krumel

@Dust: The Discussion came up a few (2 or so) years ago... I will look it up in my companies libary next week.. Don't know if it's even available in the web... But I look if I can find anything. (and BTW: I'm swiss... And jewish...So nothing about the master race;) )

Well...We ride the Mercedes Benz Sprinters... We had an Ford years ago, also get known to them in the middle east...But still I'm a Sprinter-Fan. Nothing compares to an 4W Sprinter with an big engine (forexample. 518 CDI)... We currently use W.A.S. Boxes, but there are a lot of good other manufacturers...Fahrtec, Profile, etc.... (Pictures of our Ambulances can be seen here: http://www.emtcity.com/index.php?showtopic...5&start=25)

BTW: Here (Germany), after a few broad studies took place and tried to measure the "threatment quality" of Paramedics directly educated vs. Paramedics who were trained step by step (means first EMT-I than EMT-P), it's discussed to forbid the "step by step" training. The Medics trained step-by-step had resultats that were significant worse, especially in were complex situations. It's guessed that medics that directly learn their theoretical knowledge in one block gain an broader view on their patients. Just as a comment...

Here it's much better.... 14th of March is known as "Schnitzel and Blowjob Day" here;) Came up in an Forum some years ago, meanwhile it became quite popular;)

We had Times we had 0.81..But got more units.. (And,of course, were not the states)

Update: 17 death

In an German high school nearby Stuttgart (southern Germany, State of Baden-Wurtemberg) a 17 year old former student opend fire on teachers and students. Multiple students and teachers were killed. During his getaway the committer also killed an staff member of an psychatric hospital. Later the committer got involved in an gunfight in an grocery store where three people, including the gunner got killed and two police men were seriously injured. http://edition.cnn.com/2009/WORLD/europe/0...ting/index.html I'm on standby for going to Stuttgart as an psychological first aid team-member.... Let's see if I gotta go there...

^^ (The station. Parked in front is the car of the "Chief of Rescue" of my Company and the so called "House-Emergency-Car". This car responds to the S.O.S. Buttons older people who live alone can rent. If none answers an ambulance and this car is dispatched. The "House-Emergency-Dispatch" has keys to the apartments... So this car brings the key... Of course it's staffed with an trained EMT-I who can first-Responder if necessary.) (Front picture of the "critical care transport vehicle". It's used mainly for long range intensiv care transport. The integrated light system -called Delfis- is the upcoming trend here... Especially for long range transports on the highways the driving comfort is much better than in an normal ambulance...as well as the fuel consumption) (Patient transport ambulance. Normally used for dialysis transports, interfacility transports of non-urgent and non critical patients. Staffed with two EMT-I. Normally the hole place is crowded with them, but they were all "running".. So just this one's left -had an radio-problem-. Again due to the fact that we often do long range transports with an integrated light and signal system. ) (The control-console of my rig...Due to the fact that our new rig has been assigend to another station (they broke theirs) we have to use this piece of s*** again... Very old one, but as long as it's runs... On the left side you see the radio device. It uses an system called "FMS" which can transfer our status -etc. "on scene"- by pressing one button. The black thing on the upper part is the light control system with the electrical siren. the buttons on the lower part of the pic are for scene lighting, the compressor-driven siren, etc.) The old rig from outside... Mercedes Benz 315 as well. Note that this rig has it's own door to acess the equiptment from outside. Patient compartment of that rig. Due to the fact that it's so old we have no room to store all stuff properly..So my helmet and on bag has to stay "on top"... Hate it... On the left site you see the "action wall" with Respirator, LP12, syringe pump, suction... The photo is taken close to the roof, so you might not see it, but: It's 2m high... The red pack on the left side contains all drugs... The back of the patient compartment. Stryker stretcher, Vacuum matress (on the left side), Shovel stretcher (we don't use backboards here), kids-securing system in the orange back, ferno stair chair and 2 10l bottles of oxygen;) ) View inside one of the cabinets... i.V.'s, oxygen masks, etc.... Special view... Some of you might know where this is... It's in the middle of the "Theresienwiese"... Here the world famous "Oktoberfest" takes place;) Greetings, Phil

