Wednesday, 9 July 2014

Four nights shifts and an egg and spoon race

I'm very tired after this latest run of four. These nights seem to be getting longer and longer as we are continually hammered from the moment we sign on duty until we make our weak attempts to get home on time.

There is virtually no respite now. Everybody and his dog wants (or thinks they need) an ambulance. I'm spending longer periods at scene with patients - some of them very unwell indeed - because there are not enough ambulances to cover the demand.

And this is going to become a not-so-rare event. I already feel like my time is running out and now a colleague has felt the impact of what is one of the most dangerous enterprises in the country; running at high speed to calls that may or may not be life-threatening (but that are very likely NOT to be) in traffic and conditions that are against you all the way. Some motorists simply don't see us, or acknowledge us any more. Do they think that because we are running around on blue lights so often that we're just going on yet another drunk call? Maybe so. Maybe they're right to be so unimpressed.

But every now and then I have to treat a seriously unwell person; someone I want to save. Occasionally I will be thrown into a dramatic and eventful call where it matters what I do and it matters that I do it right. Is the constant pressure we are under, responding under emergency conditions to those who've drunk too much alcohol or who've been nursing a cough for two weeks but now feel they have chest pain or 'DIB' eventually going to cost so many of those genuinely unwell people that the game is no longer safe to play?

I can't say what my heart feels; it would cost me my job and my career no doubt. But I am sick of risking my life for those who need to grow up or get themselves educated. Sometimes a little first aid training will do the trick but even that is flawed. There are first aiders out there who would rather call an ambulance to a sore thumb than risk being sued - or so they would believe. Back-covering is just one aspect of this disease of complete reliance on the emergency services.

I know I speak on behalf of the majority of my colleagues - especially my fellow paramedics. We are expected to help bring life into this world and to ease the pain of those leaving it, as well as everything in-between for not a lot of pay. We stand for everything that is important in pre-hospital medicine - patients tend to trust us more than they do their own GPs. We spend more time with them. We listen to them and we fix them whenever we can. But we are struck off and disabled from our careers in an instant if we make a mistake or say the wrong thing to the wrong person at the the wrong time. Yet here is an example of simplicity in brotherhood. It applies to doctors but doesn't apply to us.

I reserve judgement in this case of course because I don't disagree that the boy may not have been saved and that is not my problem with it (tragic and sad as it was), but I'm pretty certain that if that had been a paramedic, making the same errors in clinical judgement and saying that 'in hindsight' he'd have done something differently, he or she would not have a job the next day and would be off the professional register! He or she would probably have put in a 12 hour shift, without a break and would very likely have been given a late job, forcing him or her into overtime he or she did not request or want - ultimately making safe clinical judgements, never mind the ability to drive at high speed safely, a real problem!

On behalf of all my colleagues, all over the country - I applaud you. God knows, very few others will. And what is it you want? Respect, courtesy and understanding. No amount of extra money is going to make any difference to the way you feel, right? You want people to know that your morale is sinking, if not already in the gutter. No wonder people are leaving the profession almost as quickly as they are joining it!

I love my job; I don't particularly love the way it runs. I want us to be strict about how we send emergency ambulances to calls. I want us to be clever about how we deal with non-emergency patients. Most of all, I want support and empathy when I am out there battling with my brothers and sisters. I want to help sick people; genuinely sick people.

We need our own professional register, run by paramedics for paramedics. We need our practices and disciplinary procedures to mirror those of the other medical professions, without what appears to be an overbearing emphasis on striking us off for much, much less than the example I've given. It's simply unfair that such a drastic mistake in known procedure is apparently just going to 'go away' because it was a doctor involved.

At the end of my tour of nights, I went straight home and straight onto a grassy track where my son's nursery school sports day was being held. I held an egg in a spoon and ran like a tired man to the finish line with four or five other dads. I made it to the line second to last because I believed one of the dads who said 'right chaps, lets not run' and I was far too tired to run anyway!

Be safe.

