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30 years in EMS and I fairly quickly came down to 3 pairs of examination gloves in my pocket, 1 pair of scissors and a pen light on my belt. No more heavy tools - cutting seat belts is possible with the scissors and our O2 tanks can be opened by an attached hand wheel, no tool necessary for that. However, I'm considering to enhance the number of gloves (on trauma calls I put on two pairs of gloves, then I can get rid of one pair after the messy first minutes without fiddling and losing time to slip into another "clean" pair).
OK, I have to confess: I carry a small swiss army knife on my private keychain, which contains a very small blade, a can opener, a small screwdriver, tweezers and a toothpick. But all those tools were in use between calls only, so far.
German ALS ambulances have to be equipped with a second stretcher holder, to be folded down from a sidewall or to be placed in holders in the side wall. I used them more than once to transport two laying patients. No young medics nowadays believe this, but I have a copy of the old equipment standards to prove.
Then there were those rolling central vein catheters (you have to apply them like turning the wheel of a fishing line). Suddenly vanished somehow, after we stopped punctuating central veins on each and every CPR pt. around end of 1980ies.
(Hey, I just realised, in September this year I'll be 30 years in EMS)
I long was suspicious about the HAIX hype most of my colleagues are into, more or less I was getting things done with other brands. Just some itches here and there. Now since a month I have a pair of "HAIX airpower XR1" and I'm into this hype, too. They are perfect fitting (which is not easy with my feet), expert quality and simply great to wear. No itches!
I'm glad my employer bought them. In the US online shop they're listed for nearly ~240$, see http://www.haix.com/us/products/rescue/haix-airpower-xr1 (click on "buy now"). But they're worth it!
- Your favourite county where EMS is disconnected from Fire agencies?
Hence programs could start in the end of 2014.
My current plan is to start the German "Rettungsassistent" (very narrow scope of practice comp. to a US-Paramedic) this November.
You're aware that's the last chance to enter a "Rettungsassistent" course? From January 2015 the new 3-year "Notfallsanitäter" is the only professional education (beside physician) you can start in the EMS field and you have to be associated to an EMS agency for that.
What if you're failing med school? You can't use a US paramedic training in germany much (at least legally). But as "Rettungsassistent" you're able to get the "Notfallsanitäter" by taking the state exam within the next seven years. You would be fully certified for german EMS then. Which is pretty promising, the job conditions seem to get much better soon.
Depends a bit what you plan in your future. If you want to get a job in the US, then a paramedic license there would be the best choice. If you're just curious about the US and confident to get through med school you may take the cool experience in the states. But If you'd like to stay in Germany for your later life and want to have a fully accepted profession there, maybe the german education would be the better way to go. And starting until December 2014 you have the chance for a shortcut towards the new professional level.
Whatever you do, good luck and share your experiences in EMTcity.
Just wondering: there is a study about trauma victims' better outcome when transported fast opposite to beeing "ALS" treated on scene for extended time (just as we needed a study about this, but well...) AND there is the need to treat patients on the spot of an active shooting scene? Really?
I don't get it. What about simply getting victims out to the staged ambulances? Every police officer with basic first aid training and maybe some additional lectures in how to carry patients can do this pretty good.
We know this same procedure in other hazardous situations: rescue the patients from the hot zone by people who are equipped to survive the given hazards as fast as possible. THEN give them reasonable treatment and transport to appropriate facility. Why change this just when the hot zone is no spilled hazmat but an active shooting scene?
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...
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.
I'm working my way back into EMS, so I decided to start reading here again. Missed you all a lot!
What has changed? I'm now getting paid for covering the daytime (monday-friday) on-scene officer-in-charge duty. I did it fulltime since my boss (and EMS director) got sick last december and he now isn't allowed to do this task any more due to actual health conditions. I was just the right person (having all the needed qualifications and experience) at the right place (available at the office during work hours). Contract was fixed last week. It's only an additional task to my current office job, but beside beeing more EMS related again, it includes a pay upgrade and a company car...
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...
We once had an excercise where the fluid actually froze in the line. But this was most probably due to the fact, that we didn't used i.v. bag heaters AND the lines weren't running (after all, it just was an excercise - cannulas were applied and connected just for fake). And it was a cold november wind blowing over a large airfield. It never occured to me since then. I think, a steadily running fluid is not very likely to freeze - above a certain temperature...
Could be tested easily, though.
BTW: a lot of the "victims" were sick afterwards. They were from army and federal police and those tagged black were ordered to "play death" in very loud voice by their superiors allthough shivering from cold. We even weren't allowed to give the "death bodies" blankets...
We carry this in our MCI truck. Heats up a tent in minutes:
Meanwhile there are much smaller units, could be stored in a small compartment, needs just to be fueled from a diesel canister, just like this one:
Both of them could be used to heat up locally, even outside, when ouput flow is somewhat directed. Disadvantage would be operating them in hazardous or explosive environments...(as a flipped over car could provide)...
