It's Happening

"42 year old male, fallen down stairs, ? # leg, obvious deformity"

Clearly a bad day at the office! We headed round to the address. The door was open and Dave was lying sitting at the bottom of the stairs. There was absolutely no doubt his ankle was broken. Badly broken in fact. Seeing bone protruding from the skin is never a good sign. We dosed him up on Entonox and gave him Morphine. On the count of 2 of 3 I pulled the ankle to straighten it. He screamed, I cringed, it wasn't pleasant but totally necessary. We got his leg splinted and transferred him to ambulance. It is at this point where the NHS bill will change things. 

Pre-NHS Bill

• Up to this point it would have cost Dave nothing.
• He will be transported to the nearest hospital.
• He will be put in a cast.
• He will have an x-ray.
• He will have surgery. 
• He will need medication.
• He will need crutches.
• He will need physiotherapy. 
• He will be off work for 2 months.
• He will be charged £7.40 for each prescription he needs.
• He will be grateful for the treatment he receives.

This is how it works. This is how it has worked for decades. This is fair. Everyone gets the same. This isn't going to continue. 

Post NHS Bill 

• Up to this point it would have cost Dave a nominal fee for calling the private ambulance.
• He will be transported to the nearest hospital should he wish to be.
• He will be put in a cast at a cost.
• He will have an x-ray at a cost.
• He will have surgery at substantial cost. 
• He will need medication at a cost.
• He will need crutches at a cost.
• He will need physiotherapy at a cost. 
• He will be off work for 2 months at a cost.
• He will be charged uncontrolled charges for each prescription he needs.
• He will resent the treatment he receives.

He will be left with a bill that could be in excess of £30,000. Why? Because Dave is self employed and cannot afford the expensive monthly premiums for Health Insurance. Dave is a victim of NHS privatisation. Dave will walk with a limp for the rest of his life because he couldn't afford the surgery or the physiotherapy. Dave suffered in pain because he could only afford Paracetomol. Dave picked the things off the price list he could afford. Next time Dave won't call an ambulance. 

Dave won't be alone. How many people can realistically afford over £100 a month or more for medical insurance? The private health insurance company are already starting their campaigns and as predicted, are not targeting the people who need treatment for severe chronic conditions. These people will sadly be priced out of the market as it isn't 'cost effective' to insure them. Instead they are targeting the 'fit & well' who don't need and are unlikely to need any treatment. They will be profiting from fear alone and the vulnerable with be left by the way side.


Let us not be fooled into thinking we will no longer pay national insurance. Of course we will. We just won't get anything for it. How many people like Dave with have to sacrifice their well being because they are not well off? How many of the elderly will refuse to call an ambulance through fear that health care will cost them their home? This is the reality of what the NHS Bill will mean in the long term. It starts with a bit a outsourcing and before you know it, we are the USA, where every politician receives financial benefits from the "Health Care' companies that are crippling its population. These proposals are a complete joke and regardless of the spin that is put on the NHS Bill, this is where it is heading. We will no longer be the world's biggest 'free at point of contact' ambulance service. We'll just be another money grabbing, profiteering ambulance service owned by a faceless millionaire. We will no longer have an NHS where everyone can get treated free of charge regardless of social status. We'll be all be treated in relation to our wage packet. The only people who stand to benefit from this are the Eton Old Boys who run this country for their own personal gain. It's happening.

Not Alert

"2 year old male, high temperature"

This was my first shift back after a prolonged absence so as boring as the job sounded I was glad it was nothing to strenuous. It was an Amber 1 call which meant it was deemed to be serious but no immediately life threatening. We had a fair way to go which meant I had plenty of time to finish my Costa and Jelly Babies. That is my staple diet by the way. A shift without them is unheard of to be honest! We were about two miles away got a cancellation. 'Cancelled, higher priority call'. We accepted cancellation and waited for the new job to come through. 