Monday, 9 June 2014

Human pigeons

THIS sort of thing says an awful lot about humanity. I'm all for protecting the privacy and security of people's homes. I'm sure nobody wants to have a 'rough sleeper' bedding down on their doorstep every night, and I'm almost certain that most of the outraged people petitioning about this would rather not have a homeless person migrating towards their neighbourhood.

However. Installing measures like this to ensure that people cannot lay down is a wee bit over the top in my opinion. We install very similar protrusions to stop pigeons from landing on window ledges and overhung building entrances. Are we now treating human beings like pests?

Over the course of a decade or so,  I have become acquainted with many of London's homeless souls and, apart from the rare exception, drunk or sober - they are just people whose luck has run out. They have nowhere to go and nothing to go to. They depend on charities and pure-hearted volunteers, who often get up at rotten-o'clock in the morning to go and feed them breakfast. That way, they have at least one good meal inside them as they wander the city.

In order to sleep and to stay safe, many of them will bed down in doorways and, believe it or not, even some the most high-brow establishments tolerate it, so long as they move on before the day's trade begins. This seems to me to be a fair and just trade-off, even if, every now and then, a little debris is left behind. Generally, however, rough sleeping individuals get up, pack their things and stroll off for the day. Some return to the same spot night after night, while others migrate around the Capital.

I have spoken to and listened to many of these people. You should know that they all have a story and it doesn't necessarily involve a decline into alcoholism, although even those stories have a relevant background plot. And never forget that we can all end up where they are. It just takes a chain of unfortunate events.

I hope these spikes are removed. I understand the building owner's desire to protect the residents and we don't actually know if there was a critical point at which this decision was made. For example, we don't know that sleeping in that spot was tolerated until it became abused. Or that the area was deliberately soiled with urine or excrement (this can happen unfortunately). But there are other ways of dealing with abusers; there are less inhumane methods of discouraging such behaviour.

We still get calls from premises informing us that there is an 'unconscious' person in the street or near a doorway and when we turn up it can smack of nothing more than the need to have an unsightly thing removed from the area. All we have to do is wake the sleeper up and ask him/her to find somewhere more private and out of the way to rest. Needless to say, this exercise has cost you, the taxpayer, hundreds of pounds and has potentially taken an ambulance away from someone in desperate need of one.

If you own a business or residence in the city and you don't like the look of someone on the ground or in a doorway, try going over to them and asking them to move along. Be nice. Be polite and explain that ambulances may be called for them when they don't really need one. You may be surprised by the reaction.

Unless of course you truly believe that it's too risky and that you may get hurt. In which case I'd ask this question of you. What makes you think it's okay for me or my colleagues to take similar risks? Why didn't you call the police?

No spikes. No pre-judgments. Try kindness.

Be safe.

Monday, 26 May 2014


It's not a word used very often, and when it is, the relevance is rarely on point. But, when you are in a group of mates, out for the night and getting loaded on alcohol (because that's the way its done nowadays), and you dump one of your friends because he or she is too drunk - that's abandonment.

I don't mean dropping them somewhere safe and warm to sleep it off; I'm talking about so-called friends who simply leave their drunken mate on a bus, in a taxi... or even worse, on the street. Shockingly, the vast majority of those I've attended in this situation are female. I'd always considered girls to be more protective about their friends, but suddenly at some point in the night, all of the close-knit, protective posturing goes out of the window because one of the group is too drunk to manage any longer. She can't walk to the next club or bar. She is vomiting too much, or she is practically unconscious and a dead weight on the night's proceedings.

A few years ago I was called to a young teenager who was found by a male passer-by in a doorway in the early hours of the morning during a weekend. She was curled up, half dressed and with vomit in her hair on the step of an office building entrance. When I got her awake and she was able to speak to me, she told me that her friends her left her and she'd tried to get a cab home alone. She'd thrown up in the back of the taxi and the driver had thrown her out. She'd staggered over to the step and curled up to sleep.

This young girl's temperature was hypothermic as I recall. She wouldn't have died but she was extremely vulnerable and at risk. You just have to watch what goes on in Leicester Square every weekend night to realise what a dangerous situation lone young girls are in. Men prey on them openly, pawing at them and trying to get them to go with them to God knows where. This young girl was far enough away from the hub of things to be invisible to those vultures but not necessarily safe from harm.

