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Secouriste last won the day on November 7 2012

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  1. That reminds me of a colleague who worked in the french Sécurité Civile (part of the army specialized in heavy disaster relief, fire fighting...) who went to Haïti then. As someone trained in medical emergencies, he was given a role much more advanced than he had in France. He wasn't a physician nor a nurse, yet he was trained to help with a lot of medical procedures given the context. Interesting to see that people's qualifications depend not only on their actual skills or studies but also a lot on the context...
  2. Well, that will be an option if I fail in France. To be honest, remaining in France allow me to avoid a lot of administrative issues and also to immediately start the medical studies. The french studies are also very very good even if going through the first year is a real nightmare. I have investigated the UK, the US, Canada, Belgium, Romania... If I cannot become a doctor, I'll consider another career in health.
  3. In France too we have a very high level of education for our advanced responders who are actual physicians and nurses, and even surgeons now that we have the mobile ECMO unit The job of the dispatcher is to assess the situation and send the required response. The problem of the seriousness of the calls isn't really an issue for the advanced response so much as it is for the first responders. The problem is that the dispatchers are now more and more afraid of prosecutions if they deny an ambulance. I know the SAMU dispatchers are keen on sending an ambulance only if really needed (otherwise they call a "city doctor" who will attend the patient's home within the hour). The Fire Dept. dispatcher are the opposite. They will deny he response only if there is really nothing relevant (eg: "My heating system stopped this morning"). I give you a blatant example: last week I attended a young woman who got her hand "burnt" by squirt of boiling oil. There was absolutely nothing to be seen. She had put her hand under tap water and called us. When we asked why she called, she said "Because I didn't know what to do..." Obviously she did because she had put her hand under water... We reminded her of our real missions and then we wondered how the hell the dispatcher could send us on something like that... So you see, the problem is more related to the EMT's rather than the advanced response. Why? Because to have a straight advanced unit, the situation has to be very clear and serious. Otherwise we get there first and we ask for the doc. And we better be right in our judgement, otherwise the doc will have no qualm about reminding us why he should come, or rather not come. But of course it sometime happens that the advanced unit is called even if not really needed, because there is such a huge gap between the EMT and the physicians. For instance, a basic-LS ambulance of the fire dept. cannot transport a patient who's got an IV (from a doctor already on scene...) ... They have to call an advanced unit for transportation alone! Why? Because EMT's aren't meant to perform such gesture so they can't manage the patient once he's received the treatment. We don't have such rules at the Civil Protection, but you see the issue. In Germany, the EMT-B of volunteer units are trained to operate the Lifepack (ECG...) and the respirator. They can do it only on request (from a physician) and they cannot decide of any setting, BUT they're trusted to have the equipment (and not to use it outside the authorized situation) and operate it. In France, that could never happen. The day you put a respirator in a french BLS ambulance, you'll have a mob of angry nurses and physicians with pikes and torches at your doorstep. Fab: The medical studies in France are quite special. Many student do what is called a "P0" ("year 0") during their last year of highschool, to get in touch with the subject they'll study the next year. It's a training that comes on top of your "baccalauréat" year. They do not do 1 or 2 year of "classe préparatoire" (preparatory course) like you would to get in an engineer school. Basically all you need to get into mad school is the Bac, whatever the section (S, L, ES). YET at the end of the year you'll have an exam with a numerus closus that will allow only 10 to 20% of the student to pass on the next year. You can try twice, then you're done with med school. The working conditions and the competition between the student make it very very hard for someone without strong wit to get through that dreaded first year. I have tried to register for some med school in the UK but I'm afraid by academic background isn't good enough yet...
  4. Hey Fab, In France it's 3 years to become a nurse, after that, depending on where you did your internships and where you work (once u get the diploma) you can choose almost any medical field to work in I have friends who are now official nurses, I'll be happy to answer your questions if you have any. Welshmedic: thanks! It will be very very difficult, no doubt!
