Ambulances

I've been riding around a lot in ambulances recently. I remebered an earlier blog about ambulances, back in 2019. I re-read it and it's much better than this one. It flows more easily and it's reasonably interesting in a Big Chief I-Spy sort of way. The sort of simple information with which you can amaze your friends and confound your enemies. So far as I can see there have been no basic changes to the legislation since I wrote that blog but that didn't stop me publishing this rewrite.

This piece is about the ambulances that are contracted by the Generalitat Valenciana, the Regional Government in, the region I live in. Every now and again Valencia put a contract out to tender and anyone interested enough to bid has the potential for providing the ambulance fleet for the requirements of the region. There are other ambulances, private and NGO ((Non Governmental Organisation). The private clinics and hospitals need ambulances to move their customer/patients around and other groups, for instance the Red Cross, run ambulances which can be hired out to provide part of the safety cover at events from half marathons to encierros.

There is national legislation about the construction, status and identification of ambulances and within that legislation there are some regional variations but, in general, everywhere follows a similar sort of classification which is pretty simple, pretty logical and easy to understand.

The first thing is that, discounting helicopters, rapid response vehicles and the like there are two broad classes of ambulance - those that can provide medical care en route, classes C and B, and those that don't, Class A.

The non-care ambulances, classes A1 and A2, are used to transport ill people around and are not designed to offer medical care to patients en route. These are the ambulances that take people to rehab sessions, to visit physiotherapists and the whole range of appointments at hospitals, outpatient clinics and the like. In the legislation these ambulances are divided into those that transport people on stretchers and those which are collective transport but nearly all the ambulances I've been in over the past six weeks have been halfway between. They have space for one stretcher, space for a standard sort of wheelchair and six or seven individual seats. They also have things like oxygen and defibrillators on board. The drivers will have a qualification as drivers and as first aiders having done a course that lasts about 350 hours. Sometimes these ambulances bear the letters TNA for non assisted transport. These ambulances are predominantly white in colour and have side windows in the rear of the van. 

The Assistance ambulances, class B or class C, are equipped to take care of sick people en route. These are the ambulances that will turn up if you dial the emergency number 112. There are a range of other numbers but 112 is the foolproof one for any emergency service.

The Class B or SVB ambulances are designed to provide basic life support. As a minimum they will have a crew of two, the driver and another person both of whom will have at least the Emergency Health Technician, TES in Spanish (Técnicos en Emergencias Sanitarias) qualification that requires a couple of thousand hours of study over a two year period and with regular updates and refresher courses along the way. These ambulances are SVB, Soporte Vital Básico (in Castilian) or Suport Vitál Basic (in Valenciano) and those letters are usually very obvious on the side of the ambulance. They carry a lot of medical kit on board.

The Class C or SVA ambulances (Soporte Vital Avanzado or Suport Vital Avançat) are designed to provide an advanced life-saving service. Again these ambulances will have a driver who holds the TES  qualification and, at least a qualified emergency nurse. The course to become a nurse in Spain is a four year university degree course. Most SVA nurses also do a further two years masters in nursing on top of the basic qualification. On occasions the nurse may be replaced by an emergency doctor or there may be three, or more, crew on the ambulance. A Spanish SVA Doctor will have done six years at university, a couple of years on a Masters in Emergency Medicine and another four years or so on a specialism like cardiology or intensive care medicine. By the time we're at that sort of staffing level we're into ambulances which are "medicalizadas", they're basically intensive care units on wheels and will sometimes bear the letters SAMU Servei d'Ajuda Mèdica Urgent, Servicio de Ayuda Médica Urgente Urgent.

It seems to me, though it may not be a figment of my imagination that as the ambulances become more serious the colour scheme utilises more yellow, there are still the red roofs and red lettering but the SVA/SAMU ambulances have swathes of yellow while the SVB only have a band of yellow colour.

