krumel

The LTV is a pretty cool tool although still I prefer Draegers Oxylog 3000. Pretty cool, pretty small, able to do nearly everything;)

Damm it, just had to learn that there is no "where are you from" Flag anymore... I'm from Germany;)

That extremly cool in one of the University hospitals here: When you go in by the "ambulance entrance" the first room you see is the trauma room (with CT). directly (and directly means: directly) attached to the trauma Room is the special O.R-Area. Directly over the O.R. is the SICU. Has its own elevator to that O.R. Area...Very cool thing, you have a total transport distance of 20m at all.

If any health care provider here would inform the cops that his or her patient is an illegal immigrant would be directly loose the license due to the fact that especially health care providers have very strict rules on the professional discretion. Technically the cops weren't even allowed to use this information (although of course most of them would schedule a routine check or something like that.... ). By federal and state laws were only allowed to inform the cops when we gain knowledge about so called "severe crimes" like rape, murder, arson, child abuse which has not been commited yet. In cases of crimes already commited the rules are even harder, in this case is has to be something like "terrorism", murder, etc. Even in cases of rape or heavy assault we're not allowed to inform the cops as long as the victim shows no sign of aberration. Child abuse is a very strongly discussed topic here. By federal law child abuse is not a "crime which is a severe danger to the public" and so we are normally not allowed to report it to the law enforcement. BUT: Due to a series of child abuse with death results they changed the law that Doctors are allowed to report it under special circumstances. AND we're not allowed to leave a child which needs help at home (in some special cases even together with the cops and against the will of the parents). So: Technically we're not reporting child abuse..We're just transporting the abused child to someone who is able to inform the cops.

@Vent: I had the same thoughts before but I had to learn that is works very well when the teams are trained to work on the CT Stretcher. I'm trying to make a better picture of one of the university hospital trauma rooms tomorrow (the picture I posted is the oldest one and one of the baddest... Its one of the muncipials...They are...well...old fashioned). The thing I was afraid of most is that there would be not enough room between the head section and the CT for the airway crew to work. But as the trauma CTs are build with enough room between the Scanner and the head compartment. The last patient we brought in had an "cannot intubate, cannot ventilate properly, cannot use alternative airway" situation and it was no problem trying the fiberoptic (failed) and putting the surgical airway in. (We (including an field physican which was an anaesthesist) didn't get it in... Men hit in the neck with a chainsaw). The restraining problem is infact an interesting question and I will ask the ER staff tomorrow, but I don't think that this is such an big issue here due to the fact that most of our patients which go to the trauma rooms get intubated onscene. (we work with anaesthesist as field physicans, remember;)..) The "Trauma Center" System is also known here although not really used. We had something called "care classes". They are called "house of maxmimum care" (comparable to the Level 1 Trauma Centers), "House of central threatment" (Something between Class 2 and 3, I guess), "House of regular threatment" (Level 3) and "House of Ground threatment" (Level 4) But, to be true: This is not as specified as the "Trauma Level" System is. It mostly depends on which departments a hospital has, how they big they are, etc." but not on the equipment, not the building cirumstances, etc. Theoretically you can be a "maximum care" hospital without having an MR or CT as long as you have all the required departments.... Our equipment (excluding the hemodiaysis...this is normally performed in the ICU...But, if needed, you can also admit a patient directly there - common procedure etc. for post arrest patients, etc.-) is very similar, although "big" lab(everything which is not BGA) is normally performed by the hospitals central lab..But they are pretty fast and normally very close to the E.R. BTW: Remember: I'm talking about central europe.. I guess all Trauma Centers within the city get as much traumas a week you get within a day. So long: More pics anyone?

Yes, own CT...Becomes a Standard here... Normally there is no need to change the stretcher. The Patient lays on a "trauma matress" or is still (as its very usual in the German speaking countries) in an vacuum matress. I know two hospitals that have CT stretchers that can be modified like an normal trauma OR table. But one thing for information: Even Level 1 Trauma Centers normally have only one (maximum two) "Trauma room" /Schockraum due to the fact that we have a lot of trauma centers here (5 level 1, 4 Level 2, 4 Level 3) Also its not common to threat more than one severe injuried patient in one trauma room. (and federal law would not allow us to had equipment lay open... They are very strict...Everything has to be stored in an closed cabinets. No discussion) @chbare: Harhar, but: I know a small hospital around here with even less equipment in its "resus bay" Greetings, Phil

Used both, Stryker won....Worth every pound.

