Fire Brigade's budget per calls they receive, the London Ambulance Service's budget should be around £3 billion a year. Now mirror that across the across the country and you'll see the shortfall we face. Just imagine how quickly we would arrive with that budget at our disposal! We could probably all sit around waiting for calls, practicing getting into our ambulance really quickly, sending 5 ambulances to an elderly faller and do countless public demonstrations of our equipment... ring any bells? People expect miracles and in this economic climate miracles are not going to happen. 

So, you dial 999....& wait?! Yes. That's life. Build a bridge and get over it.

A special relationship......

"22 year old male. Unconscious and bleeding heavily"

A weekend in the city wouldn't be the same without drink, drugs, violence, vomit, blood and blue lights. More often than not, all the above are on the first job of the night. Today was no different. We were on station but our shift hadn't started yet. In a garage that holds 8 ambulances and 8 cars, our truck sat alone & being a Sunday night there was no management around and no admin staff. It was just us doing our VDI when the phone rang. We had already spoken to control to give our fleet number and skill level so they knew we were there so we had to answer! It was a begging phone call pleading for us to start early as there was a Cat A call and no other resources to send. Obviously we obliged, so not really knowing if we were missing anything we shot out the garage. It was only 3 miles we had to travel but doing that at 18:00 on the day of a Spurs vs Arsenal match and heading to Tottenham causes bit of a tricky drive. That aside, we arrived about 15 minutes later to a sea of blue lights. In the road was a guy lying on his back surrounded by police. As I stepped out the vehicle I could see a considerable amount of blood on the WPC's hands. The closer I got, the more blood I could see on all of their hands. What a mess!

The guy had been stabbed numerous times in the leg and once in the stomach and he wasn't in good way. He was pale, sweating and very drowsy. The police were applying fantastic pressure to the wounds so I took a moment to come up with a plan whilst listening to a vague handover. No one was exactly sure of what happened but what they did know was that a large crowd of 'anti emergency service' youths was gathering and were shouting abuse at us and the police. I called for HEMS back up or an FRU. In fact I believe I actually said "send me anything". If ever there was a reply which summed up David Cameron's reign of terror on front line services this was this:

"Sorry, we a spread thin. HEMS are tied up and there is nothing else available at the moment. We've got A & E support running from 13 miles away but until then you'll have to make do. As soon as something comes up I'll send them. Sorry guys"

Still think cuts to emergency services is wise? Hmmm! I wanted someone who could assist in major trauma. No disrespect to A & E support but they are not even aloud to do an ECG or give Calpol. They would be as useful as a chocolate teapot. It was us and the police. I started cutting the guys clothes off. He was panicking but we were far to pre-occupied with his life threatening injuries to be able to talk to him. Cue the police. Not only are their 12 officers trying to keep the crowd back, trying to protect us from some missiles that were being thrown but were applying pressure to wounds, opening dressing, passing us kit and constantly re-assuring our patient. No instructions needed. They just did it. The main source of bleeding was his groin. It was an arterial bleed and was taking all of my energy to apply the pressure needed to slow it down. My crew mate was placing orange cannulas (wide bore cannulas for trauma) in both his arms and drawing up fluids. It was a real mess. 

I was aware of two things. Firstly, the crowd was becoming angrier by the minute and things were getting rather volatile between them and the officers who were now almost making a cordon around us. Secondly, our patient may well die where he lay if we didn't move soon. Again, without prompting the trolley bed appeared. The police knew we had no hands to do it our self. Normally we'd use a scoop or sheet to lift someone but with the number of bodies we had at our disposal it was just a case of lift and run. We got him on board and put in the blue call to the trauma centre. As we were about to leave an FRU turned up. He dumped his car and at our request, drove the ambulance. In the back was me and my crew mate and three cops. The three who had saved our patients life. We arrived at hospital and bundled into resus. The guy was transferred and hospital staff took over from us. Off we went to the blood bath that was our truck. There was blood everywhere, everyone was saturated but it was a good job done by all. 