One last thing thing came from chatting to one of the drivers who normally drove B and C class but had been drafted in for the transport ambulances to cover a sick colleague. It was about the use of lights and horns. If it's a real emergency, urgencia in Spanish because we lay folk know when something is urgent but it may or may not be an emergency, they will put the blue lights on but they really only use the horns to protect themselves when, for instance, crossing red traffic lights. The driver told me that time after time Spanish drivers would react in a very haphazard way if they suddenly found multi tone horns behind them and, as well as drop their mobile phone, they might do any sort of daft thing - so, better to arrive safe and a bit later rather than be the first vehicle on scene having been involved in another road traffic accident.

Using your loaf

I thought I might write a blog. Then I realised that nothing has happened to me for days so I couldn't. Later, as I pottered at some unremarkable task or another, it came to me that I knew a story, dated from the year 1305, about a Scottish bloke watching a spider. If that was enough to pique people's interest maybe I could think of something. So, here it is.

Yesterday, as I sorted the recycling in the rain, someone papped their horn as they passed the gate. Now horn papping is currently a big event in Culebrón; worthy of investigation. I duly investigated. It was a white van and our next door neighbour was buying something from the driver. I kept my distance but I wondered what he was selling. Instead of asking in person I asked via WhatsApp. First I asked a British family who live on the other side of the main road, the one where they disinfected the streets today, if they knew anything about travelling shops. When the response hadn't come within an hour or so I sent another WhatsApp to the Spanish family next door. They told me it had been a bread van coming in from Pinoso.

My search for new challenges, for novel experiences, is almost boundless. Obviously ordering bread via WhatsApp just had to be tried. Tapping out my order I suddenly realised that I didn't know the names of a particular sort of loaf I wanted. This is not new. I had the same problem in the Waitrose in Huntingdon about 20 years ago when I (apparently) wanted a Farmhouse Bloomer. This time though I couldn't point. It was a very long WhatsApp message to get an ordinary sort of loaf and a couple of breadsticks. The comparison with the bloomer still holds. "Please can I have a brown farmhouse bloomer?" versus "Please can I have that large brown crusty loaf with rounded ends and parallel diagonal slashes across its top?"

The British family responded in time. They didn't tell me about Javier the baker though, they told me about Augustine and his travelling grocer cum greengrocer's van. Bread on Monday, Wednesday and Friday, groceries on Tuesday and Thursday.

Like a magician I revealed all of this to Maggie. Well a van from Carrefour (a huge French owned supermarket) passed the other day she said. There seems to be just so much that I don't know about shopping in Culebrón!

And something completely different to finish. I was talking yesterday to a bloke who lives in a nearby village called Cantón. The official figure for the population of el Cantón is 103 but I'd be amazed if that many people actually live there all year around. Nonetheless my pal says that in the village, as nearly everywhere in Spain, every evening at 8pm the neighbours get out on their balconies and back patios to applaud, shout and generally make noise to show their support for the people keeping us going at the moment and particularly the health workers. I'm sure it happens in Culebrón too but we're too far away to hear or be heard.

Heart in the small talk

I'm a sucker for gestures. The bit in Casablanca, where Laszlo says "Play the Marseillaise, play it!" and Rick nods, and they do, and they out-sing the baddies always makes me tear up.

I was just watching a video of someone called Gustaf Farwell banging out Nessun Dorma from his balcony in Barcelona just like Gavinana Maurizio Marchini did in Florence. Every time I watch the TV news I see health workers applauding patients coming off ventilators, I see the people clapping to cheer on the lorry drivers, health workers and everyone else who is keeping us going. It's good and positive. I even approve of the glossy videos being put together by the banks and supermarkets so that we identify them with the white hats when the time goes back to shopping and opening accounts. Lots of gestures.

I'm not so keen on the complaining. Complaints are often justified, I enjoy a good complain myself, I complain a lot, there are plenty of daft buggers in the world and plenty of stupid processes to complain about. The problem is that picking fault with everything and everyone isn't really that useful as it's happening and unless there's something to be done about it.

I had a headteacher when I was at secondary school who was as stupid and as pompous a little man as you could ever wish to meet. He did, though, habitually defend (what was then) British Rail with what I considered was a sound argument. It's all well and good, he said, complaining when the points freeze and the trains are thrown into chaos for a couple of days every February and pointing out that in Sweden they have heated points but the truth is that the conditions are different, the situation is different and if British Rail did spend millions on installing heated points then someone would point out the waste of money.

