Be Smart?

Two calendars run side-by-side in Israel; one religious, one civil. It means that we celebrate New Year twice a year, just to confuse everyone, including ourselves. The change of year on the civil calendar is still marked, celebrated by many just as it is in many parts of the world, although according to a press release issued by Magen David Adom, the national ambulance service, they were called to only fifty (yes, you read that right) alcohol related incidents on New Year's Eve nationwide. The Israeli population roughly numbers around the same as London, so this is a figure that the LAS could only ever dream of; they were averaging some 400 calls per hour for the first few hours of 2013. Admittedly, not all of them were alcohol related, but I can be fairly certain that a large proportion were. 

The end of the civil year also brings with it various annually-published reports, one of which being the traffic fatality report. The headline is nothing less than staggering: 2012 saw the lowest road-traffic fatality rate in half a century and on top of that, the rate is down 25% on the previous year's figures and some 40% lower than 2005. The UK could only hope for such a drastic change. In fact, the figures from 2010 to 2011 actually climbed by 3%, rather than reduced. It is a truly astonishing figure, but the question has to be raised as to how this has happened. 

As a driver on Israel's roads, I still see the shocking driving for which Israel is infamous. Drivers see keeping a distance from the vehicle in front as a mere nicety, perhaps a minor recommendation, rather than a safety measure; lane discipline is non-existent; indicators appear to be optional extras on most vehicles and road-rage is commonplace. We live in a high-paced, high-energy, live-for-the-moment country, where allowing another driver to overtake is seen as weakness and where allowing another car to slot into your lane makes you appear like a pushover. 

Other figures released today show that police have issued 40% fewer tickets for driving violations in the past year, down to 600,000 from over one million. They have concentrated less on minor offences (although the report does not specify what those are) and more on notorious roads, as well as "life-threatening misdemeanors", including dangerous overtaking, running red lights or stop signs, ignoring pedestrian crossings and, in particular, drink-driving. The police can, and do, when dealing with a driver who breaks one of these so-called "life-threatening" laws, revoke a driver's licence on the spot for up to 30 days. They can also impound their vehicle for the same length of time. 

It all sounds like a plan is coming together. 

However, what the reports barely mention is the number of seriously injured. These numbers still seem to be high, and depending on which report one reads, the numbers may still be climbing. The ambulance services here are becoming increasingly skilled at managing severe trauma patients. The times taken to get to definitive care in hospital is decreasing and the treatment options increasing. Tranexamic acid, a drug commonly used in hospital for surgery associated with a high risk of bleeding, has recently been introduced to front-line crews as a pre-hospital treatment and is having, at least according to initial reports, a serious impact on survival figures. 

All these facts and figures are optimistic, but also leave a little confusion in their wake. Clearly, better infrastructure, more intelligent and robust policing, better skilled pre-hospital providers and the obvious ever-improving safety features of the vehicles themselves are helping to save lives. This is a trend that we can only hope will continue to improve. But the fact that the accident rate is still high, that there are still so many seriously injured, is still a cause for concern. 

The human element is one of the toughest to regulate. Emotion will always play a part in a driving, particularly in light of the descriptions of the Israeli driver that I have already mentioned. Actual attitudes need changing too, but that is hard to do when confronted with a seasoned driver who has years of driving experience and picking up of bad habits. Change needs to begin from the ground up, even before a 17-year-old is allowed to start to hold a steering wheel in their hand. It needs to start with the basics, for example teaching that riding a motorbike whilst wearing almost no protective gear is a path to almost certain disaster. 

Attitudes to alcohol need to change. No more the thought process of one drink will be ok. You want to drive? Don't drink. 

Attitudes to other drivers need to change. Understanding that allowing one driver in ahead of you will not only benefit them, but will help the roads run smoother and reduce the aggression on the roads. 

Attitudes to seat belts and appropriate child restraints must change too. Particularly in certain sectors of society. 

It may take another generation, perhaps less, perhaps more, but if we want to reduce fatalities even further, we need the drivers themselves to cooperate. To understand that sometimes there really is a greater, even if unseen, good. 

Years ago, there was an advertising campaign here that promoted the following philosophy: 

"Don't just be right, be smart." 

A combination of the two would be even better. 

Fines

BBC News amongst others is reporting the new idea of on the spot fines for dangerous driving. I'm sure we've all seen examples such as the ones in the video, and worse. 

