Tag: UK

A Decade – part five

Needless to say, I got accepted.

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Once the lazy, uninterested kid at school, this was different. I dived in to the study. I would be in the library until they kicked me out for closing times. I would relisten to whole podcast lectures, write them out, just to understand and learn the material. I would organise group learning sessions, because I best learn in a group (pure selfish tactic really, but it’s a great social and educational tool too!). I dedicated most of my life that year to my first year of study. And it paid off, achieving highest marks, but more importantly, I knew that I had found something what I want to do, my vocation, my calling.

What followed from there on…well, I don’t really need to write it all down again – because that is when I started this blog.

More than five years have passed since I started as a Student Paramedic, and it is coming up to two years since I graduated as a Paramedic. Nearly a year ago now I gained my UK Paramedic Registration after making the decision to move to London, England. And ten years since I first set foot in an ambulance, which set off a series of events, more than I had ever anticipated.

A big “Thank You!” to everyone who has been, is, and will be on my journey!

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Emergency Services Show 2012, part I

Well, I was going to present you with these three posts shortly after the actual event, but instead found myself in hospital. Please send your disappointments and hatemail to Mr In.fectious Mononucleosis, 16 Swollen Tonsil Street, Throatland.

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Last Wednesday and Thursday (22nd and 23rd of November 2012) I went to the annual Emergency Services Show in Coventry, West Midlands, UK.

Impressions as a first time visitor? Quite large, mainly geared towards fire and rescue services (a lot of big red trucks and fire retardant clothing, but together with law enforcement products there was a not insignificant amount of Paramedic and healthcare-related stands.

Here are some interesting products I came across. For the record: I don’t take any money from anyone, everything showcased here are goods and inventions that I found interesting, listed in alphabetical order:

  • The Corpuls 3 monitor sports an interesting concept: it can be broken up in to three parts, namely the monitor, the cable module and the defib module – all linked via Bluetooth. Apparently great when carrying patients down stairs, I’d want to try the system out for myself. Corpuls isn’t a well known brand in the English speaking world (yet?), but is widely established in the German part of the world – the current ambulances in Frankfurt/Main (where I started my EMS experience as a volunteer) has them, and seem to be happy with them.
  • Jones & Bartlett Learning: A new “Emergency Care in the Streets” from Nancy Caroline is supposed to come out next year. They have also taken over the publishing for the UK national JRCALC guidelines, due to come out February 2013. A variety of interesting books, presented with smile. Remember, College of Paramedics members receive discounts!
  • Prometheus Medical Ltd has a new SPHERe (Specialist Pre-Hospital Emergency Resuscitation Course) on offer, based on structured information gained whilst analysing, structuring and vastly improving cardiac arrest outcome in the Edinburgh/Scotland area (more on this on the CPD post shortly)
  • The UK Home Office Centre for Applied Science and Technology (CAST) had a stand too – interesting to know how the government is involved (not having lived in the UK before), and how they help out the emergency Services. For example, it was explained to me all emergency vehicles are checked by them for electrical interference (radios etc). There’s much more to it though, check out their website.

Unfortunately, the stands of JESIP (Joint Emergency Services Interoperability Programme), and the AACE (Association of Ambulance Chief Executives) were unmanned when I walked past. I looked around for anyone in the know, but no show. Disappointing, but there were some brochures with weblinks for more info. Remember, I’m new to the UK, a show like this is a great way to get to know how everything works, and what governing and advisory bodies are in place. An unattended stand (without even a notice) is a bit of a let down, and doesn’t convey a good message.

There was obviously much more stuff at the show, but many of the details unfortunately got lost as my virus started attacking me the minute I was on the train home. To find out more? You’ll just have to come next year!

In the meanwhile, here are some pictures:

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There were big cars…

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There were little cars…

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Cars that look like balloons

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Cars so mean they need to be fenced in

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Cars Boats so comfortable that Fluffly Huskies rest their tired heads on them

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Looks like a normal Firetruck…

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…but it’s a rolling Social Media advertisement!

 

a look around.

Jumping spider, via http://www.fotopedia.com/items/flickr-3634381424

Intermission over. Semester over.

Return to work. Work to return?

Back to business. Business as usual?