As it happened a young man called 999 when he saw her lying there. He didn't touch her, and he didn't try to wake her - he didn't want to frighten her.

The most recent call (and there have been dozens prior to this) was for a young woman who'd been left on a bus by her friends. They'd gone off to enjoy themselves without the responsibility she'd burdened them with when she got too drunk to be capable of anything any longer.

She was seen asleep on the bus and taken off by a complete stranger. This man sat her on the bench of a bus shelter and called an ambulance for her. She didn't really need to go to hospital but his reasoning was simple; she was alone and vulnerable.

So, I'm appealing to you if you are someone who'd drop a friend on a night out just because you want to continue and he or she is not fit to do so. Stop and consider what you are risking. Leaving your mate behind, alone and exposed, is not clever. Parts of London are not safe for lone young females (or males for that matter). Please think about the possible consequences of abandoning someone to their fate.

If you prefer to complete your night out and don't want your friend to drag you down, then consider monitoring how much and how quickly they drink. Warn them before they get too far into it that everyone's night will be ruined if they get so drunk that they cannot function.

A lot of our workload is taken up with this, because alcohol is consumed like water and I'm seeing more and more young females 'unconscious' in the street, or in the toilets, or on the floor of a club.

Please look after yourselves. Don't be stupid and stay well away from the drink-fast-drink-lots fad that seems to be sweeping the country. Be sensible with your drinking and keep it paced and measured.

Be safe

Tuesday, 22 April 2014

Wind shift

It has been more than a year since my last post and there have been many changes.

I have changed, my job has changed and the profession has changed. Its simply not what it used to be.

I am reluctant to write in the open and honest way that I used to; there are too many sensitive people out there. It's too easy to offend and bother, either by accident or by being truthful. The design of this blog was deliberate. I set out to let readers know what I experienced and how I experienced it. The result of this, over the years, has been that a number of individuals have become paramedics after reading and following the words I wrote.

A change in my posting methodology is required; I need to write only that which is relevant and neutral while I am professionally bound to one or the other. This is the way of things these days.

The profession is different too. We are answering emergency calls that can, at best, be described as not in the least life-threatening. Insect bites, toilet-tissue incidents and sore thumbs now, apparently, count as worth our lives and the risk of losing them while we run on blue lights and sirens through an ever-obstructive and seemingly non-caring driver world. In the year that has passed, I have had my life threatened directly, been verbally and physically abused by those I tried to help and have had less and less time with my family as the tide changes in favour of the thousands of callers who simply do not need an ambulance, but who call one because they think there is no other option, or they have little or no understanding of their medical or physical problem. All of this is well documented; all of this is on your TV in the shape of fly-on-the-wall entertainment. I am not saying anything here that you do not already know.

My colleagues are tired and depressed. They are leaving the profession, or going to places where there is still hope for pre-hospital care. Paramedics have become nomadic. Almost every ambulance service in the country is experiencing a filter-through of new and experienced personnel. Potentially, if enough of the more experienced paramedics leave their service, the patient knowledge-base will stagnate to only that which is within a few years scope of practice.

Perhaps this is the best way to develop the profession. I haven't met anyone yet who agrees that it is, but nothing here makes me right until it has run its course.

Paramedics are also still extremely vulnerable to losing all that they have worked so hard to achieve because we are still registered with a body that encompasses many other 'peripheral' medical professions. We are not registered alongside nurse or doctors, where I believe we should be. Neither do we have our own professional society - we have a college but its not a 'Royal College'. Not enough paramedics have signed up for it, so it doesn't have the teeth it needs to defend us when the smallest error and sometimes (as recent stories will confirm) doing what we thought was the right thing, can get you sacked and struck off. In comparison to other medical professions, we appear to be the ones set  up to fall the hardest. Where's our protection and assurance?

I still care deeply about my patients and I still love what I do (when I'm doing it properly) but I'm less passionate about my direction of travel. I can't see how on earth we are going to be able to sustain things as they are. Everyone wants an answer; everyone wants to know how we can save money and cut the NHS workload... but nobody is asking us.