The plan for an £80 fine and three points on a licence is a start, but nothing more. 

It seems like nothing more than a political stunt when you consider that you can get fined £1,000 for throwing a piece of chewing gum in the street.

Surely, driving dangerously and threatening the safety of others should have a much higher penalty than than littering? 

What do you think? 

Apologies

This is an open letter to the driver of the car behind me earlier this morning: Stand by for a rant.

Dear Driver of the BMW X5 that was behind me in traffic,

I hope you read this - I gather I owe you an apology.

I'm sorry I stopped in front of you at an inconvenient moment.

I'm sorry I blocked your lane, (even though the other one was clear).

I'm sorry I stopped to help the elderly gent who fell right in front of us.

I'm sorry I took a few minutes to help him and make sure he was OK.

I'm sorry you may have been a little late to your coffee morning or other meaningless task.

But if I ever see you, your car, or the horn you beeped at me repeatedly,

You selfish, arrogant, ignorant, rude and insensitive person,

I may not be responsible for my actions.

Oh, and as for your apology, I shan't hold my breath.

Safer

The patient we'd just dropped off at the hospital only became a patient when the police turned up. Far from being police brutality, it seems that they just seem to have an overwhelming effect on some people. Paulo had driven home from the pre-Christmas office drink, a warm up for the main event that was scheduled for mid-December. It was only supposed to be the planning meeting, but he decided to sample some of the drinks to help him decide what to make available for everyone else. Then he drove home. Well, about half way, before he met the kerb, burst a tyre and was stopped by a grass verge. A good Samaritan witnessed the incident, and as he drove past and kept going, he called for an ambulance. Paulo was uninjured, the crash and his escape a dichotomous result of his drunken state. The police turned up a few minutes later, and as soon as they said the magic words informing him of his arrest, Paulo collapsed.

Paulo fell to the ground, making sure he found somewhere soft to drop. His eyelids held tightly shut and hands making tight fists, he failed every test for unconsciousness known to any paramedic worth their salt. However, he still refused to open his eyes or speak, and therefore won the first round. The police had no choice but to send him to hospital, although rather than being let off by them, Paulo was accompanied all the way, and would be watched until he recovered from his mysterious ailment. Round two would be won by the police as soon as he woke up. Far from being sent home, Paulo would spend hours in A&E, and then more hours in a police cell. Round three would be up to the judge.

Having transported an officer and their quarry, we were then free to go back out on the road. We left the hospital, and half way back to station, saw a car veering across lanes, bouncing off the pavement, and showing a general disregard for any rules of the road. We called control and let them know that there was probably another drunk driver on the road and asked for police to attend before anyone was injured or worse. Following the car, we were given permission to use lights and sirens to see if that would help stop the driver, but both were completely ignored.

The car seemed to be accelerating away from us, and was heading directly for a line of traffic waiting at a set of lights. Assuming that our presence might be making the driver act more erratically and dangerously, we turned off the lights and sirens and slowed down. We waited for it to skirt around the line of cars, jump through the red light and across a busy junction. That wasn't even close to what happened.

The car didn't even brake. It slammed into the car at the back of the line and stopped dead, steam pouring out the hood seconds after impact. We pulled up behind the car, radioed in to let control know what had happened and requested another ambulance, as we'd probably have at least two patients. 

The blue van that had been stationary was shunted forwards a good distance right into the middle of the junction. Luckily the lights had changed, so there was no cross traffic and the car in front had already moved off, missing an impact by the thinnest of margins. The driver got out, and looking a little dazed, walked over to us cradling one arm in the other. Even from a distance we could see that he'd fractured his wrist. The police turned up at that point, and were tasked with babysitting him until we could assess the other driver.

The front of her car was half the size it should have been. She hadn't moved since the impact, and as we approached we could see that she was conscious, breathing, and seemingly uninjured. The expected smell of alcohol didn't materialise when we opened the door, although her speech was slurred, she was confused and her behaviour was erratic. Sure drunken signs, but lacking evidence, we carried out further checks. Within under a minute, we had the answer. As a police officer looked for physical clues, we searched for medical ones. A blood sugar check was all it took. Her sugar level had dropped to less than one (or eighteen for you Stateside persons). Most people I've seen with that level have been totally unconscious, and nowhere near a steering wheel. A few hundred drops of sugary water directly into her blood stream were enough to bring her back to reality, although not the one she remembered.

"What happened?"

