Bernhard

Here: CPR will be continued (or stopped) on ground. However, CPR is possible in air, so if started there, it will be continued in air. Fast transport over large distance is one of the main advantages of an helicopter. If that's needed for a stroke patient, it's a perfect solution if an helicopter would be available. HEMS has it's pros and cons, just as everything in EMS, and one has to know them to use the "tool" appropriate. "Coolness" is not included in fact based decisions. Medical conditions for fast transport are known: hemodynamic instable/suspected inner bleedings, perforating thorax/abdominal injuries, not controllable respiratory insufficiency, (increasing) inter-cranial pressure, severe hypothermia. In those cases one should consider HEMS. But don't underestimate the time-to-scene (especially if demanded later in the call), preparation of landing zone (night?) and time for handing over the patient - it may be that ground transport even beats this. Some tactical indications would be: another unit for on-scene care and transport fast on-scene time, especially in remote or off-road settings fast transport of specialised staff/equipment (for example, we have the opportunity to get pediatric staff here quick by HEMS) ability to access a scene from birds view (not only getting information but may add another option: our next HEMS service includes mountain rescue by winch, this already helped recovering patients from deep in the woods) Again, "coolness" is not included. Know your tools!

Some interesting thoughts! In addition to my approach I already made clear, I may have to explain my background over here. Here in Germany by law everyone is obliged to help (in his scope of practise, as long as he is able to detect the emergency and as long as he doesn't harm himself or other more important duties). This implies that NO professional provider is more obliged to help, just since he's professionally educated. He simply has the same obligation as any civil lay man. Here, too, some EMS people think, they are more obliged to help than the general public, just because they are educated or have a sticker on their car. That is not the case (it would be when on-duty). They just have the same duty to act, including all restrictions ("...if it doesn't harm other duties...", this could be having to care for kids or else). Come on, how often does it occur that you come by a strangely laying person on the sidewalk or a traffic accident with suspected injured victims? It occurs to me 1-2 times a year, and that's what my friends say is extraordinarly often. I see no problem with my time-management, then. Since law obliges me to render aid (as everyone else) it's a valid excuse for getting late to work anyway here. Without equipment you can't do much more anyway. At the moment there is no ALS thing coming in mind without the need of advanced equipment. OK, legal situation here: (just as on duty) there is all possible what you can do, including accepting restrictions by situation. So if you would be fully equipped, you can do almost all what you want (can). If not, then not and it would be fully acceptable to step back to BLS or even basic first aid. You don't need to be officially on-duty here to operate in your full scope of knowledge. Good Smaritan law here covers all help from random bystanders, even fully ALS equipped and educated people off-duty (in theoretical extreme, not that this happens often). This includes beeing insured in case of own injury and having rights to be compensated for damaged things (i.e. bloody trousers, used first aid kit). Yes. But what's disturbing me, that at any time I state that I would stop to help in almost any cases one of the next arguments is this "whacker" argument. I'm proud to have my brain with me even if naked (once I had to do first aid on the beach with nothing else with me than my bathing trousers - even no gloves!). And for the scanner thingy - if you really need to have a fancy car, beeing called to save the world - make it organized, open up a first responder unit, get it professionally equipped, get members high-leveled educated, let it register with dispatch and make a significant change in your community. BTDT * You're sure someone already has called them? 6 minutes in a CPR situation would be way to long for survival. First aid is no pissing in the pool, hauling the patient away and bill them would be. Whow, never saw it this way. Do they really? But that doesn't make you the same kind if you render first aid, professionally hand the scene over to ambulance and step back. Beside that I never had significant problems with random bystanders (except the occasional drunk friend), wonder why this could be. Depends what you count as results. It may not make an impression on you, because you are familiar with much more advanced treatment, but it sure will make a difference for the patient and others to have a calm, ensuring person there who really knows what to do. Even if he doesn't do much. You have an educated brain with you. Don't forget it. Having said this, I already have encountered professional EMS providers in private first aid situations, who were severely drunk. THAT sometimes could be a real problem - they simply don't have a working brain with them... So I should add to my expectations for first aiders: as soon as ambulance arrives, hand over and step back unless specifically asked to assist further on. * I know this topic is a weak point for me after >20 year discussion and a very personal commitment to reducing responding times in my area, resulting in the now common volunteer first responder system here (and eventually two additional ambulance stations = even more career jobs in EMS). Maybe that's why I'm a bit allergic to unreflected and insulting terms like "wannabe saving the world", heard it often enough. I sure should try to stop discussing this on EMTcity further on. If interested, PM me. Thank you for listening.