"2 year old male, high temperature"

Same job, same distance, different address but this time it was a Red 2 call. One which is deemed to be immediately life threatening and would warrant a response from an FRU too. The reason given for the severity of the call was the much maligned term 'not alert'. Not alert is the most misused phrase by control. The simplest of jobs are upgraded because 'the patient is now not alert' and it is such a leading question to ask a caller. As far as I'm concerned you are either conscious or not. Being 'not alert' is the grey area of consciousness that the lay person is not equipped to decide. We will decide when we arrive and be the judge if they are indeed alert and orientated. Saying a 2 year old is not alert to me is like saying a cat has epigastric abdo pain. You just don't know! My thought on the right and wrongs of 'not alert' aside we headed round to the address. The car was pulling up as we arrived so the three of us all bundled into the house.

We were greeted by the entire family all dressed and ready to go. Parents, siblings, grandparents and the opare all standing and staring at us expectantly. Our patient was already strapped into a travel seat and was indeed 'Not Alert'. That's because he was asleep......

"OK, whats the problem today?"

"He's really hot and cold and grouchy. He also seems really tired"

"What makes you think he's hot and cold? Have you taken his temperature?"

"No but I think he's got a cold and you get hot and cold when you have a fever don't you?"

Whilst talking to her, I took the kids temperature. Normal. Pulse. Normal. Respiration rate. Normal. Skin. Normal. Chest. Clear. Seemed well to me!

"You can do but he seems OK. We'll pop him up to the hospital if you want but he's asleep and doesn't appear unwell"

"That's the problem, he is constantly tired, I'm having to wake him up every half an hour or so to make sure he's OK, I'm just so worried that he's been so tired and grouchy recently, I think it's best a doctor looks at him. Could it be chronic fatigue syndrome?"

"No. It isn't that. I promise you! You wake him up every half an hour?!"

"Yes, to make sure he's OK"

Clearly the sarcasm in my tone was lost on her. We took him to hospital despite my advise, with a people carrier of family following behind. I had to put up with unnecessary questions and over reactions the entire way whilst everything I said /suggested was being ignored. I didn't even see the point in lecturing her about what an emergency ambulance is for or how to care for her third child. What do I know?! Some people are simply beyond help. If someone woke me up every half an hour being tired and grouchy would be the least of their worries! What a tool!

It's what we wanted, right?

"1000s of Emergency Service workers seriously hacked off"

I've read a lot recently regarding what this current government is up to and I have none my fair share of bitching about it. I have no real political allegiance, nor do I think that any of the three many parties are any better equipped than each other to change things for the better. There is too much in-fighting and political gain to be made from empty promises. I have watched with frustration whilst the Tories have made universities unaffordable for all but the elite, increased the cost of living considerably, fuel prices rocket, the housing market stagnate and the economy crumble. Our armed forces were slashed on all fronts and public services faced cuts to budgets and front line staff. All can be rationalised under the heading of necessity. Financially the country was / is in a mess. Cuts have to be made to reduce the national deficit and sure, every one felt the pinch. Then, there was the NHS bill. Now there is police privatisation. These goes way beyond reducing costs. This is about profit. This is a direct assault on what our country has held in high regard for so many years. 

I have often had inter-service banter between us and police about which is the number 1 emergency service. We have our reasons why we are and they have theirs. I was going to write a 'police vs ambulance' blog where obviously, we would come out on top! In light of recent events however it seems pretty pointless. They are two great services which do this country proud. Two services which only serve to help and protect our people. They are not and should not be about profit and the cuts that are being made to both with have huge implications. You find me a voter who wanted more crime, less police on the beat, less ambulances and costly health care. I think you'll struggle.

The LAS is the largest "free at the point of contact" emergency ambulance service in the world. We respond to over 1.5 million calls a year within the M25 and employ over 5,000 staff. We are a non profit organisation as are the other 12 NHS ambulance trusts. The government cuts have caused the loss of almost 1000 staff in London alone, most of which are front line. Private, profit making ambulance services are becoming more common place and when the reforms are pushed through, in spite of huge opposition, that will signal the end for the ambulance services that so many millions of people rely on every day. We pride ourselves on the fact that everyone gets the best treatment we can give without social standing being a factor. Sadly, rather than pulling our drug guidelines from our pockets we'll be pulling out price lists. When profit becomes the driving force behind medical care people are simply priced out of the market and have to choose between treatment or rent. But hey, that's what we wanted, right?