  5. Welshmedic: Yes it's about right. The weird thing in France is you basically have two numbers you can call. 15 for EMS and 18 for Fire Dept. In France the firemen are also EMTs. The same crew can be in an ambulance the first week and on a fire engine the next week. The Fire Brigades are a true and strong lobby so even if EMS is legally ruling the whole emergency response system, the Fire Brigade has its own number, dispatching center etc... Those two structure do communicate a lot though and it doesn't change much what number you call in the end. So what you have 24/7 are: the fire dept ambulances + private responders + physicians (either from the fire dept or EMS) Some days, we give either EMS of Fire Dept some ambulances they can use. Depending on which structure, we go on "15" calls or "18" calls which are almost the same. For someone exterior it may seem there are a lot of different things, but all those ambulances are the same. Same missions, same trainings, all EMT-B. Wether it's us, Malta, red cross, private responder, fire brigade ambulance... The physicians are either from the EMS of Fire Brigade, no other option. Fab: I'm a student. I will try this year to get in the Military Medical School and try to specialize in the emergencies. I'd love to work in France with the Paris Fire Dept, or the Mountain Rescue units of the Gendarmerie (french police with a military status). I will also be able to do exterior missions depending where our armies are engaged. If I don't succeed here I'll get in a med school here but it's very very difficult to go through it. There are some place where a nurse is sent out alone (with a crew of EMT-B's already on scene) with protocols, exactly like a paramedic. This system allows savings in cases where a physician isn't needed. That remains quite rare in France and does not happen in Paris.
  6. Hey Welshmedic! I hope you enjoyed that very well made documentary To answer your question I have to point out that the various services you see do not have their own number you can dial for help. What we do is we make our ambulances available for the EMS to send them on calls. There are 2 ways, either they're in a fire station or they're "free" like in the US. If the ambulance is in a fire station it's easy: when the station is requested by the SAMU to send an ambulance, we go instead of a fire dept ambulance. If the ambulance is parked somewhere else waiting for a call, we have people at the dispatching center who will talk with dispatchers and transfer the calls directly to our ambulances instead of the fire dept. or others. In one fire station there is only one volunteer unit at the time so it's pretty easy. What you see in the video is a bit different, we're covering an event so the public EMS don't have to come into play. They have HQ there and they're overwatching the situation but they don't handle it directly, we do. I hope it's clear enough ERDoc: Thank you! I'm from Paris itself
  7. I France we have national protocols. If you're curious you can have a look here: I'll explain the names: PSC1: It's the basic first aid training everyone should know about. It takes about 10 hours with an instructor prior to which an e-learning course is requested. PSE1: That's the first part of the professional EMT protocols. It describes most emergency non-invasive procedures. PSE2: That's the second part of the professional EMT protocols. It describes mainly the signs an EMT should look for in order to achieve a good assessment and the immobilization procedures. DPS: This text is the ground rule to organize any event first aid coverage. PAE3: This is the reference document to teach PSC1 to people. PAE1: This is the reference document to teach PSE1 and PSE2 to future EMTs All these documents gather the knowledge required to pass the tests, except the "DPS" one which is only a legal frame without exam. _____________________________ In addition we, the Protection Civile of Paris have these internal trainings: PSE2+ (or Crew Chief): This training provides additional medical knowledge over precies conditions, organization and management skills and legal knowledge (basically, you learn that you're not protected whatsoever). CEPS: This training is quite similar to the one provided to the Fire Dept. supervisors. It is management and crisis handling only. The CEPS training provides skills to handle any kind of situation where an ambulance is involved. The theoretical part lasts a full week, it's a very concrete and intense training. SH: Basic training to deal with homeless people. CESH: Safety rules training to be in charge of a street patrol for homeless people. Use of BGL device: It is not part of the national frame texts but our close partnership with the EMS and the Fire Dept. led to expand our skills and perform this simple yet important measure. In dark red, the emergency medical trainings. PSC1 being the most basic (1/5) and CEPS the most advanced (5/5). Now, I'm not fond of the automatic translators. They're fine for basic sentences and translating but when things get complex or when the idioms are not common to both langages, it fails. The main issue is that the very organisation of first aid here and in english-speaking countries leads to words that have no equivalent elsewhere.