One trick I heard of but never used myself yet: mobile halogen floodlights of FD could be used as local heat supply.
Mountain rescue around here uses special blankets and i.v.-warmers, due to their usual scenes they're limited in weight & space, to carry much more high tech equipment.
In ground EMS we have a storage comparzment for warmed iv's. But not much more beside blankets. Allthough I'm looking for solutions since years...
On our mass casualty trucks we carry oil heaters, warming up a tent in minutes. We didn't use that yet for still entrapped patients, maybe a possibility.
For providers good and dry clothes are essential. Everyone of my response group has a clothing set fitting local climate more or less appropriate. We additionally can set up a heated tent (see MCI truck above) and may offer hot tea if there is enough time (and no need to treat multiple patients). Mostly used on fire scenes or SAR scenarios.
Throw the BVM out and attend an EMT class if you really want to know more. Performing mask to mouth is NOT easy for an unexperienced person and mostly will fail then, making things worse. Don't compare mannequin training to real patients.
"M*A*S*H", in Germany they aired it without the canned laughter, which was a good decision.
I liked "Emergency!". A similar german show was "Notarztwagen 7" from the 1970ies, I really appreciate the old style settings (they even have an english wikipedia article: http://en.wikipedia.org/wiki/Notarztwagen_7, for the opening titles see youtube link at the end). Later german EMS shows from the 2000s were awful, couldn't watch more than one episode each.
"Third watch" was OK in the first one or two seasons, then it turned stupid. Same for "ER".
As a kid, "Firehouse" influenced our playing a lot.
My own experiences are not to be compared due to setting, but my arguments may have included (and a lot of them are already mentioned): Sometimes it is helpful to make really clear, that the patient is able to decide and you will give him the freedom. This will take a lot of stress out of the situation, since sometimes people aren't open for arguments when they think, they have no choice anyway."Why did you call us in first place?"showing the severeness of the wound - literally. Expose the injury and give a sound explanation. I have this a lot with drunks, bleeding all over from a cut in their forehead or such, ignoring that they should get a trip to the hospital. Since a while we carry a small mirror on the ambulance just for this. The moment they see the wound, nearly 100% cooperate.explaining the medical risks in clear language. Explaining, that pain will get severe and blood loss will be significant after a short time, when initial shock mechanisms release.explain the possible treatment plan and see if there's a problem you can address ("Needles? Your leg is cut off and you still fear needles? That's cool!"). Explain chances of having the leg re-attached or at least saving more of the limb than hours later. Some simply don't know that an ambulance can provide a better ride than a private car ("Think of all the blood on your wife's seats!").Explain, that you're not comfortable with the situation. "I'm sure it helps getting you to a hospital now and I really feel bad when not giving you the chance".referring to relatives/co-workers and pointing out, that they will have the problem when you leave, including the situation getting worse (more blood, pain, getting unconcious).In case of work related accidents I point out the employees duty to get well soon and to be checked through because of possible insurance benefits in later years...Here a clear word by the supervisor/boss often helps.arguing his reasons. Often it's "can't pay" or "want family to know", sometimes "don't want friend/coworker to get sued" or even "don't want to get away from my workplace". Others are "You just want me to go to get money" or such crap. If the argument is that they won't want to cause work for us: "We already had a tough ride and now are here..." and/or "We get called out for a lot of crap (maybe insert description of drunks wanting a taxi ride) and you have a real injury here, exactly for this we're there!" - that often works for the tough farmers around here. Or "I have more work documenting when you don't want to go with me, than when I can refer you to a hospital!". Sometimes: "Every call makes our job more secure - if you're not transported, someone may decide sometimes, that there is no ambulance needed to cover this area any more...". And so on.In several cases (especially traffic or work accidents) I can treat with police: "Better go with us, or you will go with them". Mostly it's a fake treat, but sometimes work.Clear asking if they want to commit suicide. If "yes" it's legally to force him (police!). If "no", well, at least that is ruled out.Closing statement (in appropriate wording): "OK, you're fully responsible for your stupidity, please sign here and don't hesitate to call again if you then want to go with me". To the bystanders: "Please call again, if he gets unconcious. Thank you, good bye."After all, it's the patients right to be so stupid, but it's my responsibility to make certain that he knows how stupid it is. Dwayne has done a very good job in involving witnesses!
For the side question, what have happened if someone get unconcious after clearly stating not wanting help? Depends. I would be legally safe to start treatment then, assuming he changed his will the moment he passed out. Unless there is a clear written statement in place. Where "clear" and "in place" are often the problem then..."Why did you call us? Next time call your doctor who knows the situation."