The story is no different with our police force. Across the 43 police authorities it is predicted there will be a loss of almost 35,000 staff, most of which will be off the front line. The government is only to fast to criticise when forces can't cope with the public unrest so obviously reducing the amount of officers is the answer. Lets not forget our police face criminals with guns and knifes with nothing more than pepper spray and a stick. They have limited resources when it comes to crowd control with little or no use of baton rounds and water canons. Despite the lack of weapons and the few officers available, we still lock up more criminals than any other European country. What more do people want from the police? The governments answer appears to be privatisation. Out-sourcing police work to untrained, muscle heavy companies like G4S who are there for money and money alone. They will be less accountable and less trust worthy. But hey, that's what we wanted, right?

I'm not saying the emergency services are beyond budget cuts. No one is. Even the Fire Brigade will have their sports equipment budget reduced but recent government actions go way beyond budget cuts. It is quite simply, systematically deconstructing the NHS and police force for personal and financial gain. Let's be honest, if we stay as we are no pockets will be lined. I don't know what stand can be made. An e-petition with over 150,000 signatures has been ignored and the coalition the the people voted into power are simply ignoring the the people who put them there. The NHS bill and the privatisation of the Police will signify and end of an era. But that's what we wanted, right? 

NO IT'S NOT! No one wanted or wants this. No one wants costly health care, no one wants a fragmented police force. No one wants less ambulances. No one wants less police offers and No one wants this inept, out of touch government failing to deliver ALL of their promises to continue this ill conceived policy agenda. I say no one because the people it doesn't effect are rich enough not to care and only stand to profit form this countries demise.

Interestingly, if you were to combine the budget cuts of the all UK ambulance services, polices forces and fire brigades in 2011 it wouldn't come close to the amount that the publicly owned Royal Bank of Scotland paid out in bonuses in the same year. Funny that. 

It's all in a look

"42 year old male, won't wake up, caller is a child"

When jobs like this present themselves you get a real sense of apprehension. They carry more weight than your typical 'unresponsive' or 'collapsed' call mainly because of being called by a child. Children don't exaggerate, they don't know what to say to get a quicker response and they simply say what they see. If this kid can't wake their dad up, then there is a pretty good chance it's going to be serious. We headed off through the busy streets, sirens blaring, the excitement of a 'good job' well balanced with the intrepidation of what we might be going to. As I wrote 'child' down in the caller box on my paperwork a shiver ran the length of my spine. We pulled into the road to see the FRU pulling in at the other end. We met in the middle nose to nose and all jumped out grabbing various bits of kit. I was the first to the door, it was ajar so I went straight in. I shouted as I entered and a face I will never forget appeared at the top of the stairs. A boy, about 13 years of age, dressed in his school uniform had a terrified look with streams of tears pouring down his face.

"Please help my daddy"

I rushed up the stairs and into the dark bedroom. The man was lying prone on the bed, no movement at all. I touched his neck to feel for a pulse. Nothing. His skin was cool. I took his temperature and it was 33.1. He'd been dead for a few hours. For those few hours, his son had been in the house with him but every day when he comes home from school his dad is asleep because he worked nights. The only reason his son tried to wake him was because he was going to be late for work. Tragically there is nothing anyone could have done. It was just one of those things. A sudden, unexpected death. That will be of no consolation to his family but life is cruel. My crew mate and the FRU were printing of a rhythm strip of his heart for the paperwork and requesting the police. I agreed to go and see the kid. 

He was sitting in his room leaving a message for his mum. It was heartbreaking to listen to but I waited until he'd finished before I entered. He looked up at me, eyes glazed with tears and I looked at him. There was a hopeful, wishful expectation in his eyes but he knew what I was about to say, I had that look of resignation on my face. I told him as best as I could that there was nothing he could have done and there was nothing we could do. He sobbed in to my arms for a few minutes and then just lay there. I can't imagine what he was thinking but I took solace in the fact I was comforting him, albeit by just sitting there. I heard his mother arrive down stairs. My crew mate spoke to her and explained what had happened and what was going to happen. She came upstairs and went into her bedroom. I could hear the crying through the wall. There are not enough superlatives to describe the grief she was feeling but she put them to one side for now.  She entered the room we were in and without saying a word we swapped places. Again, the look we shared said everything that needed to be said. I mouthed 'sorry' and she mouthed 'thank you'. I left them together to come to terms with their loss. 