Why not using the BLS ambulance for one of them (#1, as you said)? Just trying to understand the system.

Depends on the medic and depends on the nurse. ICU and anaesthesy dept. nurses are far better in emergency situations than regular nurses, that is true. BTW, I partly stand corrected - krumel points me to the fact, that in my state, nurses (acoompanied by a doctor) are allowed to do intensive care transports and flights instead of a Rettungsassistent. They just may not be dispatched to emergencies then. Note: If there is a difference between ground and air transport is still in debate between krumel and me and as soon as I found my commentary to the EMS laws, I may win at least this one.

After all said above, I have some more. Pro: one of the rare very professional forums (the only one in english I know), I learn a lot and I get to recall a lot long forgotten. Maybe it really helps me in some decisions for my future. it's fun to get into english writing again the working chat is cool, missed IRC for a real long time (since when there were professional emergency channels) Con: readable without registration, searchable by google. if identified, i sure will get in some idiotic trouble (again). The pro's above make it worth it, though. you can't get far away enough to not meet someone from home - even here is one who knows (and occasionally works with) my department. much too time consuming! some strange things, forum options and things i didn't yet get familiar with (technically) Thanks for letting me beeing a part.

Asys, you're just telling me you're supposed to think. Nothing else I would expect from anyone with a professional background when encountering a random scene in private. It's clearly not (always) the unsafe scene some here seem to imagine. It's clearly not (always) the "too much if I stop at any person laying down". Just think, and don't make up lame excuses but professional based decisions (generally speaking not addressing anyone in special). On the other hand I may be a bit over-allergic to the ones calling off-duty first aiders "wannabe heroes". I had several strange incidents sometimes no other seems to step into. I didn't felt heroic, neither was but did it anyway, just because I was there, felt I could handle this and did. Hazmat including (teaching me something about the reality before some random first aider calls emergency). I see no difference when responding to such a thing within an ambulance or within private car. If I can detect the danger, I wouldn't go near until scene is safe. As educated professional I even may be better in detecting dangers (or clearing them). And a road itself isn't that dangerous some seem to state here. I didn't read the JEMS article about the unlucky EMT (is it online?) but if I have to stop with my family in the car on the Autobahn, my family will get behind the guard rails as soon as the car stops. Simply because I know how dangerous it is - other persons may not. What's with bleeding control, airway control, thermal control, c-spine control, comfort and general care? Fact based update for dispatch? Scene assessment (other participants, fluids etc.)? A lot to do until ambulance arrives, saving them and the patient time. No, i don't want to explain basic first aid to someone who surely knows it. But I know, a lot of EMS pro's literally fear beeing alone without partner, equipment, radio and the adrenaline rush stemming from a sudden experience without 10 or more minutes preparation time en route. That's what I argue against. No, sure. Never said that and never expected it from anyone. To close my rant (yes, I'm kinda in it, I confess), I encourage any professional but random passer-by to think, to ensure scene safety with help of his professional sense much more than any lay person can and act appropriate. And I clearly think, that noone shouldn't help because he "hasn't the right equipment". At least, don't make the same lame excuses as the random non-medical passer-by. Basic first aid is possible including a fact based emergency call, and that could be expected even from Mr./Mrs. Super-Medic. Should be... Again, having gloves with you will help.