"Well, you've had a hypo, and crashed your car. It seems that you've come out of it OK."

She took a moment to digest the information. A look of horror suddenly crossed her face. "What about the person I hit? Are they hurt?"

"Don't worry. They're on the way to hospital for a check-up." I didn't have the heart to tell her about the broken arm. "What's the last thing you remember?"

"I was having a meeting with some guy. I run an inn, and we were planning their Christmas do. He had a couple of drinks, maybe more than a couple, and I told him he probably shouldn't drive, but he went anyway. I hope he made it home in one piece! Maybe I should've taken my own advice too..." 

We asked about her medical history, whether she'd been eating regularly, all the other relevant questions for a diabetic whose blood sugar levels have dropped so low. She'd been doing everything right, so the reason remained unclear. There was still one thing we wanted to quiz her about.

"Do you remember the name of the person you met?" I couldn't believe the coincidence, and I didn't expect the answer. 

"Yeah. It was a foreign sounding name. Pablo I think." 

"Pablo? You sure?" 

She sat looking thoughtfully into the distance. "Oh. No it wasn't. It was Paulo. Not Pablo. Definitely Paulo." 

Two ambulance crew stared at each other in total silence, barely accepting the answer we'd just heard.

She broke the silence after a few seconds. 

"Instead of telling him to get a cab, maybe I should have asked him to drive me! It would probably have been much safer..."

Driver's Duties

It's a relatively rare thing for me to drive the ambulance, unless of course, I'm solo responding in the Fast Response Unit. I'm almost always more comfortable in the back, with the patients, and allowing someone else to pilot the ship around the never deserted streets of London. Apart from anything else, it's the driver's job to tidy up if there's any mess at the end of each call, and I'll happily pass on that duty.

Just for once, I fancied a change, and so took up the position of helmsman, and watched as another newbie took control of the patients.

The screen rings and displays a message about a choking baby, turning blue. Not normally known for being the fastest of drivers, my lead foot takes over and we cover the couple of miles at warp factor 9. As we turn into the quiet cul-de-sac, the computer updates us that the baby is now breathing normally and no longer choking. Even the ambulance breathes a sigh of relief.

We're met at the front door by the baby, cradled in his mother's arms. Mum's eyes tell a tale of their own, bloodshot and swollen, the drying streaks of tears running the length of both cheeks. Newbie is a little lost, not yet having learnt the art of treating a now non-existent problem. We talk to mum, find out what happened, and discover that once again we're meeting a baby who probably tried to inhale its milk rather than drink it. All is calm, except the excitable older sibling bouncing Tigger-like on the couch and telling us how they once had a fire engine and an ambulance come to school. I ask to take a look at the baby, and mum hands him over. A quick check, a listen to the lungs, a look at skin colour, an assessment of mood, and everyone's happy that a disaster has been averted.

We offer to transport mum and baby, and discover that Tigger will have to come with too, as no-one else is around to babysit. Mum wants to go, just for peace of mind, and I can understand. I stay holding on to the baby whilst newbie writes down all the details necessary and mum gets organised with all the essentials. The vast majority was already packed in a baby bag, and it just involved getting dressed and making a bottle.

As soon as we were ready to leave, I try to give the baby back to mum. He clings and refuses her outstretched arms. Flattered I may be, but now we have a problem.

"Well", I suggest, unlooping the ambulance keys from my belt and handing them to mum, "I guess that means you're on driving duties!"

I tried, didn't I?

A normal residential road, cars parked either side, and a 20 miles per hour speed limit enforced by signs and re-enforced by speed bumps.

I look right and left, see nothing, but hear the screaming engine and decide to wait. The two delicately balanced trays, full of sandwiches, aren't worth risking for the few extra seconds I decide to wait as the car appears round a corner, probably doubling the speed allowed on this road.

No more than ten paces to my right is one of the speed bumps, and the engine is slowed through the gears so that the lowered suspension has every chance of making it over without the raised hump of traffic-calming tarmac causing any damage to the precious undercarriage.

In those seconds, they see me, and the sandwiches.

And as they arrive beside me, they stop.

"Any of those for us?" asks the passenger, a giggly, over made-up and unrestrained girl of probably 18.

"Only if you and your friend buckle up and promise not to drive around like idiots", I reply.

They look at each other, and laugh.

"Nah", says the passenger, "we're not really that hungry!"

Their raucous laughter is soon drowned out by their tyres, as they screech their way down the road.