What we need is a shift in the wind.

Friday, 29 March 2013


The last shift of my tour seemed to be nothing more than one alcoholic after another. Individuals with drinking problems that go beyond binging. Emotional and psychological dependence on the stuff is what I'm talking about. This is not the same for me as picking up a gutter-vomiting teenager who needs to be taught when to stop drinking. This tugs on you and reminds you of how vulnerable humans are and where they can end up when things go wrong and they just can't cope with it all.

Before all that, I'd gone through nights and days where aggression and trauma mixed into the scheme of my world so fluently that they became one and the same.

A taxi driver crashed into a lamp-post, flattening it and continued on until he was stopped by a traffic light post, which was bent halfway by the force of the sudden deceleration. We were the second ambulance on scene and it was immediately apparent that it was not safe. The London Fire Brigade (LFB) was called because the engine was still 'live' and there was a spillage of diesel under the cab.

Inside the taxi were a driver (obviously) and a passenger. Both had been thrown forward violently by the crash but only the driver had been wearing a seat belt. However, he seemed in a worse state than his passenger, who was conscious, alert and somewhat annoyed by the situation. His neck was being held stable by a FRU pilot and one of the crew from the first ambulance on scene.

The driver had apparently been unconscious prior to crashing, according to witnesses. An off-duty doctor and paramedic both helped and they informed us that the driver had still been unconscious when they went to his aid immediately after the incident had occurred  This was a worrying bit of information, so I asked for an ECG to be done and a full set of vitals before we moved him.

The LFB had arrived after a few minutes and they were very keen to cut the doors off the cab (this was going to be the extrication method) but I'd asked them to hold fire until I'd seen what was going on with the man's heart.

A few years ago I was called to a crash where the driver had lost consciousness at the wheel and careered into a barrier. His ECG revealed a massive heart attack. I was determined to check this before we did anything else.

The driver's ECG was fairly normal but his blood pressure was consistently high. He had a history of hypertension and a stroke in the past. This seemed to be the only rational medical explanation, so we carefully removed him from the cab first, followed rapidly by his passenger. Both went to the same hospital and both landed in Resus, but the passenger walked out after a short time because he was 'fed up', apparently. The driver was found to have had a stroke and was taken to a specialist unit for treatment.

We were asked to take a 30 year-old male from police custody to hospital because he'd admitted to having swallowed drugs (allegedly). However, when we turned up, he denied it and became extremely verbally aggressive towards us and the officers. In fact, all the way to hospital, even with a police officer in the back with him, he shouted abuse and hatred at me. He made several statements about how we (paramedics) were all 'worthless' and a 'waste of time'. It felt very personal, even though I knew it wasn't but it's extremely hard for someone like me to keep a 'yes sir, no sir' attitude with an individual like this. There are things I want to say but they'd get me sacked. So, I endured and allowed him to berate me, my colleagues and my Service, until he was exhausted by his own venom.

Then a drunken Italian man continued the abuse and added physical aggression to the equation.

We'd picked him off the street after a concerned MOP had called us. Initially he was just annoyingly vociferous but it did't take too long before the drunken stares began... these are usually followed by insults and challenges. I wasn't attending this patient but I got as much of the offensive stuff as my crew mate. The man obviously wasn't fussed.

We tried to put him somewhere quiet to sleep it off because he didn't need to go to hospital. If we'd taken him (even if we'd managed to get that far without him kicking off in the back), he'd have upset every proper patient there and probably caused grief for the staff. I don't like giving hospital staff the same stuff we have to put up with. So, we tried to sit him outside the hostel we thought he stayed at.

He fell over and looked like he was going to keep falling over until someone else called 999 and another crew had to experience his violence. So, we got him back into the ambulance, after a few swipes and punches, and took him to the police station. We asked an officer if he could be arrested for drunk and disorderly behaviour but the cop wasn't having it... they were full up and had many other drunks to deal with.

Suddenly, as if by magic, the man uttered the name of the hostel he was actually staying at. We decided to take him home and leave him with staff who knew him better. The journey wasn't too far but he shouted at and insulted us all the way there.