Which problem? Handshaking the new guy? No problem for me. In my younger days I never was victim to and now as a senior I never would allow a newbie prank, neither in career EMS department nor in my vollie group. Period. But no real need to intervene, because as far as I know my fellow colleagues see it the same way, management as well. But I recall one (and since then I have the story for backing my opinion): ~20 years ago one of our medics always tried to get a new EMT "washed". For making it unable to flee he locked the door to the station. Then (outside) he ties the new EMT to a lifting chair "just to test" and then gets the hose. Eventually, one EMT managed to free himself and got to the hose earlier, washing the medic. The medic tried to flee and instantly forgot the locked door. I was the shift relief for him and arrived at the time, the ambulance just rolled out the station unable for me to catch up. Then I saw a broken door with bloody stains at knee and nose level. The "winning" EMT short after returned with the ambulance (he brought his partner into hospital two streets away) and told me the story, laughing all the way. The knee contusion and the almost broken nose (and a talk to management) cured the medic from playing this game anymore. It was the same medic that once "jokingly" threats to poke me with a needle but withdraw as I clearly stated that if he would do this he will fly through the window. I must have been extremly clear, since he was an ex-military master sergeant and I always the smallest in class. This medic was known for his strange jokes and had one or more talks to management about it. Beside that he was an intelligent guy and an above-average medic I had some severe calls with and team partnered willingly. Just never should get bored. He isn't with our service any more, retired early on invalidity some day. I suppose some PTSD. Don't tell me about bonding or such. I consider newbie pranks just a bad habit and a tradition to break up instantly with. I rather base my newbie judging on his appearance on the first shifts - does he greet? does he ask questions (or already know the answers)? does he know his profession and/or meet his level of education? and most important: does he buy a round?

Pat#1: 2 i.v.'s cristalloides, e.t. intubation and O2, c-collar (after intubation), fast splint fracture of left wrist, scoop stretcher to vacuum matress, monitoring, transport with BLS unit to trauma department. Pat#2: c-collar, 2 i.v.'s cristalloides mixed with colloides (2:1, we have HES here), O2, analgetic pain control (esketamine here), scoop stretcher to vacuum matress, monitoring, transport with ALS unit to trauma department. The transport decision is based upon the following: Both of them would earn an ALS ambulance, but this is restricted by scenario. My solution would include to transport in both ambulances driving close after another, so the single medic could switch if needed. If number one is stable and could be manually bagged easy, it would be perfectly OK if he goes by BLS - maybe we even could give the ALS unit's automatic respirator to the BLS unit if they don't have one. The second patient at the moment is more likely to get unstable going into severe shock, considering the lethargic appearance and low blood pressure. So I would take him in the ALS ambulance, providing more space for possible further actions, which patient #1 doesn't need because already done. Here, all units have vacuum matresses and even BLS has basic ECG monitoring (3-lead) plus EMTs usually know how to operate automatic respirators in "normal" conditions. Patient #3: document, hand over to the cops, no transport.

We have a demand by state police to not taking pictures on scene because of personal right issues. It wasn't forced into a department order, only hangs on the blackboard. It even is not a clear denial, just a beg for profeesionalism. This obviously is a reaction to some TV channels issuing cameras to fire dpeartments to get early in-scene pictures. Some fire departments got a bit exhausted in getting pictures on-scene, even doing their own "press service" (which is a bit over the edge for a one-unit vollie fire dept,). At least in EMS all staff is fully aware of patient rights (it's part in every step of education, beginning with advanced first aiders). Some EMS fellows are taking pictures, sometimes I did. Not to show around, but to use in training and even for public relations - making sure, no identifying is possible. And, important, never before taking care of the patient. We recently decided to buy a department camera for this things, so no personal camera/phone has to be used and the pictures are under full department control. Scene commanders already have cameras, but mainly for documenting own ambulance accidents. However, they are used to document scenes much more. Personally I never showed a picture to the ER doc, but I know several incidents that happened. Not sure, what exactly they're taking from them beside a general impression. Such things like accident mechanics we're documenting on the call reports anyway.