This job itself would have stood up well as a blog in it's own right but for me it was a great example of the special relationship between the ambulance service and the second best emergency service; the police! (sorry guys, couldn't miss out on the banter). No matter what the job is, there is a respect and admiration between the two of us. We wave as we pass each other on the road (take note fire brigade) and there is always a welcoming look of relief when one of us arrives at the others scene. This was a perfect example of two public services working well together for one purpose. The police come under a lot of stick and put up with much more abuse and violence than we do and normally shrug it off as being part of the job but that isn't good enough. They are a fantastic bunch of people who do the toughest job in the most difficult of circumstances. This country is lucky to have such an outstanding force and the sooner that is recognised by the mindless minority the better. This guy WOULD have died, I have no doubt, if the police hadn't done what they did but it won't gain them any respect or thanks from the idiots who abuse them. It wasn't their job. It was ours but they did what they had to do. I wrote a letter of thanks to their police station, only knowing their shoulder number. I hope it got to them. That's the funny thing. There are so money different police and so many different ambulance crews, most of the time we are working along side officers we have never met yet the respect and professionalism never wavers. Time after time, we call them when there is even a hint of danger and they come running. I'll always be in their debt and as such will always be more than willing to give my call sign, even on the ninth time of asking. Bless 'em!

Not quite as given...

"23 year old male, stabbed in the ribs, meet police at RVP, suspect ? on scene"

This job was the grand finale of what for me was a career defining weekend. In a break from the norm I had the same crew mate for my Friday to Sunday nights. At the time I was a relief so having the same crew mate for consecutive shifts was a rarity. To have the same crew mate for three consecutive shifts was unheard of. It was late on sunday evening and we'd had a great few shifts. We'd seen and done everything; delivered 3 babies (again, unheard of), had a cardiac arrest, cut the roof off a car, had a CVA, two MIs, a hypo and a status EP to name but a few. Being relatively new I hadn't seen much and gaining so much experience with a Pped (mentor) who let me actually do stuff was great! When this job came down to us it was met with laughter. Of course we had a stabbing! Off we went. roof lit up and sirens blaring. There is something much more enjoyable about driving on lights in the dark. Maybe it feels more like the movies! As we got near the RVP we got a message to say the police we on scene so we went straight to the address. Due to the amount of police cars we had to park about 20 meters form the house so we grabbed everything we needed and wondered over. From the moment we arrived at the front gate we knew this job was going to test us.

In a scene reminiscent of an episode of CSI we followed the gravitational blood drops up the path to the front door. The door knob were smeared in blood as was the frosted glass. We stepped inside and my boot slipped in a small pool of blood. Grim! Ahead was a long hallway leading to the living at the back of the house. Along the Victoria mosaic tiled floor was a long trailed smear of blood like the death of Malone in the Untouchables! It was quite a harrowing sight to be honest. There were hand prints of blood all over the William Morris wall paper throughout the length of the hall. In the doorway was a copper who looked truly terrified. I think the same look crept across my face as I entered the room. There I was standing there, bag in hand with 9 pairs of eyes fixed on me. The information we had been given wasn't entirely accurate. It was a stabbing but wasn't a 23 year old male. It was 3 x 23 year old males, all with 3-4 stab wounds to their chest. The was blood everywhere, each patient had their own cop who was trying desperately to stop the bleeding. All the patients look like crap. A grey complexion, eyes rollong around their sockets. My heart was pounding so fast I thought it was going jump out of my chest. I froze for a few seconds and off we went. My crew mate headed to the one who looked on deaths door. I took the other two who were next to each other on the sofa. 