I needed some (blog) time out. I applied myself hard (those of you following me on twitter got a glimpse of the uni topics covered and info shared), and the hard work paid off. My routine was work, eat, sleep. Days off consisted of study, eat, sleep. Enjoyable, but only for a certain amount of weeks until relationships are strained.

Today is my antepenultimate day of work. Three shifts left prior to moving. Overseas, that is…the UK to be more precise! Rhymes and reason to follow next week!

Busy times are gone, let the busy times begin!

Beer, Balloons and Birthdays

On one of the first nights of my trip I met up with the InsomniacMedics (@InsomniacMedic1 and @MrsInsomniacMed) and Melph (@Melph, who works as a LAS dispatcher) for a round of drinks, hellos, welcomes and stories. Was great meeting people in person that I had been in virtual contact with for ages, putting faces to names!

I told you, don’t put the Ice Cream Van in the dryer!

The night went on, the pub got louder, the glasses emptied further, and all of a sudden I found myself being a lucky and proud new owner of a fabulous toy! A bunch of friends were exiting the place, when this girl walks up to me, enthusiastically remarks: “here, have this!” and thrusts a balloon towards me.

Hmm.

“A balloon?” I hear you remark nonchalantly.

‘Twas no ordinary balloon though, let me tell you! A rather large, firm, transparent balloon, with a hint of flour inside, just enough to gently dust its innards. Resting inside was a two pence coin in mint condition, also gently dusted with flour (well, we assumed it was flour). What the heck? A quick demonstration yielded results: hold balloon on the pointy edges (not that a balloon has pointy edges really, but, you know, the bits at the knotty end and opposite the knotty end). Then shake the balloon up and down vigorously – the coin will spring to life, and enthusiastically spin round the balloon, leaving little tracks in the flour. Simple things for simple minds, but we were all highly entertained. Chance had it that two minutes later the group sitting two tables down suddenly broke out in a cheery ‘Happy Birthday to you, Happy Birthday dear Kerry!’. So, in true ‘caring is sharing’ fashion, I grabbed the balloon, wandered over to their table, and asked which of the lasses is Kerry. She owned up, and I presented her with her very own “pence in a balloon” action toy. To say she was happy would be an understatement, they whole group was thrilled to bits. I live to give 🙂

(Very) short Demonstration of a slightly over enthusiastic and manic student paramedic with a balloon.

The night carried on, exchanging stories from our cities, countries and services, first trying to trump each other (“12 leads? had them for ages!” “Yeah, but we have Ketamine, ha!”), then trying to persuade each other that our service is actually worse than the others. Strange how we hoomins roll…

Another great thing that happened that night was more of preparational nature: firstly, the night shift with InsomniacMedic was sorted out (here and here, if you missed it), and secondly, I was cordially invited to meet the control room staff over a glass of water later in the week. How good that glass of water tasted is a whole different story in itself…

 

