A lot of the people I follow on Twitter have been talking about #transplantweek, a way to get everyone aware of the need for organ donors.

In my years as an A&E nurse I only knew of two people passing through my doors that went on to be organ donors, helping people that they never met. Two people in many years is simply not good enough.

In my ambulance work I find myself going to dialysis wards, people who desperately need kidneys. The chairs are always full - people connected to machines that clean their blood and keep them alive.

I've been to people who need liver transplants, waiting for someone to donate their liver to them so that they can live. These patients are swollen, yellow and in pain, and all I can do is take them to hospital where they can be 'managed' for a little while longer.

There was a child on my patch who needed a heart and lung transplant. She was lucky and got one, and I don't see her any more.

Once upon a time, when I would go to people who had suffered trauma, we would rush them into hospital where they would get blood transfusions that would save their lives. As a nurse I can't even guess at the amount of blood products I've given people. I used to be the one sent for the blood because the storage was halfway across the hospital and it never bothered me walking the hospital grounds late at night.

Organ donation saves lives - of that there is no doubt.

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There are myths that doctors will 'let you die' so that they can get their hands on your innards - I can tell you that this is completely untrue.

I've been on the organ donor list for as long as I can remember. I wouldn't be on it if I thought there was anything 'dodgy' about it.

You'd accept a kidney if you needed it to survive, why wouldn't you donate one when you no longer need it?

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Why don't you sign up today - help someone out when you pop your clogs. It's the ultimate in green recycling.

Register as an organ donor.

Di you know that both my books are still available in shops and on Amazon?

Blood, Sweat and Tea

More Blood, More Sweat and Another Cup of Tea.

But did you also know you can download them for free for pretty much every platform under the sun. (And here for the sequel)

They are also now on the Apple iBook store, also for free, so if you have an iPhone or iPad you can read them on that platform as well. (And it has been downloaded quite a lot from there - a few more and I might make the top twenty free downloads chart). For some reason you can't like directly to an iBook store page. Which is a bit daft - do try and fix that Apple.

And finally - 'Blood, Sweat and Tea' is now available as an audiobook. Huzzah!

iTunes link

Amazon link to CDs.

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Feel free to download the free editions, and then, if you like it, buy a physical copy for your loved ones (from the emails I get, it would appear that mothers really like them). That way both my publishers and I get some lovely, lovely money.

OK, self-pimpage over.

So... What is it that makes an ambulance?

What sort of equipment do you think needs to be on a vehicle for it to be classed as an 'ambulance'.

You'd probably think that it would need a stretcher, a carry chair and some sort of medical equipment. Perhaps something to take blood sugars, blood pressures and tracings of your heart.

Maybe it would need something to deal with broken limbs, a board to strap you to if the crew thought that you had a broken neck and maybe even some drugs to treat conditions such as asthma, heart problems and allergic reactions.

You might also expect bandages.

You would, of course, be wrong.

We have had the official memo from one of our Assistant Director of Operations.

To be a working ambulance you need...

1) A vehicle which passes the legal requirement of basic roadworthiness - decent tyres, has a windscreen, has working lights and is taxed.

2) A Bag-valve-mask and a defibrillator.

3) That is all.

That is all you need to have a working ambulance - or rather an ambulance that will stop that all 'important' (and utterly bloody pointless) ORCON target.

This level of equipment means that you can perform pretty basic life-support - no drugs, no clever airway management.

If you have asthma, you will be wheezing like a wheezy thing with not a thing I can give you.

If you are having a heart attack I won't be giving you the aspirin that vastly increases your survival rate.

If you have a broken leg, I'll have no way to splint it. And I may not even have a stretcher to put you on anyway.

But I will have 'stopped the ORCON clock', and so the job will be a 'success'.

And this is happening - a friend of mine was sent out on an ambulance with this level of equipment. He was concerned by this and wrote a letter to our medical director who replied that this is a good policy.

Over 50% of the time I'm sent out on a vehicle without a blood sugar kit, and without other equipment like Scissors or a Paediatric Advanced Life Support Kit.

The London Ambulance Service calls itself a 'world class service' - but I think it's a bit rich to refer to yourself as this when ambulances are being sent out with this level of kit.