I'd never done a stabbing so had never seen a stab wound. These were particularly bad stab wounds. As one of them was breathing I could see his accessory muscles move inside the wound. This was above both of our pay grades. We called for two more ambulances and HEMS. We continued to assess and prepare a handover for the other crews. All the stab wounds were dressed in three sided dressing, basic OB's were taken and the police were utilised. It was frantic. There were dressings everywhere, my crew mate did a production line of cannulation while I drew up bag after bag of fluids. After what seemed like an age the other crews began arriving. Eventually there were 18 people in the room, all fighting to keep these boys alive. HEMS took charge and began arranging extraction of them all. The police started moving the mass of vehicles that were blocking the road while ultrasounds where done and we let the hospital know what we were bringing in. The decision was made for all three to go to the same trauma centre as it was a thoracic specialist. In each each ambulance was a crew,  a member of HEMS, a cop and a patient. The convoy of 3 x ambulances, a DSO, an FRU, a HEMS car and 4 police cars headed off through the streets of east London reminiscent of a Presidential motorcade. This was it. This is why I started this job. This was what we trained for. This is the perception of the life and death on the streets people imagine.


Some forward thinking by the hospital had got all the other ambulances cleared from the entrance. We drove up the ramp and all reversed into our bays watched by 5 other tucks. The blue lights were reflecting off all the buildings around us and the vehicles just kept piling in. Each with our respective patient we headed down the long corridor towards the waiting resus teams and what a sight. About 40 staff awaited us; Nurses, Doctors, Registrars, Surgeons, Consultants, Radiographers the lot. We transferred our patients across and I stepped back to listen to the HEMS handover. As I did a hand rested on my shoulder.


"You're up! It's your patient, you know what to say, just take your time, you'll be fine"


The consultant demanded quiet for the handover and all the eyes on my trauma team fixated on me as I glanced at my PRF and stepped forward. Despite not stopping for air I made to to the end and everyone jumped to work on. I retreated back to the safety of my ambulance and a well earned cigarette. We had our customary HEMS debrief where we get to ask questions and they get to tell us how well we did. It is basically an exercise to make them feel intelligent and reassure us that we did what we should have. 


Despite the obvious issues raised by the prevalence of knife crime to me that wasn't what this job was about. For the first time in my career I felt confident that I had done what I had to, well, and under extreme pressure without needing a safety net. The fact that parts of the job were becoming second nature was comforting and reassuring. To be honest, I struggled a lot at training school and until this point wasn't convinced becoming a paramedic was within my grasp. This job changed that and i'll always look back with fond memories as the time I ceased to be a newbie.

No excuse

"Emergency Service workers assaulted - Again"

As I grew up, I was led to believe that the emergency services were good people. The police caught the robbers, the firemen dragged people from burning buildings and paramedics helped people who were hurt. The thought of attacking these good people was not a notion that had ever crossed my mind. It wasn't until I was old enough to read or be interested in reading the news that I began to hear of the violence and abuse which emergency services have to deal with on a daily basis. 

Obviously, wrong as it is, the police expect it and are used to it, and therefore are trained to deal with it. Battons, CS gas and Taser guns are but a few of the things at their disposal. The firemen, who do not have such tools nor the training do however have strength in numbers. They generally respond 2-3 engines at a time and lets be honest, 18 fireman isn't an easy target for abuse. We however, travel in pairs at best, often solo in a car with only a 1/2 day course in conflict resolution.

Verbal abuse is a daily occurrence as are threats of violence, but more worryingly acts of violence are becoming common place. In the past year or so, only a handful of high profile incidents are reported on the news, most notably the crew who got shot at. This however is not an isolated incident. I personally have had a knife pulled on me, been punched and kicked, spat at, had bottles thrown at the ambulance and that's just in the last year. I've had friends chased with poles, pushed down stairs, surrounded by youths, had threats to their lives and driven at. These don't make the news, they simply become mess room moans.

We are an ambulance service, we work horrible shifts, long hours, night and day, rain and shine to help people. We shouldn't have to go to work with fear of assault or abuse. The fact that stab vests are standard issue speaks volumes of the state of this country, but what is going to be done about it? The signs in the trucks say how anyone who abuses the staff will be prosecuted blah blah blah but in reality nobody is. Nothing happens. The CPS never have enough to prosecute and the police rarely take it further than diffusing the situation. What will it take for something to be done to solve this problem? Crews to be crippled or killed? Will there be public outcry then? Every one knows the problem exists but no one is willing to make a zero tolerance stand against it and until they do, going to work with the fear of getting sworn at, spat at, punched or kicked will be the norm.