LASting Impressions

Twenty aspects of the London Ambulance Service

  1. General: The London Ambulance Service (LAS) is the largest free ambulance service in the world – and quite a busy one as well, as you can imagine. Attending over one million calls a year, covering 620 square miles (1600 square kilometres) of Greater London, this is achieved with 900+ ambulances running out of 70 stations, with over 5000 mostly front line staff.
  2. Vehicles: Ambulances are not the only vehicles used to respond to 999 calls (the UK wide emergency number) – the LAS use cars, vehicles and bicycles as well for fast response; allowing paramedics to cut through heavy london traffic a little better, and also spreading resources over more vehicles.
  3. Cleanliness: Being such a busy service, staff don’t have much down time to clean the vehicles – and it showed in some of the cabs: dust, scratches and grit on the dash and instruments. One could see that they are constantly on the run, wear and tear slowly gnawing away at them as they are subjected to the harsh life of emergency response. In response to this, the LAS now have their ambulances cleaned by an external company – not as often as some paramedics would like to see, but a burden off their shoulders nonetheless.
  4. Tiers: Talking of paramedics – not all frontline staff are called so. There are different levels of tiers. Starting at ECA (Emergency Care Assistant, or A&E Support in the LAS), this is the basic level of ambulance training including CPR and Oxygen administration. These crews generally do low acuity jobs, but are also used to back up higher level crews on emergency calls. Next level is the EMT (Emergency Medical Technician, or just ‘Technician’) – a generally dying breed around the country, as not many EMT courses are held anymore. Skill level is intermediate, excluding any invasive skills. Highest level amongst the LAS is Paramedic level. London has (unfortunately) recently stopped employing Emergency Care Practitioners (ECPs) – which were specifically skilled for low acuity calls (such as wound assessment and management, falls with minor injuries), and trying to keep such patients out of hospital, thus saving resources and money. For major trauma cases, paramedics can request HEMS (Helicopter Emergency Medical Services) – the london air ambulance, which is staffed by a doctor and a paramedic, and is based at the Royal London Hospital. Alternatively, a BASICS Doctor (British Association for Immediate Care) can be called if they are available. These are doctors with additional pre-hospital qualifications that volunteer their time (see RRDoc blog). Yes, that’s right, you can call upon a doc if you need them, and they happen to be available. Not my way of organising care, but I’ll leave that for possibly another post.
  5. Clinical Guidelines: As the LAS is a NHS trust, they follow the clinical guidelines of the JRCALC. Generally evidence based, I heard a few disgruntled voices that they are not being updated often enough. Fair enough, the online version does state 2006 (thats five years ago!), but it has had its fair share of individual updates. I personally think it is great that there is a central resource for clinical guidelines in the UK.
  6. Clinical Governance: Didn’t get much exposure to this – they work during the day, and I was on at night. Staff I chatted to hadn’t had much exposure to them either, which didn’t sound too promising I must admit.
  7. Fatigue Management: Generally twelve hour shifts are done in London – working frontline ambulance staff are pretty much on the move for the whole twelve hours. Official rest breaks are given if possible where crews are only to be called on highest priority jobs – but this is not always possible due to lack of resources – instead, they work through the shift, are allowed to knock off 1/2 hour early and receive 10 pounds extra pay that shift.
  8. Occupational Health & Safety: Seems a big thing in the LAS, with all ambulances having pneumatic tail lifts – no lifting necessary! On higher priority calls, a rapid response car and possibly a second crew will be sent, so there are (generally) a multitude of hands at the ready for complicated extrications.
  9. Working Conditions: Mediocre, compared to Australia. Pay is below nursing level, maxing out at roughly 30 000 pounds a year (depending on shift pattern, hours worked, what station etc. Quite complicated). Holidays are 27 days a year (decent IMHO). Rostering is done on a station and individual basis – as you know, InsomniacMedic only does nights on the car, others only do days, some do mixed….
  10. Relationship with other services: Good – similar to other countries I have found. Great working relationship with the police force, somewhat crew and day dependant with the fire brigade. The LFB don’t attend medical calls. Generally great working relationship with the hospitals, both professionally and socially.
  11. Response Times/Distances: Here’s a can of worms that I shouldn’t be touching…so I will just link a website: Clinical Quality Indicators
  12. Cost: Free to the end user, all covered by the NHS.
  13. Station Duties: In theory, keep things tidy. In practice, enjoy the precious few minutes on station with a cup of tea, as crews are out most of the time.
  14. Hospitals: The few bits I saw: Can’t complain. Saw some strange driveway arrangements, but apart from that, it was all friendly, clean, and most fairly modern. Ramping/Bed Block has dramatically decreased over the past few years, it got quite bad 2-4 years back I was told. The staff all seemed professional and caring, the little interaction I had with them
  15. Registration: Is covered by the Health Professions Council (HPC), and only applies to Paramedics. To keep your registration, proof of continuing education via attending courses, reflective practice etc must be documented. Generally Paramedics saw registration as a good thing to keep standards up, even if it was not policed enough.
  16. Equivalency of Qualification: For those of you who want to work in the UK (apart from having to sort out immigration), firstly you will need your HPC registration if you are going to work as a paramedic – then you can apply with one of the 12 ambulance services in the UK. But, as InsomniacMedic points out, getting a job in the LAS may prove difficult in the next few years…
  17. Drivers licence: You’ll need an EU C1 truck licence, as the ambulances weigh more than 3.5 tonnes.
  18. Foreign Paramedics: There are plenty of them around, with London being such a multicultural city you’ll fit right in. I couldn’t even get away from my own brethren – at one scene the paramedic was Australian…
  19. Respect amongst the public: Not as high as in Australia (where we are the most trusted profession seven times in a row!), but people still occasionally give way to ambulances even without their lights and sirens activated (a strange phenomenon)
  20. More DetailsOfficial websiteWikipedia linktwitter account

Any additions, corrections or questions? Feel free to add a comment, or contact me via the ‘Contact!’ link above.