  8. Fab: Bonjour! You found a great video here! You can see our teams working during a big event coverage from 20:55 to 27:10 This video is so awesome I actually tried to subtitle it, but all I can do it make a translation script, I'm completely unable to do the whole synch process... To answer your question, the doctor gets shocked by the pacemaker (internal defibrillator) the patient is wearing. He explains the pacemaker interpreted the chest compressions like a shockable rythme and delivered a shock. As you noticed, it's this shock that restores a stable circulation. It's the first time in his career that he experienced such thing Richard: Hello and thank you! Yes, thank you for giving the right term. It's quite hard to translate the first aid vocabulary we use here, especially regarding the organisation and roles of everyone. A "crew chief" seems like the right word, except I wasn't designated. To access these responsibilities you have to go through a test and then an additional training. There is one evening of tests, then 2 days of theoretical training then, if you succeed all this, there is a field training during which you have to complete objectives. Once you've completed all your objectives you become an actual "crew chief"
  9. Hey Mike(s), Like it is said above, I've written quite a long post about "guns" in France and USA, you can check it out on the link provided above About the school shooting itself, it was big news, made special editions and we had live broadcast from the US. I'm going to be very blunt and cynical, but when we hear about a mass shooting in the US we think "Oh, again...". It sounds like a bombing in Middle-East: it's terrible, but it has happened before and will happen again. For most french people, it seems logical that having so many guns around with such little control, it is not surprising that gun violence is so frequent. One thing that shocked many people too was how the journalists hunted down the kids and asked them very precise and gruesome details on the event, shoving the camera in their faces... I'm sorry to sound so vehement, but I'm merely translating the general opinions about it.
  10. Hey, thank you DFIB and Patton! I'm sorry I haven't seen there was new replies in here! Well, I'm always happy to learn about other countries and I think this is a great opportunity to tell people about the french system! I really like the french-US exchange, but I'm also interested in the rest of the world. Where are you from if I may ask?
  11. Is this like "The Onion"?
  12. Well, you're the most welcome! Thank you, and no, english isn't required for our service. We are actually only a few EMTs with a "fluent" english, but most of the others can handle english-speaking patients well
  13. Bieber (nice name ) : Well, the "stay and play" system works when you have the money to have emergency specialists doctors responding with all the appropriate equipment. In France, the EMS is called the SAMU. It is a public service (free of charge) that provides that advanced medical care. In many situation, they can start a comprehensive treatment very early and hand out a clear diagnosis before even leaving the scene. But of course, we all respond at high speed, using our lights and siren Although it doesn't happen much that we use them to get to the hospital... What's your average scene time? Well, depends on what's the issue! If the cause of the problem is clear and can be treated by our simple actions, it doesn't take long to call the EMS and ask for permission to transport. That can take something like 10 or 15 minutes. Even if the problem seems minor and/or well known, we take the time to make sure it really is! We are especially on the look for psychological causes. For instance, a drunk guy or girl often has personal issues that may be helped by talking with them and listening to them. Same for all kind of minor health problems. "Big" situations, where the patient is in a serious state and need advanced care on the scene can take up to 1h30 or even 2 hours (that's extreme) ! What treatments do you provide on scene versus en route? Well, I'll answer you with my level of qualification. Basically, if something is to be done, we do it prior to transport. During the "route" time, we'll carefully monitor the patient and remain vigilant to anything change of the health state. The whole meaning of our system is that nothing is supposed to happen during that time. If it does, it means a mistake was made somewhere, or that we're in a very rare case of sudden degradation of the patient's state. In that situation, we stop the transport and call a mobile ER. If the patient is transported by a mobile ER, they will do all the stabilizing work on scene first. If for some reason the patient's state suddenly worsens during the "route" time, they'll proceed to the appropriate treatment. But you really have to keep in mind that beside the cases we'll see below, the patient is stable during the transport. Do you guys have mandatory scene times? No, we just take the time to do things right. What about for trauma calls? Ha ha, good question! Indeed, in case of trauma, we all know that the only outcome will be "go to the hospital". So those kind of cases are treated quicker than