It is these jobs that make you numb, these jobs that stick with you. As cavalier as many of us are by saying things don't effect us they do. We all use bravado and tell a good story but these are the jobs where all you can say is 'that was shit'. And it was. We can be sad, shed a tear and even relive the job for a few weeks or months but at the end of the day, our patient's son and wife have to continue their lives without a husband and father. It puts all of our first-world problem into perspective really.

Safe to Approach

"25 year old male, stabbed in arm, bottled, bleeding heavily"

"Red base, are the police running on this, obviously we won't approach until they on scene, over"

"Roger, police have been requested, stay back until they arrive"

"Roger, will do, let us know when they are on scene, over"

"Roger, Red base out"

Now this is what I'm talking about. I nice stabbing to kick of proceedings! Not wanting to be cancelled we shot round to the RVP and hit 'at scene' at the earliest opportunity and waited. We donned our stab vests and got our pile of kit ready by the side door. You never know with a stabbing how bad it will be. Puncture wounds are an unknown because you don't know how deep the wound is or what damage has been done inside. Some stab wounds hardly bleed at all, some don't stop bleeding. It really is pot luck. We'd been sat there for about 10 minutes with no word on the fuzz so called up for an update.

"Red base, any ETA for the police? Over"

"Standby one..........Roger, police are on scene and the road is lit up like a Christmas tree, over"

"Rog"

We'd parked a few streets away so trundled round to the road. It was a dog-leg cul-de-sac, as we got near to the end we could see a very large group of people outside the house. I saw a number of vehicles following me into the road so assumed it was more police. It wasn't. In fact, there were no police on scene whatsoever. About 10 people surrounded the ambulance all shouting various different things. Then I heard:

"One of them stabbed him and the other pulled out a gun"

Gulp! We were now blocked in, we were expected by all around us to get out and help their friend yet there was quite a possibility someone was still on scene with a gun. This in a occasion I deemed worthy of the emergency button.

"Red base, red base, there are no police on scene and the attacker is still here with a knife and gun, we are blocked in the road, urgent police, I repeat urgent police"

"Are you safe? Are you in your vehicle, police on way"

"Rog, we are still in the truck but are surrounded by people wanting our help with the patient"

"Police ETA 1 minute, stand by"

Everyone was getting angry that we were not getting out and to be fair, I saw their point. Regardless of blame, they had called an ambulance because someone was stabbed. All they saw was an ambulance arrive and the crew refuse to get out. It wasn't their fault  there had been a monumental cock up in EOC! Speaking out the half opened window, I asked where the patient was. The pointed to a figure sitting on the wall about 20 feet from us. I asked them to bring him to the back door of the ambulance and we'd treat him inside. After a few insults, plenty of swearing and the over use of the word 'bruvs' he was brought over to us, we got him on board and locked ourselves in. Luckily a few seconds later the road was indeed lit up like a Christmas tree as the cavalry arrived and we were able to treat him without fear of getting shot. We ended up taking our patient to hospital who had minor injuries. They were just surface wounds which we dressed on scene and would probably need stitches. It was all a much to do about nothing really but that wasn't the point. We were sent into an extremely dangerous situation with possible knifes and guns without any back up whatsoever. How on earth can that happen?!

"Sorry guys, that message was meant for another crew!"

That snippet was sent down the MDT. Bloody cheek! I didn't appreciate the exclamation mark on the end for starters. I didn't find it funny. We'd It was far to soon to be cracking gags as far as I was concerned. I was told it was safe to approach and it wasn't. What kind of idiots turn up to gun fight with a number 3 dressing and an OP airway?! The LAS! Luckily we'll be putting this one down as a near miss!