What are your resus/Trauma bays in the hospitals in your area equipped with? What do they look like? How does the communication between the prehospital and hospital stuff work? To answer my own questions: Here its the new "trend" to equip the so called "Schockraum" with an multislice CT. As an standard the "Schockräume" are equipped with: - Anaesthesia machine/ICU respirator (normally an anaesthesia machine) - Multiparameter monitoring (ECG,SpO2, invasive Pressures, CO2, NIBP, etc.) - Conventional C-Bow X-Ray - Defibrillator/pacer - Ultrasound - Fiberoptic airway solution - Masses of surgical and emergency medicine equipment (etc. for foleys, arterial BP, chest decompression, surgical airways, etc.) Example photo: (Muncipal Hospital Munich - Schwabing- Level 1 Trauma Center Adults & Pediatrics)

In the german speaking countries (mainly Switzerland and Germany) its very common to EMT-P's to work in the hospitals. Normally they work in the E.R. and the anaesthetic site of the OR. For myself I worked 6 month in an emergency department. My task were: - Managing the cases (due to the fact we didn't have a special case manager) (means: Find beds within the inpatient units, managing certain examinations in the departments, organizing interfacilitiy transport) - Being the contact person for the dispatch and the ambulances. - Leader of the "emergency department code team". Due to the fact that the physicans often change between inpatient units and the E.D. the "E.D. Code Team leader" was a kind of a Leader for the organization of the arrest (etc. control the change of the persons whos compression, make sure the "lab runner" is there, = everything not medical). When imminent action was necessary and no physician (or no physician who know what to do) I was allowed to do all EMT interventions I would be doing "outside" (i.V.'s, intubation, needle decompression, some meds). I had very little to do with the "everyday work" in the E.D. due to the fact that those tasks normally took enough time. But when boredome grabbed all of us (yes, happended sometimes) or the E.D. was overcrowded with "non criticals" of course I was able to do foley's, apply bandages, took labs, etc...But this was more "nurses works". Due to the facts that E.D. nurses here aren't allowed to do invasive interventions and are normally not "that fit" in emergency medicine as well as the fact that I had very wide comptences given by the chief of the E.D. my rank was clearly above the nurses on the same "height" as the chief of the nurses/shiftleader of the nurses was. But: Not once I feeled I had to use a "rank" due to the fact that this hospital was one of the best teamwork jobs I ever saw. (I could still kick my own ass for leaving for that stupid gurl....)

....when you have certains bums which know how to write their own records/documentations. And they are imitating your documentation style exactly.... ...when get called to an bum. When you decide to take him to a hospital he answers "Uhm, yeah, which days today?" "Thursday" "Ahh Thursday. Todays the day for the St. Elsewhere Hospital, tomorrow the university hospital!"

Hmmm... From my point of view it seems at least reasonable what they did. For me this is a definitive canidate for an ""small volume resuscitation", our protocols suggest an bolus of 250ml of HyperHAES (Contains 15g of HAES 200.000d, 18g of Natriumchlorid => pretty hypertonic). This we would have pushed togehter with another 250ml of normal crystalloid fluids. BUT: Normally a RR of 90 without any signs of severe shock is nothing we normally threat due to the fact that a "preventive" shock threatment has been shown as an source of problem cause it increased the speed the severe shock developed. (Remember: When you push the fluids the patient will dilate his vasculars again, quit centralizing, etc. and will become unstable faster than before) So IMHO the crew did very well...

Hi, learned not to remove the patch until needed (i.e. cause she got unconscious, etc.), like welsh said for the base line reasons. The problem with mixing opiate/opioids is the receptor block. The fentanyl is blocking the my*1 rezeptor already (and much stronger due to the fact that it is much more my1 dependent)so the morphine will mainly go to the kappa1* rezeptor which is mainly responsible for the respiratory depression. So more morphine mainly means a bigger risk for an respiratory problem, not necessary a good pain relief.... I woul consider using the analgetic effects for an very strong pain in this situation. For an normal pain relief going up with the fentanyl's dose seems sufficient for me. * Couldn't find and do not know the right name in english..sorry. Greetings, Phil

The first list of funny quotes are known to me as "Quantas Quotes" which would make sense cause of Quantas indeed didn't have any real disasters so far.

I guess most medics do:D

Hi Vent.. The Point is: The examples you brought are clearly unprofessional, I agree to you. But: 1. Rumors: Do also occur when i.e. an crew meets an staff member in an gay-club, strip club, the headquarter of a sect, where he is "first aiding" before the ambulance arrives.... just for example... Did the staff member do anything unprofessional? I would say no... Unprofessional are the people that create the rumors... 2. Hygienic aspects: Not cleaning the sheets of the bunk bed is always unprofessional and uncooperatively.... No matter if you had sex or not... 3. The aspect of how fast you can get to your rig: Thats a big point... Don't know the rules overseas but for us its normal to sleep only your shirt and boxers on in your room during shift.... Dunno if its the same in the US EMS.... In case you're required to sleep in full uniform of course there might be an time advantage.... I would not blame the people for having sex while on duty... I don't care...I would blame them for being unprofessional or/and dumb enough to let other people know,etc.... Thats the true point....People are in (99% of the cases) to dumb to follow those rules.... But: In the case none knows, I'm not affect by what they do (no matter if its the unhygienic bunk bed, the longer time they need to take the call they should safe my life...) I'm simply not interested in what other people might do or not...