A night out on the town: an observer shift with InsomniacMedic (part II)

…and after a bit of thinking, the memories come flooding back to me – ‘Railway Panic’ and ‘Onion Allergy were the answers I was looking for. I won’t waste too many words on the latter – if you reckon you have an onion allergy, don’t eat onion salad. Quite simple really.

The former though was an interesting job – hyperventilation at the train station, and what a hyperventilation that was! Had never experienced it in such and extreme, even IM admitted that he placed this at the top end of his experienced hyperventilation scale. IM did the whole talking/calming/medical bit while being pawed, then grabbed, and finally hugged by the panicked patient. I diplomatically shifted out of her reach, and moved the partner out of the way to ‘get some details’, which calmed her down a little. The crew arrived, and patients partner and myself went back to the patient for the handover – only for the hyperventilation (and the hugging) to flare up again. I took said partner again to ‘get some more details’, and the situation finally got under control. Panic attack, or possibly a metabolic disorder – or something entirely different? We’ll never know. One of the downsides of working on the car; it makes following up on patients that little bit harder. All in all, an interesting job to attend though!

The next job just reaffirmed that everybody loves IM. After being hugged at the train station, the next patient (an ever so slightly inebriated feller) commented how smart he looked. Unfortunately moods change quickly, and after accusing IM of having connections with the Russian, Israeli and Polish secret police, this newly found friendship ended as abruptly as it had began just three minutes earlier.

Our last job was noteworthy too: Called to an elderly patient, feeling generally unwell over the past few days, deteriorating steadily until the family thought she really needed to be seen. Indeed she did, but more by medical people than the two police cars that came racing to the scene just as we pulled up. Why they had been dispatched? We don’t know, and neither did they. They had just been sent. They marched upstairs with us, and promptly marched back down again when it was clear that they had been sent in error.

We hadn’t though, as our patient wasn’t looking too good at all – awful colour, altered conscious state and all other little signs that send little alarm bells ringing in your head. Rapid extrication down some narrow and steep stairs, and a few minutes later the patient was on the stretcher in the ambulance, getting the full workup – only to go in to cardiac arrest. You know that extra pair of hands you always wished you had on a cardiac arrest? That was me. “You happy staying in the ambulance to do CPR?” I was already getting in to position, and seconds later, was cracking the poor patients ribs. Makes me cringe every time, horrible feeling, those first few compressions. Urgh. Again, never got the final outcome, but an interesting job to be involved in!

Spot the taxi!

Dawn was quickly approaching, and we were sent back to station for the last part of the shift – we were both tired at that stage, and my eyelids were becoming pretty droopy.

Here’s a summary of jobs we did:

  1. ?? (stood down)
  2. OD & ETOH (stood down)
  3. Fainting & ETOH (stood down)
  4. Chest Pain (stood down)
  5. Faint (stood down)
  6. Panic attack
  7. Drunk bloke with a cut to head
  8. Chest Pain
  9. Onion allergy
  10. Abdo Pain (stood down)
  11. Generally unwell turned resuscitation.

 

Back on station for the last hour of the shift, another similarity struck me. IM and myself both have developed the great genius of answering secret telephone calls for other people on station. The difference being that in Perth, they call you  on the defib batteries; in London, they call you on the TV remote.

– ~ –

A big thank-you for everyone I met in the LAS that night for making me feel welcome. Great chatting to you.

And of course a massive thanks to Mr InsomniacMedic for organising the shift and taking me out!

A night out on the town: an observer shift with InsomniacMedic (part I)

The tube is packed, brimming full of commuters who are heading home after a long day at work. I blend in with the masses, the only thing potentially giving me away that I haven’t spent my day at a desk is the stripe of reflective tape on my dark green uniform trousers – people probably think I am a street sweeper. The train snakes its way through the tunnels, passengers swaying gently from its sidewards movements. All doing the standard practice amongst busy public transport worldwide; people keeping to themselves, hiding in their own worlds by means of books, headphones and blank stares. All unaware that instead of coming from work, I am on my way to work. Well, not technically work, as I’m on holiday. Maybe an adventure holiday of sorts?

