Bernhard

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Bernhard last won the day on November 21 2015

Bernhard had the most liked content!

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    Male
  • Location
    State of Bavaria, Germany, Europe

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  • Occupation
    Rettungsassistent

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  1. Why do we transport dead people?

    I'm glad we have the right to pronounce death on scene. Medics may decide due to "safe" signs of death, as rigor mortis, livor mortis and non survivable injuries plus asystolie. Working a code for some time with no effort (ROSC) is up to the emergency physician we then have available on scene. As far as I know I never had ever worked someone who now shows an appallic syndrome. Either they died soon after or they survived. Secondary survival rate has dramaticallly increased with new CPR algorithms, in my starting years (end of 1980ies) this was more or less randomly. I at the moment recall just one patient before 2000, where the neighbour started CPR:this neighbour was a seasoned medic, his assisting daughter an experienced anaesthetics nurse, basic equipment available for them plus the ALS station and receiving hospital just a few minutes away. As I entered the room, the patient already was e.t.'d, we just had to attach ECG and provide defibrillations. Patient left hospital a week later, totally recovered. Since then I had a few saves, more and more since ~2000 when we started using AHA/ERC algorithms. Actually, to answer the question in the topic, yes, I once transported a death person. Transporting bodies is ruled out in our states EMS law (and was back then, but it is time.barred anyway...here's the story: We had a call in the church just neside the station. With service in full progress we CPR'd between all those praying people, somewhat scary (but not the first time for me, yes, they already talked about me to write a book). We moved into the ambulance, then pronounced dead after some while. Chaplain came into the ambulance and said a few words. Dispatch notified us about enhanced arrival time for the hearse car (sp?), so the supervisor, who was on scene in another role, felt the urge for a decision. His first suggestion was to drop the body off in our station so we were available again. I talked him out of that. The chaplain notified, that he had the keys for the local morgue, which happened to be just around the corner beside the cemetary. So the supervisor decided to take this opportunity...and we drove the body in our ALS ambulance slowly into the cemetary. Just as we arrived there, the hearse car arrived. Disclaimer: things have changed since then, I never would do this anymore (meanwhile, I'm supervisor myself, maybe this call was one of the reasons), it was totally against the law, noone has ever found out and all went well. At least I learned (talked a bit with them), the burial services are quick enough to wait on-scene. People are very pragmatic here - next time I'll tell the story about the other chaplain calling us, as he found out that the dead person wasn't medically cleared, up to his arrival... To adresse another perspective mentioned here: After having some incidents I took a crisis intervention class to be trained to handle the relatives. Was an eye-opener! Never would like to work in crisis-intervention myself, but I use the skills to handle non-medical situations since then. I strongly suggest such a training to all young medics! (BTW: have a happy new year, everyone!)
  2. How many patients have you intubated this year?

    2015, until now: 2 ET, ~5 supraglottic myself. Assisted when partners applied one on a few more. And I have an office job... Primarily I choose the supraglottic (we use Larynxtubus here), ET only when supraglottic doesn't work for some reason. On one instance my supraglottic AND ET attempt wasn't succesful, so this is not counted above. HEMS doctor eventually was able to push another one in after several tries. We got a fairly good CO2 reading, but it didn't help: hospital later diagnosed a high c-spine fracture and totally confused airway situation, pronounced dead in the ER (44 y/o motorcyclyst, head against street sign post as we found out later).
  3. 2800 addresses where you can't go without PD

    Here dispatch has address specific information, which may include potential risks, mainly used for hazmat info - don't know if any of that contains potential violence. Decision usually is based on type of call. It's very rare, that a police unit is dispatched with EMS just because of a suspicious address. I didn't read the attached thesis: Is there a process in the Scottish Ambulance Service to delete the flag when there apparently is no danger anymore?
  4. Funniest EMS stories

    Let's see. Last week I was mistaken for a towing service by a very confused young police officer at scene of a vehicle accident,was target of heavy flirting by a 89 year old woman at a nursing home, fallen out of bed, vomited, short of breath/possible aspiration - but instantly fell in love with me,rescued a cat from a tree (OK, this wasn't a real call, just spotted the cat in distress on a private walk).We'll see what follows next week.
  5. Old folks Still here?

    We're in chat. Where is everyone else?
  6. Old folks Still here?

    BTW: I'm still in chat now at this very moment. Oktoberfest was nice, I visitied with my new workplace colleagues. I didn't serve a shift this year, though. Friends reported it was relatively calm, just the usual ~400 patients per day..
  7. Old folks Still here?

    That's 3:30 AM on friday over here...(UTC+2). I'll do my very best...
  8. Old folks Still here?