When we tried to walk him to his hostel, he became very aggressive and his arms swung at us. So, I went to the hostel and got the manager to come and collect him. This worked (eventually) and we finally got rid of our cargo.

Ironically, I was told by the manager that the man didn't usually drink and that he was normally very quiet and gentle as a lamb. Alcohol has a way of stripping away the human side.

I got chatting to a lovely 74 year-old lady who works in the theatre (she still teaches young Thespians) after we'd been asked to take her to hospital following a fall in the street. I suspected she had a broken nose, so an x-ray was needed at the very least. She was quite embarrassed about an ambulance coming for her and said "I thought they'd send a bicycle".

We talked about Groucho Marx and 'The Broons' from our lives in Scotland (she was from Edinburgh). It was refreshing to meet a patient like this after the night we'd had so far.

Our only true emergency of the shift was an 88 year-old female who'd had a recent chest infection and who could barely breathe. We had to take her into Resus on blue lights. Her condition was serious but when I saw her later on she was a completely different person; normal colour and breathing well again.

The first alcoholic we dealt with was a 53 year-old female who was shouting the odds when we arrived. Her carer looked terrified - she'd called 111 and was directed to 999 (this happens a LOT), so we had to attend.

The woman was drunk. She had no immediate medical issues but she had a long history of physical and emotional problems. She'd lost a few important people in her life and everything had spiralled out of control.

She didn't need or want to go to hospital and we could see that she had en extensive history of having ambulances come to her and then leave without taking her in. Dozens of calls like this had resulted in absolutely nothing being done about the problem.

It was very clear that she had mental health problems but that they are not being addressed, simply because she gets drunk and then refuses all help. This cycle has to be broken before she will get any better. Until then, thousands of pounds of tax payers money will be spent allowing her to continue on until she kills herself, dies accidentally or kills others by misadventure. She smokes a lot and it doesn't take a genius to see that if she is drunk enough and drops her cigarette on the floor, among the debris of cooking fat, paper and alcohol, she will burn... and so will her flat, and the flats above hers. It's happened before. It's a fairly reasonable prediction.

In the end we had to leave her, after an hour of chatting and trying to persuade her to go somewhere safe with us. Her sister arrived and sat with her and this woman made me think harder about it all. She was very defensive with me, very agitated and laughed almost manically when she spoke of her sister's condition. It was clear that the poor woman was reaching (if not at) the end of her rope. From what she said to me, nobody had shown any real interest in her sister's problems. I could see the depth of her hopelessness and I wondered how easy it was to get there.

Nobody seems to care. Her GP and the other services are trying everything they can but there seems to be no solution. That just can't be right. At the very least, a Section for her safety should be considered.

Our second alcoholic is someone I know. I've attended to her several times. On each occasion, she leaves hospital without treatment, begs for money on the street and then goes to the nearest shop to buy booze to keep herself drunk. It's not unusual to attend more than two or three times in a single day because  if she doesn't call us, a MOP will. It goes on and on.

She is very well spoken 61 year-old woman and she always says that she knows what a burden she's become and that she wants to end her own life. This is pretty much what they all say but the reality is they want help. REAL help. They don't need us taking them on pointless runs to A&E and they don't want pity or anger or hatred.

Economically, it would be far cheaper to give them the help they need. Take them away from their environment and all alcohol for as long as it takes. Give them new purpose. Instead, we just keep chucking money at the problem without reaching a valid resolution.

I'm not being Utopian, believe me, but up close and personal... these are vulnerable people with nowhere to turn except us. We are NOT Social Services, neither are we the AA or any other agency responsible for this kind of support. It's time we looked at this again.

Be safe.

Friday, 22 March 2013

The happy Space Hopper

Aww, bless her. She went through a lot of pain and yet allowed me to write this story up. This is Laura and she had an accident.

If you look closely at her right elbow you'll see it's not quite the right shape or size. In fact, she's fractured and dislocated her Humerus so badly that the Radius and Ulna (the lower arm bones) have detached completely and slid upwards and behind the upper arm. This photo was taken by her boyfriend 'Brummy' while she was being treated.