I’m on holiday for a reason: to relax and recover from the stressors of work, and catch up on some sleep that shift work has robbed me of. What better way to achieve all of the above by going out on a night shift in one of the biggest and busiest cities in the world? See, just my point.

Apparently it was a typical night out, with communication breakdowns being an integral part of the shift as I struggled to exchange words with patients. We were either cancelled (~54% of calls), and didn’t get to see them, or thick foreign accents and a poor grasp of the english language prohibited clear communications (~36% of calls). One the patients was in cardiac arrest (~10%), which didn’t help much either (dead people don’t tend to be too talkative anywhere in the world it seems).

But let’s start from the beginning. I met Mr InsomniacMedic (hereafter known as IM) at his his ambulance station, where he was dutifully checking his bags for the upcoming shift. We jumped right in to it, IM showing me what he carries whilst on shift, whilst I dutifully munched on a banana (he hates the things). After a brief introduction to the station, its surroundings and inhabitants in green, we were ready to go…if the car had have been there. The day shift paramedic was on a late call, and was delayed bringing the vehicle back. Too bad so sad, time for a cup of tea for IM and some answers from me: What the heck is an Ambulance Officer? I had genuinely confused the crews with my uniform and its associated emblems: Officer is a rank that designates a managerial position within the London Ambulance Service (LAS); was I some sort of manager seeing how things were working out on the road? But why is the uniform different, with all that reflective stuff…new uniforms begin introduced? Upon closer inspection: St John Ambulance Shoulder Patches – are you a volunteer? What are you doing in London, how long are you here, is it part of an exchange programme, where are you off to next, how do you like it here, how do you know IM? The last question proved to be tricky on occasion, I reverted to tactical silence and let Mr IM tell his colleagues we were either pen pals, or if they knew about the IM blog, that we were blog buddies. IM isn’t too fussed about secrecy in regards to his online precence – he just doesn’t want people to make a connection between the virtual IM and the real IM.

Educational poster at the station 🙂


The car is still not on station, but there is more to be explored. One of the Hazardous Area Response Teams (HART) are at the station too, and IM organises a quick tour with one of the HART team members. We don’t have anything similar in our service, but had read dribs and drabs about HART – so it was great to see the ins and outs of the trucks, what their area of deployment is et cetera. Basically they are their own self contained medic units wit breathing apparatus, CBRN suits, generators, Geiger counters, life jackets for water rescue, CO detectors. And bulletproof vests – the HART team are the tactical medics amongst the LAS too! Admittedly, they don’t get many call outs, and can get through night shifts without leaving the station, which makes them a great target for collegial jokes of being lazy, but – as a few paramedics point out – when the faecal matter hits the ventilator, the HART team are going to be right in the hot zone earning their money, with the rest of the service looking at them through binoculars from a safe distance. A place preferred by many.

Hart to Hart


The last bit of HART equipment had just been shown and explained to me when, by perfect timing, Mr Dayshift brings in Mr Vauxhall for another 12 hours of punishment, a.k.a. our Rapid Response Vehicle for the night had arrived. IM has been working permanent nights on the ‘car’ as it is known here for many moons now, and loves it. Initially hating the solo response and night shifts, it was the only way of managing family and work comfortably. Out of necessity came toleration, followed by appreciation of this shift pattern – nights bring out special people, roads are generally clear, and the emergency lights make  funky patterns and shadows as they bounce off the surrounding cityscape. We definitely have something in common.

IM and myself got talking about spelling errors. Seems the LAS is not immune either!


We grab the car, have a brief chat to the day shift medic who seems like a thoroughly nice but mad bloke (must be an entry requirement). This is one thing that struck me very positively in the LAS: everyone was really welcoming, chatty, and interested why I was there. Seems everyone knows at least someone in Australia, or has been there on holiday, and was super keen to compare experiences. Professional comparisons were also very interesting, comparing organisational structures, skills, meds and of course my uniform (which was well received!).

Our office for the night. And a shot of IMs leg…pure hawtness!