I wouldn't consider (or degrade) people who simply want to help as "hero wannabes". A real hero wannabe would make sure a press photographer is near. But exactly your said difference makes a professional random first aider much more qualified to ensure scene safety even with non-standard equipment. BTW, it's much the same with arriving at a vehicle accident scene with an ambulance. We all know, that a full lighted ambulance doesn't make much more scene safety than any other car and there are much more reports of emergency professionals getting hurt in service. On my ambulance I have the same standard equipment every german commercial car driver has: a warning triangle, a safety vest and a blinking flashlight, plus some blue lights (BTW, all of them I have on my private car as well). Would you - considering extreme scene safety first - in your ambulance drive by then or wait a while until police/fire arrives and secures scene with all their fancy equipment? Or do you really have significant more warning equipment on ambulance than on your private car (except some flashlights)? And especially then a pro provider can sense the danger much more than a lay man. If too dangerous, I wouldn't stop, yes. But I may be much more creative in organize help otherwise...(and if it's just a very good sight report to dispatch). I can't really prove otherwise since there is not enough scientific research in this despite very general aspects such as "early aid helps". But I can say, that some of my random interventions significantly reduced time-to-notifying, gave some people a safer feeling, enocuraged others to help as well under my lead and may help the one or another bleeding less or even getting into hospital soon enough instead beeing carried home by POV first. That's someone can do even without any equipment and "just" an educated brain (OK, gloves will help a lot). That's correct and I never doubt that or wrote otherwise.

The text is great! When I see other fathers level of care for their girls I'm always so glad to have a son. But...maybe we'll see us somewhere soon at some family party. O_O At the moment we have an issue here - a 17 y/o girl from our vollie department dated a 20 y/o paramedic colleague of my EMS department, so I know both very well. Normal girl-and-boy-thing, romantic feelings and all. But her father simply can't get it, that his little girl grows up and falls in love, now she's even not allowed to attend our meetings or come to service and so, just because it could be that the young man comes across (he's a certified trainer, so sometimes we have him in our trainings, there they once met). It seems, we get enough stuff for a movie. Robert De Niro would be a good cast for him. I meanwhile ran out of personal experience knowledge I could give those two, never had such a difficult girl-dad for my dates! Tips welcome.

One dot too much, try: http://www.thelunatick.com/ems/rules.html Cool that this old list still is around, it's from my young days on usenet (no www in internet). Three of the points in low top 20 are from me.

I don't agree! "Obligated to help if someone is in need [for emergency medicine]" includes detecting the need first. With a certain education and EMS experience you simply don't hop on any homeless or drunk or car accident where you see everyone standing around discussing. But if you see a homeless drunk on the main railway station laying within the baggage cart stock or a car sideways in the middle of a dark meadow with lights still on, THEN you stop. Even if in an MVA a person clearly still sits in their car and some people standing around obviously helpless. Maybe the car in the meadow is abandoned or the drunk homeles really is drunk and homeless from free will with no medical condition - that is a risk I take. All of the above scenarios I was in - the homeless was suffering from low blood glucose level (even not drunk), the car driver was heavily injured and it took a while to extricate him and the sitting patient just was a little old lady totally shaken up by the accident she made but without any medical condition. I already stood (in my best business suit) in the driver's compartment of a totaled truck full of HAZMAT, just because you couldn't read the markings (I have a photo). Yes, this includes getting late to work - but who am I to decide without a closer look that "someone is not in need" or "that's not the time to find someone in need today"? Again, having EMS experience helps a lot clearing a situation, so that I can do my business again faster than a lay person. Even if this implies you see someone in desperate need and you simply decided this morning not helping today, I won't judge it, it's totally your decision. But not mine. EDIT: typo and making a statement clearer.

Sorry to take illusions, but the descripted weirdness IN FACT IS the real world...

Maybe they simply didn't like all the providers join in singing? SCNR.

