Harold1

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we are talking about nurses who doesn't necessarily have ED, ICU, CCU or Anesthesia-experience. The nursing education is organized locally.

We are talking about one of the Dutch-Antillian islands, were we do believe that the Dutch nurse-based system for pre-hospital care is among the best in the world, to be preffered above the American paramedic-model. However I don't think we can afford the Dutch system. And untill we can afford it, we have nurses on the bus, without any specific ambulance-training. Maybe it's about time that we start thinking about alternative (and indeed cheaper) options to upgrade this system to ILS- and ALS-level.

In my country a choice has to be made whether to continue with a nurse-based ambulanceservice or to start with a EMT/paramedic-based EMS-system. Can anyone give me good arguments why EMT/paramedics would be better than nurses (with ED or ICU-background)?

Are there any of you guys that use Type II van-type ambulances for the 911-work on ILS/ALS-level? If yes: do you have enough space for your equipment and to do your work properly? Do you get support from another unit or the FD?

When someone makes statements like this, he's usually jumping into gerenalizing conclusions, without really knowing anything. Sorry to dissapoint you. I started my carreer in EMS in 1998. That's almost 10 years ago.

As a matter of fact I will give it a try. Not to find out if it is irritating, because that is the exact reason why we use the method. If EMT City opens a thread about international EMS systems, I will be happy to provide you with all the details about the Netherlands, Belgium and the Netherlands Antilles.

I can assure you that if this was for example a Dutch EMS forum, the reactions would have been very different. This is not about how medically or ethically responsibly the procedure is. It's about mentality and the way you interpret things. Yes, in the US I would probably lose my license and face charges. But outside the US borders...people look differently at things.

No one ever reacted violently while getting alcohol up their nose. Not in my experience. Hoewever they did wake up. No one ever filed a complaint either. I think it's typically American to have a lawyer in every corner of the street waiting to take medics to court. You couldn't disagree that a lot of procedures you do aren't needed, but done as a precaution, as prescribed by the book, so that you are covered in case of trouble. Look at the paperwork that you have to do, just so you can't get caught if you're taken to court. When you cross the borders you'll see a big difference in mentality. People get what they need to stay out of trouble, not what what the medic needs to give, so he doesn't get into trouble. Our little technique may not be the most elegant way of dealing with fakers, but it works just fine. I don't even consider it an important issue. I find it interesting that you guys react predictably and exactly the way an American would react. Like it's soooo out of this world. That's how we know you guys....Americans are the one who would request a plastic surgeon the stitch a simple laceration, they are the ones that expect us to come lights and sirens when they break a leg, they prepare letters to sue the hotels when they fall down a slippery floor, they react hysterical to blood... Do you know how many medical professionals would refuse to ever work in your country just because of the tiredsome way of overreacting to everything? We don't use alcohol to determine the level of consciousness. It isn't some sort of punishment either. It's an effective stimulus for the patient to wake up. We're not talking about South America or Africa either. We are in the Dutch Antilles and most of our medics, including me, are trained in the Netherlands and Belgium, were they have excellent EMS systems. I've asked different physicians, nurses and paramedics in both of these countries about this subjection, as I do evaluate my actions seriously. They all said basically the same: it's not nice, but it's harmless. Hey, we all know how Americans can overreact...

If all of our actions were to be limited to protocols and procedures, you may as well put robots on the ambulance instead of medics. Don't tell me that you never divert from the book. That would be too much of the puritan blood or a total lack of creativity. Keep thinking that you guys are soooo good and that every medic outside of the US is a monkey in uniform. We don't expect any different, that's why you're American for. My buddies and I do pull a lot of ideas out of our arses, Dustdevil. We do think about our work. You guys don't have the freedom to think for yourselves. We do a lot of good work down here, so I couldn’t care less if you approve or dissaprove what we do, just because we do things differently.