We were called to a 'possible dislocated elbow' and managed to get to the address without being cancelled or diverted (which could easily have happened as it was a very busy night for drunks and they, as always, take priority over broken bones).

When we got into the flat, Laura was on the floor and her boyfriend and three others were around her. There was a bit of giggling going on because alcohol had been imbibed (responsibly in this case) and they were all good mates who thought this was awkward and rather amusing, which it was at times. Although having broken a bone myself, I sympathise completely with the general feeling in the room - you know, if we don't laugh, we'll cry... that feeling.

My crew mate and I started putting her at ease and I explained that I'd give her a little pain relief. She was quite drunk - not stupidly so, but enough to keep her grounded while all this was going on and her arm looked pathetically useless to her. So, I gave her a little morphine and a LOT of Entonox. She was perfectly capable of self-administering the gas and it helped her a lot. So much, in fact, that she was positively bursting with happiness at times. She was like a giggling crippled starfish on that floor.

This was going to be an awkward removal because the flat was a couple of flights of steps up and walking her out was our only option. My crew mate, who is a student paramedic, had never seen such a  serious fracture/dislocation, so I spelled out the plan so that we could move her safely and without causing any further harm if possible. It was not going to be easy.

After a bit more gas and a bit more reassurance, and with all her friends settled down to the reality of her condition, we began to move her from the floor to the ambulance. We had no vacuum splints, which would have been ideal, so I made do with a box splint and padding when I got her out of the flat. Holding her arm stable whilst walking with her was the only realistic option we had, given the position she was in, the position her arm remained in and the environment we had to negotiate.

It was a long, slow and careful process. I felt the bones of her arm shift only once during the move; there was a bit of a crunch as they ground together (crepitus) but it wasn't allowed to happen again.

As soon as she was safely in the ambulance, we packed her arm into the splint and positioned Brummy so that he could keep it stable during the slow drive to hospital. He was more than happy to help and assisted with humour and smiles for Laura. That's the way it should be really. She was in pain and she had a fairly serious injury, but it wasn't life-threatening and she needed to be kept up-beat so that she could bear it.

She told me she'd had several fractures in her life; she seemed prone to them when she had the most benign falls. I suggested she may want to investigate the possibility that she had EDS, or another condition that was causing this.

We popped in to see them both in the Resuscitation Room, where they'd been taken so that Laura could have the dislocation reduced. They were in good spirits (well, Laura was mostly off her head on drugs by then).

The arm was reduced but it failed and the plaster had to be cut open and another attempt made. For a good few hours the poor girl went through painful and uncomfortable procedures to make her joint behave. It finally settled into its anatomical position on the second reduction and re-plaster.

The X-ray shows the extent of the dislocation. Laura had to return to hospital to have bone fragments cleaned out and may have to have pins put into the joint.

And how did she manage to do all this? Well, you are already thinking she was hopping about drunk and fell off the big rubber ball... but you're wrong. She was hopping about, as were the others, having a laugh and enjoying a dinner party with friends, but she successfully completed her hopping fun and dismounted. She then took a few steps around it and fell to the floor so awkwardly that she did the damage that now renders her temporarily disabled.

Crazy huh?

They had been drinking, yes... but in the privacy of a friend's home. They had been fooling about on a big inflated ball whilst a little drunk, yes... but they were having a dinner party and it was that or Charades. They called an ambulance, yes... but they needed one. This is a genuine accident and there was a real injury. Not one of these people went out to get so drunk they'd end up in a gutter, vomiting their stomach inside out. They were, in fact, pretty sensible, decent and thankful individuals. Brummy had even been preparing to take his injured girlfriend to hospital in the car, rather than 'waste our time'. I can tell you right now that her injury would have been much worse by the time she'd reached hospital if they hadn't called 999.

My sincere thanks to Laura and Brummy for their permission to highlight this call and for their great sense of humour and common sense. I wish Laura the very best of luck with her recovery, and I'll keep you all posted.