It does seem to me that, once the game is on the best you can do is the best you can do. Obviously when it's all over you can do a bit of finger pointing and calling to account. Maybe things can be improved so that next time the mistakes are different ones. In the meantime I'm all for the gestures of solidarity. To the politicians trying to do their best, to the health workers being forced to manufacture protective clothing from bin bags, to the volunteer food deliverers, to the celebrities giving money, to the people sewing masks or using their 3D printers to produce ventilators, to the cleaner in the old people's home who has decided to stay on, to the singing and non singing police officers and to those people who can't do those things so instead they organise an online yoga session, dress up as dinosaurs on the balcony, shout Happy Birthday across the street or make uplifting YouTube videos.

But I never do have the time

Do you know that Louis XVI wrote Rien, French for nothing, in his diary, on the day the Bastille was stormed? That was 14th July 1789, one of the key days in the French Revolution and one of a series of events that would lead to Louis losing his head. If you do know you'll probably be aware that it was an entry in his hunting diary, to record the number of animals he'd caught, but it's a better story if you miss that bit out.

My diary for yesterday could say nada, Spanish for nothing, though without any reference to the unspeakable in pursuit of the uneatable. Well not really nothing. I drank several pints of tea. In fact I'm drinking so much tea at the moment that I've stopped flushing every time because our cess pit only has a capacity of 2,000 litres and we could well fill it really quickly if this quarantine continues.

Reading too. Actually the two things go together, drinking tea, sitting close to a gas heater and reading. I nearly always have a book on the go but normally it takes me a couple of weeks to finish one, maybe longer. I'm on my second since we've been in confinement and I read about 100 pages yesterday. For me that's a lot. It looks as though my new Javier Cercas book is going to last me four days though it's possible I might knock it off today, day three. I probably have a book, a book with paper pages, waiting for me at the newsagent in Pinoso but, at the moment, five kilometres is a long, long way. Thank goodness for Kindle.

Watching the news too. That's become a key activity. The 3pm news on one channel and the 9pm new on another. The bit I enjoy best are the little uplifting stories. Normally I'm more of a radio man and "newspaper" man. I usually listen to the radio, live or as podcasts, as I do those household jobs or drive from one place to another but I only seem to be listening to the radio in the morning at the moment. It seems odd considering that I have more dead time. That could be because the heavy rain of the last few days has kept me out of the garden and weeding and listening go so well together. It's the same with reading news. I've kept up my consumption of Spanish news in written in English but reading Spanish news in Spanish has definitely tailed away.

Evenings it's Netflix, Amazon Prime and broadcast telly but a lot less than I would have expected. I have joined Maggie in watching the British News though which is something I don't usually bother to do.

Occasionally, I pull out the little book that I use to write down new Spanish words and I have a few minutes trying to unsuccessfully memorise that new vocab. Twitter and Facebook and WhatsApp are there all the time. I still haven't worked out Twitter properly, following threads can be very difficult, but I've been using it quite a lot over the past eleven or twelve days. Facebook meanwhile is full of rules and regulations and information from Town Halls and police but there are even more cute animals, clever quotes and hoaxes than usual. More hoaxes than anyone could imagine. I noticed that I was getting the same hoaxes in English yesterday as I've been getting in Spanish for days.

You will notice there are no chores, no jobs around the house, no catching up with painting. Thank goodness that hasn't changed.

And, blogging of course. Even though I've nothing to write about.

Surprisingly unsettling

I've just been into town.

There's a video doing the rounds on social media of a woman runner scuffling with a couple of police officers in Madrid. We don't see how it started but the woman is screaming blue murder and shouting for help. The comments on the sound track by the person taking the video and from the neighbours on the adjoining balconies are not supportive of the runner. A loose translation might be something along the lines of "Smart arse, you should have stayed at home - you twat".

We're fine in Culebrón. We have space, inside and out, there are only the two of us plus the clowder of cats. Since I went to the supermarket on either Monday or Tuesday I haven't been outside the front gate. The time has passed quickly though and I'm not finding time to do enough reading despite apparently having endless days in front of me.