This was a long speak although for me (maybe cause I'm swiss...we're know for being slow;) ) i can't still follow you're point of how something none else as the two "participant" knows (and I assume that.... everything else is dumb, yes) could hurt the our profession. Okay, the follow up "relation or not" trouble could hurt the working enviroment...But this happens everywhere where men and women work together.... And again: I'm not for sexual activities during a shift..I simply don't care.

As I said above: I have strict rules for myself....But: I don't see the point where having sex at the station which none gets to know about it makes someone unprofessional. From my very personal point of view professionalism ends somewhere..When the rig is 100% okay, 100% clean, the way the provider takes care of his/her calls, I'm not seeing why this person is unprofessional just he/she is having some fun at the station none else will know about...

No problem. The training is standardized for the hole nation;) I would say theres no focus in our training althought in Europe some kind of trauma you don't see some kind of trauma's only very ocassional. I prefer the trauma calls;)

Thanks;) But I have to admit that I've been trained in Germany (Munich, Bavaria). The role of the "emergency physican" differs from every Kanton to Kanton..In some of them on every (more or less) emergency they will dispatch an M.D...In some regions they won't dispatch doctors generally. Normally in most regions they will only be on scene when there this a serious MVA, an pediatric emergency, an cardiac arrest, etc. One important point in Switzerland and Germany is that you normally don't use "algorhythms", "standing orders" or "textbooks" that much...Normally we decide what to do by our training but more on an individual approach to every situation than a textbook.

If you count two fast kisses for my gf while she visited me on duty: Yes... For me I have a very strict policy against any screwing around at work;) (But I have to testify that my GF became a EMT-B because of my bad influence...But she's working for another department of the same company..) But I know that I'm very alone with that position here.... In my former company I heard and witnessed sooo many "stories"... Best one: One of the ambulances is stationed at one of the cities biggest fire department. A female collegue and her shift partner decided that their shift was pretty "boring"..So she decided do give her colleague some oral pleasures...at the back-footboard of the rig...well.... everyone knows whats coming next...an call for the entire fire department.... and the two didn't even notice... As I was on the main station of the company I had the honor to answer the call of the chief of the fire department.... Well....Good one... The poor firefighter was a bit...ehm....angry....

Much better than working in Germany;) (For Germans Medics Switzerland is something like the "holy land of EMS"... ) Well...I will try to compare from an US view and describe switzerland a bit.... Switzerland is organized in so called "Katone", a thing between a county and a state... Some "Kantone" are very small with approximatly 30.000 citiziens, some are as big as an regular US State. Every Kanton is very "self-governed" so the EMS looks different everywhere you look, not only because there are 4 official swiss languages;) The emergency Nr. for medical help is (in most "Kantone") 144... FF and LE have their own numbers... Normally the ambulances are Mercedes Benz or Volkswagen based. The term of "ALS" or "BLS" Unit are not common in the german speaking countries, you just differ between "Rettungswagen" (ALS Ambulances) and "Krankentransportwagen" or "Einsatzambulanzen"(Both Patient transport ambulances with more or less equipment). On every "emergency call" dispatch will send an "Rettungswagen".... Swiss health care providers normally are very well trained and so are most EMS Personel. On every "Rettungswagen" you find at least one diplomated "Rettungssanitäter", a training very similar to the Paramedic. In addition in most regions you are able to get medical backup by bringing an emergency physican or an especially trained Critical an anaesthesia care nurse to the scene. Swiss "Rettungssanitäter" are trained (an in most regions allowed) to start an I.V., an I.O., defibrillate and pace manually(as well as we normally don't do and use the AED.., give a big amount of drugs and start an narcosis.(but this will normally performed by the "backup" as described above) Will write more later, got a call

Were working mostly with the Lifepaks although most of us hate them due to the same reasons as mentioned above. But, as we heard from the chiefs, 12 years of complaining just suceeded and they are planing to buy a new series of defib/monitor. As far as we know the Zoll or the (in the German speaking nations very popular) Corpuls (http://www.corpuls.com/en/corpuls3.html) are in discussion 'cause philips didn't even respond to the invitation to offer..... :shock: I hope it will be the Corpuls device...Pretty cool new stuff of technology...Bluetooth rulez:D

Hello everyone, I've been to the forum a while ago but lost contact while moving during europe. My names Philipp, I'm a 22 year old hald german hald swiss paramedic. I'm working currently near zurich and part time in Munich.. Yeah.... Dunno what to add... Thats is..

Brian, you've got a Message

Of course. Should I mention that I have a goood connection to one the best schnaps- distillery in europe:D I contacted the canadian consulte via phone and mail. on phone they said it would be easier if I have service before I get to them.. Lets see if they answer the same on mail:D (But hey, who counts on a "we call you back" from a gouverment agency. Damm it, was I surprised... )