* With respect to recent emails. Can I just clarify once again that Laura gave me express permission to use her name, so she has no objection whatsoever to having her name seen on this x-ray! The photo was taken by Brummy specifically for use here! Thank you.

Be safe.

Thursday, 21 March 2013

Major trauma

My friend got a delivery of heavy shelving recently. This is where the delivery guy decided to leave it when she didn't answer the door. She was in at the time of the delivery but she just didn't hear him. Her door opens outwards....

Two patients at once after a fight broke out in Covent Garden. Both men had been beaten up quite severely and one had been left unconscious. Both had head injuries but I was more concerned about the man who'd been KO'd than the other one, because, although he had a fractured nose and cheek bone, he was alert, orientated and responding appropriately. The other man began a slow decline from the same state to somewhere relevant to the severity of his injuries.

His skull appeared depressed where he'd been kicked or punched - probably whilst on the ground - and that gave me all I needed to divert him (and his mate) to a Major Trauma Centre (MTC), rather than Accident and Emergency.

We can take serious trauma patients to specific hospitals, where specialist treatment is immediately available. It has to be done with caution, however, using good clinical judgement or, as in the case of this man, instinct. I don't mind getting it wrong if the alternative is that I could take someone to an inappropriate treatment centre and there's a delay in their care. I think that applies to most of my colleagues too.

En route, the man with the broken nose bled all over the ambulance floor; it was difficult to stop the flow until I wrapped a dressing around his head. The other man began vomiting. I'm sure we made the right call.

I'm known for my opinion on binge drinking, especially with young people and I still believe our NHS ambulance services should not be tasked to recovering people who deliberately go out and poison themselves with alcohol. However, there isn't much option and no resolution of the problem is in sight. So, we take them off the streets and to places of safety (usually hospitals) and that's that. But everyone has a duty of care for young drunks when they are in their professional arena. So it was disturbing to hear that a bus driver allegedly told a semi-conscious 17 year-old and his friends to leave the vehicle when he became sick.

Taxi drivers have little tolerance for this either, and I completely understand - they will spend a good few hours cleaning up the mess and will earn nothing while they do it. Bus drivers will have to get their vehicles cleaned too and they will be off the road.

The problem is that throwing a young person off public transport and leaving them in the street might just put them at risk. Years ago, I posted an incident where a taxi driver had taken a teenage female off his vehicle because she'd started vomiting. He left her in a doorway, in the small hours of the morning, in the freezing cold, with very little in the way of clothing to keep her warm. She was left exposed and dangerously vulnerable until someone called 999 and we picked her up. It happens almost every weekend.

In this case, the young man had friends with him but he was still left in the street, surrounded by people waiting for buses. He was almost unconscious when we arrived to take him to hospital. He was very cold and had been sick all over himself.

It may not be appropriate or convenient when a drunken person starts vomiting and messing up your clean vehicle, but it is a simple matter of judgement for anyone to assume that, if they are in such a state, then maybe they should be going to hospital - but not via the street.

Our last job of the night was another head injury but this time it was much more serious. The man had been hit by a taxi and had almost gone through the windscreen and into the cab, such was the force of the impact.

We arrived after the FRU and there was a paramedic and student paramedic dealing with him as he lay motionless on the ground. A small crowd had gathered and were watching and filming, so I asked them to leave the area. I've never understood why people would want to film someone's personal horror. It's not illegal because it's in the public domain but it tasteless and pointless.

There was a lot of blood around and it made the scene hazardous for everyone working there. The four of us managed his airway, started getting IV access and assessed his injuries, which were multiple and major. He was still breathing and still had a pulse, so there was still hope.

HEMS arrived and soon we had blood being transfused and more advanced intervention going on to save the man's life. It took almost 30 minutes to stabilise him and get a decent pulse so that he could be moved. He'd been RSI'd and immobilised fully for the journey to MTC and when we got there he was still breathing and had a better BP than we'd measured whilst treating him in the road.

Heading home after a shift like this invokes two things; a feeling that something worthwhile had been done and a life might be recovered from tragedy, and reflection on the skills and procedures carried out, so that they can be honed further.

Be safe.