The car is in a bit of a state – it has seen better days. I am told (and later experience) that everybody is so busy that there is hardly time to give them vehicles a clean – but then again they do get external cleaning agencies to mop their vans which is a nice thing 🙂

IM quickly explains the interior gadgets (SatNav, radios, job screen, procedures) to me, and leaves the best to last: the gloriousness of the electronic air horn!

Yup, his boots are as polished as he claims!

 

As our bags were checked, off to our first standby point it was, which for memory we didn’t reach. Somebody, somewhere had dialled 999 and we had been automatically activated as the closest vehicle. We never found out who called, and why – we just got told an address to go to. No priority, no details, no name, no nothing. Bit dodgy if you ask me, sending a single paramedic to an unknown scene. Violence and knife crime is not unheard of in London, and crews tell me they frequently drive past addresses of calls like these until more details, another ambulance, or the police arrive as well. I should mention that we did ask for some details regarding this job – but whilst waiting for them, we were cancelled. Next job was similar – automatic activation, but this time we actually got some details about the job. Unfortunately the route we were sent on was blocked by a locked gate (two minds, one thought: WTF?!). Whilst finding an alternative route on the map, we were cancelled. In fact we were cancelled on the first five jobs.

Judging by my notes, further jobs included a ‘Railway Pume’ and an ‘Onion altney’. Maybe I should check my handwriting…

 

to be continued, stay tuned!

 

Highlander

Last hour in Edinburgh, and going back to my roots having a continental breakfast. I’ve ditched the attempt of adopting local culture (which I suspect isn’t local culture at all) of having haggis for breakfast – I’m not convinced.
I am convinced though of the natural beauty of this country, the layers upon layers of history in this little city, and that I will be back for a visit – still have a whole heap to check out. In the mean time I shall read some great Scottish writers such as Robert Louis Stevenson and Ian Rankin.

And did you know that the Scottish apparently invented skyscrapers? These 15 story high medieval complexes regularly crumpled down in a heap of rubble, but hey, it’s an attempt.

Big thanks to Kal from Trauma Queen for showing me some of the night life both on and off the job, to ChineseCallum from BrewDog brewery (www.brewdog.com) for introducing some bloody good brews to my palate, to the Digitals for a warm welcoming and a glass of water, and to BamBam for another glass of water and a couch seat. No thanks to the nosy bloody cat though – get yer nose out of my chocolate croissant!

Enough, gotta catch my train. More to come once I have a) slept more and b) have a full sized keyboard.

Tales from a remote island

So remote, in fact, that the inhabitants have developed such strange and unique habits such as drinking tea, speaking with funny accents and honestly believing their football team will beat Germany in the world cup.

Yes, I’m the the UK. I’ve walked all over London, met up with some lovely paramedics, done a night shift with InsomniacMedic, met up with Jim from the British College of Paramedics and am now sitting in a cafe in Edinburgh, eating haggis for breakfast and writing up my experiences:

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Segue

Hello!

Moving right along from my last post, I would like to announce my way of making sure I keep sane, seeing ‘the big picture’.

I’m coming to see YOU!

Holidays are quickly approaching my republic. I thought travel would be a great way to spend my time. Plus, I thought to myself, I would try to turn as many virtual acquaintances in to meeting and seeing the real person behind all the text they write. So, dear tweeters and bloggers – if you want to know what a real Australian looks like, your out of luck. But I am able share some great insights in to Australia (yes, including the the ambulance service), and can come up with a bad joke or three if required as well (check my facebook profile as a repository for them…).

I might even bring my pet kangaroo Skippy with me, and whack a croc meat steak on the barbie, if quarantine allows…

If you’re close to any of the following cities at or around the following dates, give us a shout (comment, email, tweet or telex). My travels will be taking me to the UK first, and InsomniacMedic and I have organised a tweetup in London for the 4th May, exact location to be confirmed. I will be then travelling up to Scotland (why? why not! Kal seems to like it there), and hopefully stopping on the way somewhere, maybe Newcastle if Mister and Mrs 999 are around!

…and then I’m off to the US and Canada – again, let me know if you are around, and what date suits you best!

  • NYC: around the 17th of May
  • Toronto: around the 21st of May
  • San Francisco (hopefully with Monsieurs Schorr and Setla): around the 25th of May.

Oh, and if any of you need a hand on a shift, I’d be thrilled for a ridealong!

See you all out there under the CoEMS banner 🙂