But who am I to complain that I don't have the right amount of kit? After all, the people who make these decisions are paid a heck of a lot more than me, so they must be smarter.

It is, as regular readers will no doubt have guessed, all because of the frankly dangerous ORCON target - dangerous because our ceaseless chasing of this clinically worthless target means that patient care is suffering.

The government has decreed that a number of targets will be dropped - the four hour A&E wait, the Police Pledge, Literacy (well... they haven't specifically said that literacy must be cut, but if you are cutting the education budget by 25% then that is the sort of thing you are going to get).

Sadly, no, tragically, it would seem that the ORCON target will remain. And so resources that could be spent on, oh I don't know, fully equipped ambulances, are instead being spent on beating that damn clock.

However I think that there are those in management who probably like this - after all they can understand how to chase this target as opposed to being capable of setting a standard of excellent patient care.

The mosquito is dead, killed by chemical warfare. The only side effect being my new understanding that spraying insecticide into your eyes tends to sting a little.

Loads of good ideas in the comments although I am somewhat disappointed that no-one suggested this...

It brings a warm fuzzy glow to me - and a desire to see a similar, but larger, system strapped to the top of my ambulance for destroying the tyres of drivers who pull out on me while I'm driving on blue lights.

2:00 AM

....

2:30 AM

...

3:00 AM

...

3:30 AM

...

4:00 AM

...

4:30 AM

...

Every thirty minutes.

Every. Damn. Night.

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I've not been sleeping well, in fact I've hardly been sleeping at all. The best I can manage is a half doze before the bitch wakes me up.

For the past few nights there has been a mosquito in my flat. Every half hour she has been buzz bombing my face, looking to land in order to suck my blood.

Try as I might I can't catch her.

So every half hour I slam on the bedside lamp, grab my glasses and rolled up copy of Wired Magazine and dance futilely around my bedroom trying to track her down.

But she always seems to vanish, only to return half an hour later as I've just dropped off to sleep.

If I could I'd just sleep and let her feed - I've been bitten so many times the bites don't bother me so much now. But there is something in my animal brain that wakes me up, instantly, when a mosquito buzzes past.

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Female mosquitos are the only ones that bite - they use the blood to build their eggs. Male mosquitos are harmless and eat nectar and fruit juices.

Female mosquitos track their prey by body heat, scent and by sensing the carbon dioxide given off by breathing.

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I try to breathe quietly, to form a pool of carbon dioxide to act as bait. But she doesn't come.

I turn on every light in my flat, my eyes scan the walls for silhouettes, but to no avail.

Every half hour I wake.

I'm trying to shift from night shifts to early starts. It's hard enough for me at the best of times, but to have my sleep disturbed in such a fundamental manner is making it painful for me.

I want to sleep during the day and hunt at night - just like her.

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You can tell a male from a female mosquito because the males have larger and bushier antenna.

The base 'buzz' of a mosquito's flight is around 400 Hz.

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Every half hour I wake.

My eyes snap open and I look around the room. My attention is drawn by 'floaters', retinal cells floating in the fluid of my eye. That's when I can open my eyes - without sleep they start to fail after around twelve hours of use.

I want to cry. I probably will today - lack of sleep has that effect on me.

I feel like I'm in an Edgar Allen Poe story - 'The Telltale Mosquito Buzz'

Later today, when the shops have opened I'm going to buy the nastiest, evilist, most enviromentally unfriendly spray that I can find - then at the half hour point I shan't look, I shan't open my eyes.

I'll just listen to her approach and empty the contents of the can into the air above my face.

'Do not inhale' the can will say - but It will do it's job, because either that bitch will die, or I will.

And at least then I won't be woken by her again.

It's never a good sign when your patient has her knickers around her knees.

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'Woman in Labour - outside newsagent shop'.

So far, so boring - another maternataxi job, walk on walk off, baby arrives a few hours after the end of our shift. No sweat.

My crewmate is driving, blue lights to do a job of a taxi, when a minicab swerves across the road and pulls in front of us.

"Oi! Can't you see the lights!?", shouts my crewmate - we are used to the crazy drivers of Newham (especially the minicab drivers) but this one really takes the biscuit.