In Germany in most (I even think in all) states, EMS laws restrict pre-clinical access to the Rettungsassistent (paramedic) and emergency physicians (in case one is needed). Nurses without paramedic license are not allowed to staff responsible positions per se. This includes emergency care and non-emergency transport, inter-hospital or intensive care transport and helicopter EMS. There are some ways to get nurses to paramedic level and vice versa with reduced education time, but both have to take the tests of the other. I don't see the nurse as "best pre-clinical provider" - there are a lot of things a nurse isn't able to handle with "only" a nurse degree. Especially the regular nurses, often they even aren't allowed to do i.v.'s. let alone intubation and even most other care without a direct doctor's order. An experienced nurse from anaesthesy or intensive care sure is better able to handle emergencies, but even they are used to have a doctor in minutes at bedside and a clean environment. The medic is alone - even in germany, where we have the abilitiy to have an doctor on-site, often enough he is far more than just a minute away. Some hospitals around here even hire paramedics for their emergency department, since they are more organized in stressful multi patients settings. That's the official reasoning, beside that I believe, they simply are cheaper...and nurses associations don't like that. Beside the law restricting non-medic's staffing ambulances here, almost all nurses I know would be afraid of beeing on the street in the given settings. All nurses I know working in EMS have EMT (Rettungssanitäter) or medic (Rettungsassistent) degrees, which they have to obtain additionally to their nursing school. As WelshMedic stated, that nurses are able to triage, that's left to us medics here as well: we have the opportunity to turn down a call, not transport to hospital and get a General Practioner. So you don't need a nurse for that. Just a GP system that works. That I consider strange. If there's no doctor (which could happen and will happen more and more), the Rettungsassistent is well able to perform all duties. At least legally and by scope of training (i.v., pain reduction, airway and a lot more are perfectly legal things for medics here). However, I must admit, that a lot of my dear medic colleagues seem to be very comfortable in letting the physician do all the fancy stuff and don't think too much about the job. It has to do with the low pay level and often bad backup by the company/organziation plus very bad representation by medic "unions". Personally I can't understand this and don't hesitate to give the best care I can and let the doctor at home if not needed (there are rules when I HAVE to get him, those are followed, but that does not hinder me to bridge the time until his arrival with all needed stuff). In my little german department (krumel knows it) we we're able to do this some 20 years ago - it was common to work in hospital for medics on duty. A welcomed opportunity for practising things. When the pager goes off, you left the hospital and worked on street. I was very sorry when some lawyer (or other suit & tie person i assume) considered this as inappropriate. But there is no thing that hinders a (here: german) paramedic to spend a week in anaesthesy department occasionally - we're supposed to have continuing education anyway, this would count as such. I did it and it sure helps in practising things you're not having often on the street. So my opinion, based on German law/setting: nurses don't make better paramedics, but they surely can make good ones if they got the same education (which they would be required anyway here if willing to get out on the street).

Oh, I always thought the "remember" part is hers? Works fine here. Congrats!

What do they say (text/wording)? On the cell phone question: we don't have a specific policy. Most of us switch to vibrate and don't answer during calls. One or another occasionally does but that are those colleagues I don't attest much professionalism anyhow. We have cell phones issued by the department for organizational business (one per unit), those are answered even during calls, if appropriate - it's most probably regarding the actual call, mostly even a call-back to a inquiry initiated by the unit. Most "creative" ring tones are a plague. Some have a defib loading sequence. May really scare me at the wrong time...

For sometimes strange definitions of "near". Once my team was attacked by a drunk, team mate took injured colleague to medical post, I pinned the attacker down with two bystanders and called for police support. No cop available...(tent closing time is high time for LEOs). We constantly were attacked by other drunks who tried to free or help the "poor" man laying down below us. Eventually we managed to get other stretcher teams to the scene for assistance until police force came and took over. Despite of the included suspense and the good feeling of surviving this, I this year really was very glad to learn, that our new outside container locations are within sight of a security/police standpoint. The last years I had my share of knife attacks, rumbling drunks and strange people to deal with on our old container posts ON the festival grounds. And I am really not jealous of (sp?) the others outside at the surrounding streets, I like to watch them rolling by. I myself feel simply too old for this sh*t, in my age it's far better to treat some nice young lady's feet. That's something noone seems to understand who didn't work there at least once.