I see on the telly, hear on the radio and read in social media that, in Spain, the place where I live, people are facing the hard times with determination and with humour. The examples of moral support, such as the applause for hard pressed medical staff or the concern for the lorry drivers who are keeping us all going but can't get a cup of coffee or anything to eat along their route, are legion. There are almost endless examples of good, decent action like shoe workers turning their machines to sewing medical masks. Not everything is positive though. There are plenty of selfish people too. Runners seem to be right up there and I've seen lots of Facebook posts from local police forces reminding people to be civically minded and to comply with spirit of the current rules. A simple example is that people are choosing to get their bread from a baker on the other side of town as the cover for a bit of a stroll. There are examples of lock ins in bars and I just saw a video (photo on this post) of the traffic jams out of Valencia city on Friday evening as people headed for their "holiday homes" content to risk taking the virus with them and happily flouting the one person per vehicle instruction. There are still some politicians crass enough to think that now is also a good time for point scoring.

I know which side I want to be on. But we had no eggs, bread, tomatoes, peppers or juice and our alcohol stocks were down to strangely coloured liqueurs and the wine in plastic bottles. The cats also seem to have remarkably healthy appetites.

Shopping aside there were a couple of other reasons for leaving the house. One of the things I've found time for over the last couple of days was to sort through my old English teaching materials looking for stuff to throw out. That had added about 20 kilos of paper to the usual recycling stash of cans, cartons and bottles sitting by the front door. Just to top it off Amazon were threatening to take my order back out of their delivery locker if I didn't pick it up by Sunday. The just about justifiable reasons for a quick trip out were building.

I chose to go out for the supermarket dead time just after 2 pm. It was a good decision. The rainswept roads were almost deserted and there was easy parking just outside the supermarket. I didn't have to queue to go in and I got my handwash and plastic gloves within seconds of entering. It was really quiet and nearly everything was in stock. I didn't like it though. It was all a little unsettling. When all this started I was one of the "well the flu kills 35,000 people every year and nobody notices" crowd  but I found myself hanging back whilst someone in front of me moved on from the area of the shelves where I wanted to be - no point in being foolhardy. It's impossible to go anywhere in Pinoso without bumping into someone you know. There were pals and acquaintances in the supermarket but the conversations were nothing more than polite or humorous exchanges of a few phrases. I have to say that I felt really uncomfortable; a mixture of concern that I was doing wrong by being there and that I was putting myself and Maggie at unnecessary risk.

I did all my jobs without any complications of any sort but I was really quite pleased when I closed the front gate and got to wash my hands.

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Talking to a couple of people on the phone back in the UK I've realised that people there are unaware of the restrictions here in Spain. This list is not exhaustive and it's not official but I think it gives the basic scope of the restrictions.

During the validity of the state of alarm, people may only circulate along the roads or spaces for public use to carry out the following activities. They must be carried out individually, unless accompanied by persons with disabilities, minors, the elderly, or for any other justified reason.

1. to buy food or other primary necessities, or to get prescription medicines from the pharmacy
2. to visit medical facilities in case of urgency
3. to go to your workplace or to carry out labour, professional or company duties
4. to return to your habitual home
5. to visit banking or insurance institution
6. to assist and care for the elderly, minors, dependants, people with disability or especially vulnerable people
7. for reasons of overwhelming force or situation of necessity
8. for any other activity of an analogous nature duly justified
9. to walk your pet (close to home and quickly)
10. to fill your vehicle up with fuel.

All retail businesses are closed the exception of those selling food, beverages, basic necessities, pharmacies, those offering medical, orthopaedic, optical or veterinary services, those selling newspapers, petrol or hygienic products, technological and telecommunications equipment, those offering telecom services, those selling animal feed products, dry cleaners, launderettes, hairdressers for health related home visits, E-commerce or commercial activities by phone or mail. Vehicle workshops may also open

All "food serving" businesses are closed: Tabernas y bodegas, Cafeterías, bares, café-bares. Chocolaterías, heladerías, salones de té, croissanteries. Restaurantes, autoservicios de restauración and similar. Bares-restaurante. Bares y restaurantes de hoteles, except when providing services for their guests. Salones de banquetes. Terrazas.