    I'll be there... See you!
  9. Mobile Stroke Ambulance

    Finally, managed to get back in here again. On the topic: in Germany, I know the first mobile stroke unit was on the road in November 2008 in the german state of Saarland as a partnership between the local University hospital and the German Red Cross (largest EMS provider in Germany). Website in english: http://www.mobile-stroke-unit.org/en/ The Berlin fire department started ~2011 with a mobile stroke unit (reference: http://www.berliner-feuerwehr.de/technik/fahrzeuge/rettungsdienstfahrzeuge/sonderfahrzeuge/stroke-einsatz-mobil-stemo/ in german). It crashed in a vehicle accident March 2015 (reference: http://www.berliner-zeitung.de/polizei/unfall-in-tiergarten-berlins-teuerstes-feuerwehrauto-hat-einen-totalschaden,10809296,30156902.html in german), wrecking roughly 1 million Euro. However, I don't know any results.
  10. More on backboards and spinal immobilization

    Bad thing is: this just STARTS here...my last 20 years in german EMS before 2009 (when they started equipping our units with them) I lived well without any backboard. However they prove useful in certain situations, but not in all - just as any tool in our hands. Still glad, ED nurses haven't much to tell us here...
  11. More on backboards and spinal immobilization

    Sadly, not necessarily: vacuum mattresses are standard here since the 1970ies, but since backboards were introduced a few years ago, it gets more common to strap down each and every trauma patient on them. I'm fighting against it wherever I can, but can't argue much on-scene when I'm not happen to be the responsible medic. Discussions are fruitless. It's something new and therefore it HAS to be used. ITLS procedures seem to promote this (really?) and a recent external ITLS trainer giving some update lessons countered my arguments with some blunt statements instead of logic and/or evidence. Kind of frustrating how most colleagues follow this "new" paradigm of backboarding here.
  12. Hello. So where are you a EMT or medic?

    Really? How come that? How do you do this? Just wondering if that's really in your "job description" or if I just don't understand something. BTW: I see my task in EMS to safely get to the scene dispatch already was suspicious enough to assign a valuable resource (my crew & my ambulance) to, assess the situation and decide if it's either an emergency to be treated immedeately, an issue which has to be transported to hospital or a doctor's office, something we "just" need some ambulatory help (and call a doctor for house visits or point to an open doctor's office - they have to provide 24/7 coverage here), another thing we may offer help (lift patient back into rolling chair, call police, ...) or nothing at all (false alarm, ...). Doing whatever my findings in #2/#3 needs. Preparing for next call. Goto #1. Glad, my system has all those options in #3 and let me decide (if the public or dispatch didn't before). This opens a bunch of possibilities to provide the needed level of care, and yes, you have to be very sure about what you do. Maybe this system is close to this community paramedicine thing mentioned here, just that it's not me who provides that but the regional physicians association. Oh, to answer the OP's question: I'm neither an EMT nor a medic, technically, since those job titles don't exist in my country. I'm a german Rettungsassistent (2 years education, highest level of non-physician emergency care in Germany, so somehwat compareable to a Paramedic in the U.S.). Living in Germany's most southern state: Upper Bavaria, near citiy of Munich. So much for my excuse for lack of understanding, bad grammar and funny spelling. In english AND german...
  13. What do you do with psych patients?

    We have three psych specialised hospitals here, within 30-45 min away. Plus a tox center including psych ward. That tells a lot about the people here... We're required to transport there in isolated psychiatric issues, but they can't handle medical/trauma problems, so if there is one, we go to next ER instead. They will take care of interfacility transport afterwards. "Out of service" isn't an issue, dispatch will call another unit from out of area to cover ours (mutual help between countie EMS is required by law here). Police is able to force someone into psychiatric care in case of "danger for others or self", a judge has to be informed not longer than 24hrs after that time and has to make a decision not later than 48hrs after the person was forced to (this is state dependent in Germany, I describe the legal situation in Bavaria). Our paperwork is the same for any transport, police has to do a bit more (so they often refuse to force someone if not really needed - in their view) and judges/psychiatrists are used to it. So, my suggestion: get a totally clear understanding of your local laws and protocols regarding this issue. Don't let you be fooled by someone who may have read them - or not. If your law and protocols support the way it is now, then you may get further on in improving care. The strategy depends on your standing, the frequency of such issues and the one or other problem that is caused by those situations. Ask colleagues, superiors and ER staff. If noone else sees a need to change things, check your position twice...
  14. Party? BTW, regarding "party": y'all missed (the real) Oktoberfest this year...when I find time over the holidays I will write a short report about my shift.
  15. Ketamine... PCA?

    Benzos are not required for Ketamine, but they are a friendly gesture... In lower (analgesic) doses the psychotropic effects are near zero, if getting sedative/anaesthetic the probability gets higher. It's kind of a play with unknown probabilities on the given patient. In a side effect this enables you to give Ketamine in higher doses without respiration depressive Benzos, if the actual situation calls for that trick. A large part of your patients will get over it without the psychotropic side effects. But noone really can say how many (I don't have research papers at hand, maybe someone actually can quantify it). So Ketamine is a great tool. As with every tool you need to know, where and how to use it (risk/benefit). But if you allow patients do dose themselves with Ketamine by PCA this simply would raise the probability of having effects as Wendy described. I would consider this an inadequate substitution of better drugs especially if it's due to a bad risk/benefit analysis. But what else, if no better drug is available? However, we're talking about the U.S. here, land of the most sophisticated medical system, if I recall correctly...come on, "drug shortage", really, please?!?