"Erm... That's our patient", I say.

In the rear of the minicab that is parked across our nose is our patient, her husband and her two other children, both under the age of six.

I hop out of the ambulance and walk to the back of the cab. Inside our patient is stretched out and screaming, the husband is on the phone to our Control (and seems a bit upset that they don't understand that he is on some road in some part of town - he isn't sure where he is and is annoyed that the calltaker isn't psychic).

Her knickers are down around her knees - this is not a good sign.

I quickly peer between her legs - and can see nothing out of the ordinary.

I'm aware that we are blocking one of the main roads on my patch - behind our ambulance is a bus, and behind that I row of cars.

Our woman stops screaming and I suggest that we change vehicles to our ambulance. She agrees and, exposed to the world and before I can cover her, waddles into our ambulance giving the bus passengers a sight they never expected to see today.

My crewmate gives the husband a hand with the luggage and the children while I put my patient on the trolleybed.

For some reason people seem to want to bring the entire kitchen sink with them to hospital when they are having a baby - this woman has four bags, along with two children she made earlier.

I take another better look between my patient's legs - again nothing unusual, and I'm certainly not going to stick my hands anywhere they don't belong to see how far along we are - besides it's outside our training.

We get the other children buckled in and I tell my crewmate to start heading for the hospital. I let the patient know that I'm glad that she tried getting a cab rather than just calling for an ambulance like many of our 'service users' - but that maybe she should have called a little bit earlier...

Then my patient lets out an awful cry and I realise that this isn't the normal wimping out about early labour pains.

I take another look and see a bulge...

"On second thoughts my beloved", I shout to my crewmate, "We're are going to be having the baby here - grab us the spare maternity pack from the side cupboard".

"What?!"

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And so I find myself hemmed in by luggage, with two small children undoing their seatbelts to come and have a look at what is appearing from between mummy's front bottom, all while trying to deliver a child who seems to be in two minds about coming out or not.

The head delivers, and then stops. My patient is convinced that she can't push any more and I suddenly turn into a midwife and start being... rather firm... with her.

A bit of pulling, a bit of pushing, and the baby boy pops loose. The cord is not so much 'cut' as chewed through by the, apparently rather blunt, scissors in the maternity pack, and dad gets to hold the newborn as mum is too tired.

I look at my audience - two gape mouthed, but excited, children and I tell them that they now know where they came from when they were babies.

Turning my attention to the dad I tell him that it is his job to tell them how they got up there in the first place.

Smiles all round, not least from me, because I'm fully aware that if there were a serious problem with the delivery, my training would be sorely lacking.

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We arrive at the maternity department after pre-warning them that we were coming in with a 'BBA' - 'Born Before Arrival (at hospital)'. The midwives ignore us until finally one slopes off to make a bed up for the patient. They aren't massively interested in hearing my handover either - but I give it anyway, I'm far too used to dealing with this particular group of midwives to worry too much about their attitude towards a lowly 'taxi-driver'.

Outside, with the luggage and the other children, the father shakes my hand and thanks me - his face a big grin.

And it's all fine - and I'm happy, and it keeps me happy through the shift even though my next patient is a drunk who tries to hit me.

Role Models

In the final part of my series of whinging, moaning and general grumpiness I'd like to look at the one thing that road staff truely have no-one to blame except themselves.

Where are our role models?

It took Mary Seacole, Florence Nightingale and others like them to start to drag nursing up from it's roots as a 'Doctor's Handmaiden' into a profession of it's own.

Likewise you have Sir Robert Peel and his effect on policing, Elizabeth Fry and her prison reforms and countless scientists from Gallelio up to Prof. Brian Cox and Dr. Ben Goldacre.

So, who is the role model, the innovator, the spiritual leader of the ambulance services?

Josh from Casualty - a fictional character?

What name do we think of when we, as a profession, ask ourselves - who is the paragon of ambulance work, who is the person we should aspire to be like?

I can't think of anyone who fills those shoes and the people who I think are great EMS are rarely heard from.

I think that it is about time that we started looking for role models, or start aspiring to be one ourselves.