We had the case here that during X-mas season an nice old man bought two bottles of (very expensive) read wine downtowns... When he left the shop he slipped at the stairs down to the subway... Well... cracked his skull, subdural bleeding... But: The two bottles of wine got shattered to pieces..So everyone thought he was"just another drunk"..Well... This subway entrance may be used by about 100.000 persons within one hour during the x-mas season..... As someone called my colleagues the poor old man was already hard frozen.... That's what we call a "modern society"???

zippy said everything;) Thanks:D But, I have to admin that Friday night was very calm...Three call within 8 hours... Can't remember when Friday's late shift was so quiet the last time. (One "Emergency door opening" with the FD..Old lady missing...But wasn't in her flat, too...Two -exucse me- extremly bariatric pregnant ladies with gravidity complications... ) I've got the allowance from the chief of rescue to take some pictures as long no patient or patient care is visible..I got to buy a new card-reader, afterwards you will get some more pics.

Just ask, sometimes I find a WiFi spot in the city and enough time to answer.

No,No, youre not annoying me a bit, but I'm off to late shift in 5 min. The helicopter EMT-P normally is a HEMS-Crew member. (Most of them rotate between helicopters and the ambulances) some helicopters (especially the one's which an rescue wrench) also have "board mechanics" (mostly also EMT-P's) additonally. Here in southern bavaria the Helicopters crews mostly are trained as mountain rescuers, too. The emergency physicans of the helicopters mostly are anesthetists, sometimes also trauma surgeons and internal medicine specialists... They get also an special "heli training". In case an severe pediatric emergency is reported some helicopters get an additonal pediatrian or pediatric anesthetists on Board.

The judge decides;) When something goes wrong the question is: Did it go wrong because the medic did something wrong? Then he medic...well... doomed... When something goes wrong because of "risk of life" (etc. the patient discovers he is allergic to the drug you gave him for the first time of his life and dies...): By german law: None's responsible.. The rule of "break a law when you can safe a life" is on the "bürgerliches Gesetzbook" (general book of laws), this is the highest law beside the constitution...All other laws are "under" this law, so none's able to sue you as long as you can prove you tried to safe life/health of someone when breaking the law....

No Standards at all.. Yeah..Not really. Arrest and Chest pain is (kind of) standardized by ERC or AHA (the EMT-P in charge decidedes), some use PHTLS in Trauma.. But generally medics and doctors are very free in what they do... We're trained to find "the reason which fits best". We're trained to decide by our background knowledge, not by the book..So if you the right way to explain it you're free to do what you want... There's no "procotol" or "book" you use and none's gonna say anything as long as you can explain it by your background knowledge.. (Example: Last shift: Normally we give midazolam -as well its written nowhere it became a habit for everyone- in epilepsia... Well... I had medical reasons for an epilepsia call not to do so and to use diazepam... Ain't no problem...My decision) For outsiders this may look strange but it's the effect of the very strange law system here... There's no federal oder state law that says "you are allowed to do what your chief of medicine says.." or "you are allowed to do this, this and this"... There's only one law that says "Medicine is only to be done by Doctors or alternative healers". (BTW: The last law in modern german law which was signed by Hitler.... One more reason to hate this..) Then there's a federal law that defines the hours of training an EMT-P gets..And additionally it says: "The Paramedic has to learn everything he might need to save a life when an doctor isn't available"... How much is really "everything" differs from county to county... Here in Downtown Munich we're allowed to do a lot more than some medics in rural settings. (for example of course we do i.V.'s without a doctor being enroute, of course we use non opioid analgetics* and a much wider range of drugs we give... *Opioid analgetics are handeld very strict here.. Only trained doctors might use them And overall, there's another federal law that says: "In case you safe a life (or limb or health, etc.) with out you're allowed to break other laws".... So: Later, when I will do an i.V. on my patient I'm gonna break a law..because another law tells me to... Crazy? Indeed......

Both.... Friday and Saturday (remember, weekends start fridays here)can be really "bad as days" for you... I'm fearing my late shift today...They gonna hurt me....

Differs...The main part of the medics get payed, but sometimes there are so called "volunteer shifts" when volunteer medics work part time... For example the Red Cross here gets money to get an additional ambulance running friday and saturday night. Would be difficult to find a full time medic for this so they run it with volunteer medics...