Museums, discotheques, auditoriums, sports facilities, attraction parks, leisure activity centres, processions, popular fiestas are all closed or cancelled.

Attendance at places of worship and at civil and religious ceremonies, including funerals are possible only if  there is no crowding and people can be kept at least a metre apart.

Out to play

I like to get out and about. Anything from a film to a fiesta, a gallery to a concert, the theatre and, occasionally, even sports events. Doing things suits me. On the other hand in the last seventeen years I have had a couple of short stays in hospital - one in the UK and one here. Much to the surprise of those around me I quite enjoyed those brief medical sojourns.

So far I'm finding the same with being confined to home. I'm not longing to go for a walk or ride the bike or sit in a bar or even go to the pictures. The situation has changed and I'm being told that the best thing for me, and more particularly for everyone else, is that is that I stay at home; so stay at home it is. That said I did go out today. We needed food.

Culebrón itself is festooned with police tape to seal off the public spaces which I noticed as I passed through the village to drop off the recycling. Pinoso, our town, was quiet. Not dead quiet but quiet. I parked without any difficulty outside the bank and by the supermarket. I did have to queue to get in the supermarket but only for five minutes or so. One of the staff was on hand to ensure we maintained a "safe" distance and when someone came out someone else could go in. The free gift on entry was a squirt of alcohol based handwash. The buying looked absolutely normal to me. People were comparing prices and ingredients, nobody was shovelling products into their basket/trolley and most of the shelves were full. I couldn't get mince for the chilli nor butter for my toast and I wondered if that was because of us Britons. Spaniards do use both products but nowhere near as much as we do. By the checkouts there was parcel tape on the floor to remind shoppers to maintain a distance. The only incident of any kind was that there was one chap buying fruit or veg who wasn't using plastic gloves. Someone from the store pointed this out to him and he was less than polite in his response.

Obviously my situation is very straightforward. I don't have the virus, so far as I know, and nobody I know has it either. So far all the dead are just statistics to me. More prosaically I'm not having trouble getting to work, my kids are not at home all the time, my mortgage is paid, I haven't had to close down my business, my income is relatively secure and so on. For some people this sudden stop must be throwing up all sorts of problems and heaven knows what the long term effects will be.

But for an old, fat, English bloke this week's idea of getting out and about was dropping off the recycling, going to the cash machine and the supermarket.

Everyday life

It's really strange. Nothing much has changed and yet everything is very different.

I'm sure you know that Spain is in a "State of Alarm". Basically what that means is that Central Government has taken special powers for itself for the next fortnight at least. In effect Central Government can change the usual rules. Lots of those things would have happened anyway but the response is now more coordinated. For instance where we live the Valencian Government had already decided to close nurseries, schools and universities but with the Central Government now in charge that sort of closure has been made uniform across the country. The general principles of the measures are easy to understand. Close all of the places where there are usually lots of people (day centres, schools, parks, theatres, restaurants, fiestas), tell people to stay at home, try to keep the economy ticking over, keep basic services open (food shops, chemists, petrol stations), limit travel and when travel is necessary ensure that it is a solitary affair. The more governmental "curfew" type things include putting lots of police and the less militarised parts of the army (the emergency response section) on the streets, requisitioning supplies of things like masks and hand wash and making it possible for the health authorities to draft in extra help like nearly qualified medical students and private medical staff if they need to.

I have been in equal measure amused and ashamed reading the comments of my compatriots on the Spanish Facebook page of the Citizens Advice Bureau. So much of it is patronising, bellyaching and thinly veiled anti Spanishness. Several of the entries are of the "Look how smart I am" variety. An example. "So, if you can only travel one in a car and neighbours can't visit each other does this mean that single carers will have to leave their children unattended at home when they go out for food?". There are, though, plenty of genuine questions and real problems "My sister looks after our dad's medication, she knows what he needs and why and she collects his meds every month from the chemist but she doesn't drive and I don't know enough about his medical history to do it myself. Can I give her a lift?". For this type of question I think it would be really difficult for anyone to give an answer, especially as taxis are still in business (with rules about disinfection) but I am 99% certain that if the woman were stopped in such a situation then the police or whoever would be appreciate the genuineness of the case. Then again there are lots of examples of people who were moving home today, who are camping in the remains of a packed up house, and where the removal companies have said that they are not allowed to work. No flexibility there and probably quite rightly even if it does seem hard.