usual. If the trauma is minor but needs transport, like a broken leg, wrist, head-neck-back injuries without clear sign of seriousness (like a clear deformation or complete loss of mobility...), we proceed to the immobilization then transport. The assessment we make is to be sure that there is no vital danger or potentially serious consequences if moving the victim. If the trauma ins't vital but looks quite severe, we'll call a mobile ER for pain treatment and fracture "reduction" to be performed by the ER crew. Also, in case of doubt, we ask for a doctor's advice before doing anything, that's a legal matter. If the trauma can cause a vital danger (gunshot, severe blood-loss, head trauma with signs of seriousness...), the mobile ER is called straight away. They start the stabilizing procedures then quickly evacuate the patient to the nearest appropriate surgery service (neuro, cardio...). What is the criteria for lights and sirens use for you? As soon as we respond to a call, we use ou lights and sirens! We can also use them to quickly go back from the hospital to an event we cover, after we've transported someone. That requires to ask the permission on the radio. Cscboulder: As you can see on those links, no our ambulances aren't big. When I said 5 I should have been more precise. We are not 5 EMT treating the victim in the same time. See how we are organized: - Ambulance chief: Seats on the front. He's the one in charge of the whole crew and in charge of the scene he's called to. He's responsible for everything, including his team's safety. He's an experimented EMt who received tough additional trainings to be able to work with the Fire Brigade (in France they act as an ambulance service too). During the route, he gives instructions to the driver and operates the siren and lights. The main concern of the ambulance chief is managing the third parties. - Driver: Obviously drives the ambulance. Once on the scene, he's responsible for signposting the scene (if on the road) and managing the traffic. If some equipment is requested by other EMT who are treating a victim away from the ambulance (at home, in a shop...) the driver will get it and bring it to them. - Team foreman: Seats on the "captain seat" on the back. In a lot of cases, the ambulance chief cannot fully dedicate himself to ensure the treatment of the patient. He transfers his prerogatives to the team foreman, who is 100% in charge of the patient. The team foreman coordinate the assessment of the patient, and all the actions of the EMTs. The ambulance chief gives the main guidelines, the team foreman is the "conductor". - EMTs: Seat on the back. The EMTs, usually 2 are under the orders of the team foreman. They check up the vital parameters, seek signs and proceed to all the immobilization/handling techniques. They are the "hands" of the team foreman, they don't talk to the patient. What is asked to them is to execute orders quickly and correctly. So you see, in the end, inside the ambulance there are never more than 3 people around the patient. If a mobile ER crew arrives on the scene, only the team foreman will assist them on behalf of the Civil Protection. Of course, all the immobilization/handling techniques will be performed by the EMTs only, the doctor's team not being trained to that. To give you an accurate picture: On a bike crash: - The ambulance chief will call the Police, go after witnesses to gather informations on the crash and seek potential "hidden" casualties, manage all the third parties and work with all needed services. - The driver has set the traffic cones, he's in charge of traffic regulation. He can be asked to take the stretcher out of the ambulance and take part in the patient handling. - The team foreman is assessing the victim's state. He'll decide how to proceed, he'll conducts the whole procedure and make sure everything is done right. He'll take part in the patient immobilization/handling. He's focused on the patient. - The EMTs will check the vital parameter, perform the palpation, remove the helmet... They take part in the patient immobilization/handling. They're "bound" to the team foreman. I know that can sound a bit weird, but it allows us to be quite independent in most situation. You have to know that Paris as a lot of old buildings with many floor, no elevator and narrow stairs. Bringing a patient down to the ambulance requires at least 4 people! You can see here that 5 isn't all that much. The 5th guy is usually the ambulance chief who will open the way and carry the heaviest bags to relieve the rest of the team. Hope it was clear enough, please excuse my grammer mistakes. Also please note that the examples are voluntarily simplified, I won't write down the whole checklist of each case we can encounter. I think our and yours don't differ much. For instance we too have a "PQRSTMHTA" Which includes all the details possible on the patient's injury or sickness, history, allergies, past treatments...
  14. Hello and thank you for you message, I'll sure stick around and try to contribute. I don't know if there is any other french EMT around. I'll also try to set up a gallery presenting more of the Civil Protection (people, equipments, ambulances, mobile HQ etc..) and other french emergency services