Yes and no... The doctors only come to the "ALS calls" with their own vehicle (they are normally stationed at the hospitals) The paramedics come with the Ambulance.. For the Paramedics the "minimum education way is: Basic high school degree (after the 9th grade), waiting till youre 18, then doing your Training (2 years normally), then...Being an EMT-P... The EMS is never runned by the hospitals. The biggest provider is the red cross (which is an charitiy organization, not an company), the St.Johns Order, the Order of Malta and the "Workers Wellfare union" . The F.D's, municpal EMS-Systemsand the private Companies take only minor rules... I would say nation wide it's about 75% Red Cross, 7 % Order of Malta, 7% Order of St.John, 5% Muncipal EMS, 4% F.D. and 2% private Companies.

I'm sorry, but I don't know if I understand you right. Do you refer to the paramedic education or the general "advanced education? For the paramedics: because doctors fear if they educate us more, they could be driven out the prehospital emergency care (as the insurance companies want since decades due to the high costs)...Doctors have the only real lobby here... For general education: You have school much longer. For your A-Level normally you have 12 or 13 years of school...Especially the last years are very very hard... Much longer that you do...And afterwards simply go directly to an university... But so for example med school here takes up to 6 or 7 years... (and also remember: The school system is for free. The university were until a few years, but now they are still very chep about 1000€ a year. And every student with poor parents gets financial aid by the feds AND a student loan as well)

Can't answer, too ashamed.... For the EMT-I (Rettungssanitäter): None For the EMT-P (Rettungassistent): When you get your EMT-I before: None... If you do it directly from zero: Basic high-school degree (below that there's only "no education/no degree")... It's a real shame.... But, as written above unemployment is a problem so most EMT's have their A-Level's cause the chiefs aren't even looking at the ones without it.... In Germany the people who want to study medicine often have to wait up to 5 years for it in case their A-Level marks aren't relly god (you need an A+ in all your A-Level topics to do it directly!).. So many of them start working as an EMT or R.N. before they study, work for a few years full time, than during their med school part time. (Remember: there's no college in Germany... You go to school from the elementary school to A-Level high school (13 or 12th grade) and then you go directly to the med. school)

The back of the new ambo's are normally 2m (6.56 feet) high as required by EU-rules. (Thanks god...I'm nearly 2m high...Bad for the hair, but it still fits:D ) The shown ambulance is even a kind of "small"...as you can see in the first pictures, there is approm. 120cm (4 feet or so) between the head of the stretcher and the cabinets in the newer one... And here the last thing I could figure out someone wants to knew: The shift times;). In rural settings most stations work with an 12h shift system (change a 7 am and 7 pm normally), some still work with an 24h system which has to be abolished within the next years due to EU law. In urban setting the stations with "not sooo much" work normally use an 12h shift system, the stations with more calls (downtown, zones with social problems, etc.) use an 8h shift system (normally from 7.am to 3pm to 23 pm or so... Round about...The times differe slightly so not all station's change at the same times. An normal EMT-P works between 40 and 48 hours a week and earns between 1500-2000 EUR (1900 to 2500 USD) pre tax (which makes normally after Taxes, health insurance -obligatory here-, etc. are paid makes about 1000-1200 € -1200 to 1500 USD post tax) per month. You normally have between 15 to 30 payed holiday days per year (changes from company to company). Day were you are ill are not counted, in this case you get paid 6 weeks, afterwards the health insurance pays 80% of your income. If you work overtime normally you add the time to your "overtime depot". When you collected enough time you normally get a day of, sometimes you can also get extra money for it. The problem here is unemployment...Due to the fact that the paramedic Schools get paid by their students they produce a lot of "paramedic trainees" which do not have any chance to get a job in the ambulance and even if they get their training somehow done there is a very little chance for them to get an job on the rig...Most of them is driving an Patient transport Ambulance, etc...