Not yet read all of this thread, but sure will if I have enough time (or need a distraction from work). Great post, big problem... We have no bench, we have two real seats including seatbelts (in driving direction) beside the stretcher and one at the patient's head (driving backwards). it's relatively common to transport one laying and one sitting patient if needed. In older ambulances (when old german ambulance standard was valid before the EU wide came to effect) we had only one seat beside the stretcher but the possibility to fix a second stretcher (foldable emergency stretcher as used in disaster response). Therefore I had the opportunity to transport two laying patients more than often in days long ago. The 2- or even 4-stretcher ambulance concept now is a thing only known to disaster response services. What I would have done? Used my local possibilities...: We have enough ambulances, within a time frame of 30 minutes I can have up to 30 regular EMS amulances and around 5 different EMS helicopters. Within 60 minutes this would make a lot more (100 ambulances, 30 helicopters or so if I really really want). Happens from time to time if our neighbouring MUC airport calls for mutual help (happens around once a year, mostly for preparation issues - what a sight!). If regular EMS helicopter won't fly, it would be time to call in help from the police or even the army. Our police helicopters are euqipped with emergency stretchers fixing points and can be used as transport units in case of need. Most police helicopter crews are additionally trained as EMTs, a ground medic or doctor and equipment will be taken on bord. The police crews are known to flight in far worse weather conditions than the civilian EMS helicopter crews (allthough most of them are ex-police or -army pilots). I had it only once that the police helicopter unit leader himself barely made it safe to the ground and didn't allow the second heli to land. The one patient he then transported through heavy snow storm survived due to his effort. The other patient had to go by ground ambulance but wasn't that critical. Some of our non-transport first responder vehicles are old ALS ambulances. Usually they're not allowed to transport any more, but if real needed it would be possible without problems. Did this several times. We have volunteer disaster response units, which are capable of transporting patients. one such standard transportation squad (2 ambulances) is designed for transportation of 2 laying and 2 sitting patients but some can take up to 8 laying (not much treatment possible then, though). Level of care with those units is "Advanced BLS", some are even real ALS. Those units will be deployed in events with >10 patients, can be called earlier if needed. Each county has at least one such squad. Expect response time around 15 minutes plus driving time to scene. Happens occasionally. Each german standard fire fighting vehicle has a foldable stretcher on board, unfolded usually fitting in the crew compartment (transverse). Thus, a very basic transport would be possible. Never had to try this, just heard from a neighbour county (where firefighters decided to do so, until EMS command-on-scene were able to stop it). If there is such a number of patients that all available transport capacity wouldn't help getting them away at once, I call in a medical treatment post. Standard volunteer disaster response units (each county has at least one) can manage around 25 patients on-scene, depending on severity (25 at least, if only minor injuries, they can handle far more). Deploying time should be a maximum of 30 minutes plus driving time to scene. Within 5-10 minutes after arriving they should have built an operational medical post (inflateable tents and such) and beeing able to get/hold patients stable for next transport. Does happen. There are concepts to handle more than 50/100/... patients on scene to buffer transport with multiple standard disaster response squads. A sufficient large treatment area for 150 patients or more is built up within 20-30 minutes. Deploy time depends, if called out of nowhere usually within 2 hrs. somewhere in Germany. I only know one instance that this was needed recently in Germany: the Loveparade 2010 fatality. But in Duisburg there were multiple large units on stand-by near the event, so they were available on-scene within ~30 minutes. To get around long transport at all I would suggest building up an operation room or a whole hospital in the field: European community disaster modules are able to perform basic surgery and next Red Cross ERU (Emergency Response Unit) "field hospital" is 2hrs flight time away. It will take 2-3 days to build it up, though. All in all, I never had to leave a (living and willing) patient on scene. And I don't want to do so. Over here it's just a matter of knowing the possibilities (see above) and calling them in quick. My personal record of patient transport with one ambulance is 4, plus 3 staff. All in an old, small VW bus... (yes, it was looooong ago). Oh, you didn't meant me. Too late, all written above. Just be prepared. I was in such situations often enough to participate in developing a mutual aid and disaster system so that nowadays it works as written above. A lot of effort, time, money and sweat needed to be invested...