The old fashioned sources of information - radio, telly and newspapers are keeping us informed about the bigger picture and they have turned Fernando Simón into the sort of media star that Ian McDonald was in the UK during the Falklands War. On the other hand the stuff coming via WhatsApp and Facebook is notable for its mix of mischief making, point scoring, genuine information and heroic or heart-warming kitten type stories vaguely related to viral infection. I can't really tell you what it's like out there because we are not going anywhere and where we are there are very few other people. If we were in a city or town we may notice that there was no traffic, we could join in the applause for the medical services or even sing the Spanish version of "I will survive" from our balconies. Out here, in Culebrón, hardly anyone passes our door and I had to stand on top of the old water deposit to see if there were traffic on the main road (that's what I did for the photo at the top next to this post). Anyway it's drizzling today and a bit miserable so it's a good day to drink tea and read books.

I had intended to walk the recycling to the bin but now I'm thinking that it might be more responsible to wait until I need to go in to town and do the recycling and shopping together. Then again I'm not that sure about going in to town. We do need some things and I have no money in my wallet but I'm sure we can manage a couple of days more before hitting the cash machine or replacing our depleted supply of potatoes, thyme and tinned tomatoes.

And good luck to my sister and brother in law who were in Spain on Saturday in their motor home and decided that they would be better off in the UK. Not far to go now but maybe you should stay at home for a while once you get there!

Nothing and nothing else

I haven't done anything very interesting for a while but that won't stop me.

I went to stand outside the Town Hall yesterday evening. Every first Friday of the month at 8pm - a reminder that violence against women needs to stop. I've done it a few times. Nobody notices but I should be there. Afterwards the group often puts on a film. I haven't been to that for ages but I did go last night. The film was called Frances Ha and it wasn't bad at all. The interesting thing was that it was introduced by a couple of young women who I think were still at school. They were speaking in Valenciano which means that I caught about as much as I would if I were in a Belshill pub late at night talking to an 80 year old local who was a boxing contender in his youth. The young women talked about similarities in style to Jim Jarmusch and Woody Allen, about the handheld camera movements and the framing of the scenes. I was impressed. I don't think the majority of the students I've encountered across the years would know who Jim Jarmusch is or be interested in finding out.

I spent a bit over six hours in Elda hospital the other day. The friend of a friend had a terrible stomach ache. The local health centre sent her by ambulance to the nearest big hospital and I met her and her partner there to do the Spanish. It's the fifth time I've been to Urgencias, A&E, in the time I've been here either as patient or companion. Everything followed the "normal" pattern, the one I've seen every time, stabilisation, admission, a first consultation with a doctor who decides a course of action in this case a bunch of tests. Then a bit of a wait. This time that became a longer wait. Then they needed the emergency bay and my couple had to wait with her wheeled bed parked in a corridor. The staff were grumbling and complaining about the situation but all that NHS, abandoned in the corridors, stuff came to mind. Not that there weren't a bundle of staff around all the time but it was a corridor.

I listen to a podcast called ¿Qué? done by a couple of people who work on the English edition of el País, a Spanish newspaper in the same class as The Guardian and the New York Times. The podcast is in English and they welcome feedback. I've tweeted them, I've emailed them. I've been mentioned in the podcast a couple of times. In fact I listen to a number of podcasts and several broadcast radio programmes. I sometimes comment on those too. Last week, when a Saturday morning programme was talking about punctuality I made some comment about the late running of Spanish TV. As they read the comment out the presenter said Chris has written again. It's the same with a few podcasts and radio shows, multiple responses, "Hi Chris, nice to know you're still listening". Twitter and Facebook and email and what not almost persuade you, one, that you, one, knows these people as real people rather than disembodied voices.