Little addition: Most places in Germany can be reached by so called "Rettungshubschrauber"/RTH (comparable to Trauma Helicopters) with 15 Minutes. In opposition to the system of the trauma helicopters in the USA those Helicopters are mainly used to bring the emergency physican to the (not only trauma) scene. It's often the case that the emergency physican boards the ALS Ambulance, performs the advanced care and accompanies the ambulance to the next hospital (where the doc will be fetched by the heli again). But of course they can perform normal "air rescue" as well and are also used for middle range patient transport. The station nearly the sea and the mountains are normally equipped with an winch, most other helis are able to operate with an "long line". Due to the high risk of night "outside" landings the normal air rescue helicopters do only operate during daylight. For interfacitily transport there is a second class of helicopters not so focussed on emergencies, the so called "Intensivtransporthubschrauber"/ITH (critical care transport helicopter). They are able to fly during the night and often stuffed with special EMT-P which are also registred ICU Nurses and and doctor who is an ICU doc. But of course both types of helicopters can jump in when the opposite type isn't available... (Christoph 1 - the first rescue helicopter in Germany and my hometown helicopter- performing water rescue together with the emergency divers of the Munich FD.) (Card of the air-Rescue stations in Germany. Most air-rescue helicopters are operated by the automobile club of germany because historically the helis were intended to mainly respond to MVA's. (The idea came up 1971 in Munich, one of the years with the record of "MVA-deads" took place. when the MVA's got reduced they started to do normal rescue.) (Thanks here to the marvellous guys from Munichs Helicopter Nr.1 - Christoph 1- and their page: Their Website BTW: Nearly all german helicopters are named after the patron of the travellers, the holy St. Christoph. Only some special stations runned by privatet companies and the miliatry rescue helicopters (SAR) are named after another scheme. Something to the med. equiptment: The ALS ambulances mostly are equipped with an eletrical suction unit(Weinmann , an Draege Oxylog 1000 or an comparable respirator of an german brand (Weinmann again , an LP12 (AED, Pacer, 3 channel ECG), an hand-held pulse oximeter (mostly Nellcor) and an syringe pump by B.Braun. (There are rumors that we got the brand new corpuls 3 next year...Would be cool. The most advanced ECG/Defib thing I'v ever seen...Kicks Physio-Controls as a hundret miles wide...) The emergency physican vehicle normally brings an LP12 with 12 channel ECG, Capno, SpO2 and sometimes NIBP with it... Sometimes also and more advanced respirator (Oxylog 2000). The helicopters often use Oxylog 3000 and propaq encores for their critical care transport tasks. And, to improve my mind reader capabilities some information about the "stretcher System" In the german-speaking countries normally the stretcher isn't lifted in the car by the medics, it will be moved on that "ramp" you could see in the first picture. This ramp is designed that the stretcher can be driven in it with its own wheels. When the stretcher is looked in, the ramp will be moved to the ambulances normal height. The stretcher now rests on the so called "Tragentisch" (stretcher table), which can also be position like an OR Table etc. whith trendlenburg, etc. (see a video here: http://www.youtube.com/watch?v=U0sKCedo7dU ) In addition, some stretcher table can be even cushioned so the patient won't feel the "road" so hard.

I made a little presentation here: http://www.emtcity.com/index.php?showtopic...mp;#entry206766

Just edited the main post while you posted;)