After consulting at least a dozen ED-physicians, nurses and paramedics, we would still stick to the practice of shooting 70% alcohol trhough the nose when dealing with fakers. It is definetely not harmfull. and those of you that call it torture...give me a break. I'm not waiting for any American to tell me what is to be considered torture and what not. I'm glad that I don't work in a stressed environment like in the US where you have to fear to face trials even if you fart to loud.

I have been on their recruitment webpage before. It doesn't say if they hire every year. Yes, as a citizen of Aruba I have a Dutch EU-passport. Working or studying in the UK won't be a problem.

Is there anyone from the UK who will be visiting the EMS Expo in Las Vegas in October?

I'm bloody serious. What's wrong? Maybe we've missed something here...

Doen anyone know if the London Ambulance Service recruits new paramedic students on a regular basis or just occasionaly when they have a shortage of personnel? I learned that many NHS ambulance services are now only hiring paramedics that come out of college. Are there any other agencies that still do it the old fashioned way (in-service student paramedic positions) besides the LAS?

When we have a faker we often push 2cc's of Alcohol 70% up their nose. Nobody can resist that. HAs anybody else tried that?

It's not uncommon for us to have a response time of 30 - 60 minutes when things get heated up in the city.

I remember my first ride-along being at age 13, with a volunteer ambulance service. Today I don't think that it's appropriate nor responsible to put a 13-yo kid on an ambulance. But it definetely contributed to my choice of persueing a carreer in EMS.

Yesterday we were enroute to the ED, code 3, with CPR in progress, when we collided with a car. No-one was injured. The patient didn't make it. We had a crash with an ambulance just last week, one early in 2008, and one in december last year. I was wondering if there are more paramedics on this forum with the same experience. What happened? What were the circumstances? How many times have you or your partners been involved in MVA's while working on the ambulance? How common are accidents with ambulances in your area? How has the accident affected you in your job?

I thought it was weird when I arrived at a casino two weeks ago for a code and everyone was busy playing their slotmachines. Our patient was lying right there in the middle of a whole crowd. Nobody started CPR.

Between 10.00 and 14.00 during weekdays. Then between 17.00 and 20.00. during nightshifts usually between 3.00 am and 5.00 am. But like elsewhere, it's really unpredictable.

It's funny you brought this up, because we face this problem on a daily basis in Aruba. At every MVA or other situation the photographers and camera-men will pop up out of nowhere. If they don't make it to be on scene in time, they'll pop up upon arrival at the ED. The most gruesome frontpage pictures of dead people seem to sell the best. It's horror when you have to deal with rather painfull situations and the same fight starts over and over again between the patient, his family and the paparazzi. I find it even more disgusting to see everything in detail in the newspaper the next day, especially when it concerns private issues of the patients. We can't really stop it. It's useless even trying. I do my best to get my patients in the ambulance as soon as possible with the doors closed. Sometimes I cover their faces with blankets when we get out at the ED. That's about it. What I certainly don't do, is provide information to the media. They keep trying, because some medics DO provide them with the information they want.

We work on a small island, Aruba with its unique challenges. To name few: limited capacity of units, no back-up from neightbouring areas, a lot of air ambulance evacuation calls from the hospital to the airport, and above all.....an island mentality and a "one happy island"-way of life. We also experience a great variety of calls, because we have every setting on a small scale: rural, city, beaches, industry, and even calls that originate at sea or in the air. All cases that require medical care on university hospital level have to be evacuated to the mainland of South America (Venezuela, Colombia) or the US.

In Aruba we have two options when we get a case that does not need ambulance care. Either we treat and release, or we contact a physician of the ER in the area for consultation. Sometimes we assess, treat, document the care and then arrange for transportation to the ER by personal vehicles. We only have three or two ambulances on each shift, so we have to make sure that units are not kept busy with BS.

In Aruba there is a significant difference between week calls and weekend calls. Aruba's most frequent calls during the week: - "Sick person" (which can be anything) - Syncope with unknown cause - Diabetic emergency Weekends: - MVA's - Violence/falls/all types of alcohol-related injuries