I usually am suspicious when approaching a patient. Any patient: kids get anxious, drunks spill, mentals spit, aggressives hit, older ones grap and all others bleed or vomit. On the last meters to the patient you usually see or smell the problem and can hold a certain distance (switching to visal/voice diagnosis first) or use another angle (outside the reach of arms and spitting). I may fix the near arm soon (taking pulse, not letting loose) and pay attention to the other arm, which solves ~50% of above problems. And don't hesitate to force them turning their face away or hold a gloved hand between them and you if they tend to spit/vomit (intentionally or unintentionally). It's always good for fast reaction to constantly have one or both hands somewhere between your two bodies. Don't turn around if in reach of the patient (needs scene management skills with placing the equipment or team work). Having escape routes help (watch out for equipment), even if it's just a few quick steps back. Again: that's not a procedure just for aggressive situations, but even for the nice little old lady sitting in her armchair. She will spit & grab, too. Seems to work: until now I had just few stains from such events. Never in the face, some on the shirt, most on the gloves (but that's what I wear them for). Occasionally by kneeing into something that just happened before. I think, most partners think I'm too suspicious with patients. But I have my share of stories - however, I always "won" until now, some of those partners not. They want to change it here soon. Until now only law enforcement officers are specially covered in the book, the change to include EMS and firefighters is on the way. But just higher punishment afterwards still won't let you stay clean/uninjured before.

All the best wishes!

Thank you all. I already forwarded these informations to them. Actually one girl even doesn't want to work in the medical field during her trip any more - after two years doctor school (and some more to come) she now is really thankful for any burger job. That's holiday and perfect for getting the brain relaxed, she said.

I have the usual red cross plate of my volunteer membership in my car. It licenses nothing really much, since any active red cross member can carry this sign, no need to be special emergency medical trained. In our case here in our village, it's an additional indicator to allow parking directly at the station. But the different meter maids don't seem to care much, I got written up several times now (costs 15 EUR if I want to pay, a phone call if not).

And there a lot of things between those extremes. If you're only going for "real life saving" than you're challenged very rarely. Most things are minor injuries, some broken arms/legs/ankles and flesh wounds (well, you know what usually happens in vehicle accidents) or the occasional unconcious-for-some-reason pedestrian. A professional acting first-aider (with EMS background) can help a lot there, too. And if it's only by staying calm and assuring that help is on the way - other than all others just trying to stay away from the patient or some laymen doing strange things. I personally know the other extreme, one EMT, part-timer in a private company of neighbour county who happens to live in my village: scans radio traffic and chases in his private car, almost fully equipped (including EMS jacket over driver's seat, big red emergency jumpkit "presented" on the back seat, star-of-life and blue reflective stripes all over the car). Was "dropped out" our local volunteer unit for similar strange behaviour even when ON-duty. Needless to say that his EMT-training he got in his company and his EMS-experience is the best of the world and we others all are just amateurs (almost citating correctly). And: he's no youngster, something over 50 y/o! I'm seriously willing to let him get shot forcefully removed by police next time, already said this to him and have rarely seen him since them. But those extremes are not the topic here: that would be the stinking regular minor injury or uninteresting trauma call with just some blood or the orthostatic dysregulation or the 1000. epileptic seizure you see in your (EMS) life. Only, for those random passers-by and for this patient it may be the biggest disaster in their experience NOW. A trained professional as first-aider could make a difference even with no equipment. And as I expect that someone helps me if I'm laying down with some stupid broken ankle, I would do it for anybody else if possible. And I really wonder, why someone would not do this.