Hi, as many of you pointed out that you are interested in "how the EMS in Germany works and looks" I thought I will make this short presentation. First of all the background: The EMS System in Germany is a so called "state duty" (in opposition to communal or federal duties). Each state has it's own laws.... In Bavaria (where I mainly work at the moment) the system is unique. The state does all tasks that can be performed state wide such as buying the rigs and the med. tech., charge the insurances (remember: everyone here has one), etc. So the state buys the ambulances and left it over to the so called "care providers". Those care providers (which in Bavaria is mainly the Red Cross) get the instruction to "get this ambulance 24/7 on this position" and get paid for this, not for the calls they respond, etc. Where an ambulance (and how long) will be positioned will be decided after a structural analysis every 2 years. (For example by company has 4 ambulances 24/7, 2 which work for 15h, one which works for 16h) The idea is that the ambulances which make a lot of money (by responding to a lot of calls, for example in an urban EMS) are cross-financing the rural stations which only respond to one or two calls a day but are required by law to exist. (State law says: 95% of all street adresses have to be reached within 15 min) The car: The ambulances are bought by the state and left over to the care providers. To make the cars cheaper, the state buys about 100-200 rigs every time... And they are all the same (same chassis, same motorization, same construction). Due to this in case an ambulances crashed it's easy to replace it by an backup ambulance even from another company. The ambulances will be replaced every 200.000 km (124274 Miles). Note: In most parts of Germany the seperation between BLS and ALS Ambulances does not exist. There are only "Patient transport Ambulances" (although often they are equipped better than most US BLS Ambulances) which normally do not respond to emergency calls (or just as a first responder) and those ALS Ambulances. ALS Ambulances (so called "RTW" or "Rettungswagen") are stuffed normally with one "Rettungssanitäter" (comparable with an EMT-I) and an "Rettungsassistent" (comparable to an EMT-P). Although "Rettungsassistent"/EMT-P is very well trained (1200h hours of very intense theoretic training, 400 in the hospital, 1600h as a trainee on the rig under the supervision of another "instructor EMT-P) they are only allowed to perform i.V.'s, intubation (without any meds), defib, and give some drugs (mainly Glucose, adrenaline, some inhalatives, diazepam and tramal) (changes by the local protocol... We are allowed to give Ketanest, Midazolam, prednisolon, Dimetiden, needle decompress...But were outstanding..Only two other counties are known to are allowed that much) when an emergency physican is on it's way to the call and won't be there fast enough to perform the intervention. The hole "advanced care" normally lays in the hand of those emergency physicans who are transported to the scene with an "Notarzteinsatzfahrzeug"/NEF, a care comparable to any other "Fast response" car around the world. Those cars will be driven by an EMT-P. (In some urban areas there are special "ALS" Ambulances where the emergency physican is directly part of the ALS Ambulance) For special situations there are also "pediatric fast respond vehicles" (staffed with an pediatric critical care physican and one EMT-P) and critical care transport vehicle (stuffed with an critical care physican and normally with one or two EMT-P which are registred ICU-nurses as well) available. The cars are mainly Mercedes Benz Sprinters (due to supply difficulties there was one serie with Volkswagen Crafter, but this chassis is nearly identical), motorized with 110/ 150 (KW/PS) Diesel engines. Due to federal and EU Law the "light and signal" section is...well... can't compare it with an normal US ambulance.... The hole chassis and the box has to be very stable (9 G is required for everything) so in case of an crash they normally are pretty stable. Here are some pictures: (This pictures are not my private pictures cause I'm not allowed to take any photos at work now) (Backsite with "Stollenwerk" Stretcher - a German Stretcher brand, comparable to Stryker...We had Stryker...But *cry* to expensive) (the cabinet section in the front area of the patient compartment) (Overall view) (Another back view with the main "care provider" seat. Note the cabinet on the left. Here all O2 is stored in its own "steel cage": 2x 10l bottles for the ambulance and the backup 2l bottle for the respirator or airway set.) (Site entrance with the backpack and the pediatric back. The care providers can decide what system they want to have. Most stations decide they want to work with one backpack and a seperate O2 source (etc. from the inhalation system of the respirator or an own O2 set), some work with a "case system" -as we do although I for myself hate it- with two cases, one for circulations and trauma, one for airway) (Night view with all lights on..As I said before: Not to be compared with US ambulances..... ) All pictures are linked from the page of the Red Cross Obernburg-Miltenberg (thanks to them). Further pictures can be found on their site here. (Common emergency Physican vehicle operated by the FD) (and yes, for the emergency physican vehicle we're using other brands than mercedes, too. BMW and Volkswagen are also very popular.) Edit: I found a video of my ex-partner (*cry* the one and only Porno-Boy) which demonstrates pretty good the sound of an typical german ambulance: http://www.myvideo.de/watch/2447999/Rtw_Bl...hrt_in_Muenchen)

The 3000 is "old" here...We got it since 2000 or so;) The new "toy" we got is the 2000+...New, improved 2000 with an "real display", much more "shock resistant"...But afaik not yet certified outside the EU. Oxylog 3000 is more like the Evita 4 ICU Respirator than the 2000, both in handling and the way it works.... But I like it pretty much, its easy to use, very very strong and long lasting.... (And believe me, I was in vvvvvvveeeeeeeerrrryyy bad situations with it...) I would guess it cost about 22.000 USD...But don't know for sure. Copied from the draeger website: Draeger Medical Canada Inc. 120 East Beaver Creek Road, Suite 104 Richmond Hill, Ontario L4B 4V1 Canada Business Support Phone: 905.763.3702 Toll Free 1.866.343.CARE Fax: 905.763.1890 Email: canada.support@draeger.com Sales Support Email: sales_dmci@draeger.com Service Support Email: service_dmci@draeger.com