Bernhard

I recall my father stopping at a vehicle accident scene and giving first-aid, leaving me alone in the car. I was around 8-10 years old. He never had more than an outdated basic first-aid course and no connection to EMS, but pulled an unconscious woman out of her car to lay down on her side. Damn, was I proud of my father! But I understand you: having a small kid I'm responsible for is one of the reasons I may not give direct help, if I would have to leave him alone. But there would always be some other possibility, maybe just instructing others or something like that (once I even handed him to another person, but this was in a plane in some thousand meters above ground, so I was pretty sure that he doesn't get lost while I treated the cramping passenger). At least anyone can call emergency services, especially since the availability of mobile phones. In Germany every bystander is obliged to help, "as needed and as possible without harming himself or other duties" (rough translation of Germany's §323c criminal code). The good samaritan would be protected from any claims and is even covered by public insurance for injuries and damages on own clothes/equipment. This applies to off-duty emergency personel as well, even to tourists by the way. And I would do, I already did and I would every trained EMS provider expect to give first aid in any situation, where on-duty care is not yet on scene. This includes, that I'm able to see/expect someone beeing in need. I won't stop at every basic vehicle accident - that would be too much. Just when I see or expect someone laying on the ground, sitting in a wreck or I see a crowd standing around one spot looking down (most probably then there is someone laying there - once, it was a deer...). I even stopped at some suspiciously looking cars beside the road, somewhere between the trees or bushes, damaged/unnaturally placed. Until now I never found someone in there, though. But it could be, I already had numerous EMS calls, where some random passer-by just found a victim by checking out a wreck. Two exceptions: when it would put me in serious danger (this could be an accident on the other side of the Autobahn - I would never stop and cross this kind of high-speed road, it's simply too dangerous and next turn around mostly miles away). And when I'm responsible for others, who would be in danger if I leave them alone (i.e. my minor-aged son - but soon enough he will make a perfect assistant in such situations, he already treats his toy animals fairly good). If on-duty providers are on scene and I see they're out-numbered by patients I even then would offer help. Well, in my own county I know almost all of them (and they may know my car) and in mass casualty situations I would be immedeately in charge anyway, but I would do it outside my area as well. I won't be offended if they don't need another hand. This all is true without equipment as well. I usually always have at least my brain, my mouth and a pair of hands with me, good enough for first aid in most emergency situations. Every car in Germany is obligated to carry a small first-aid box (mostly band-aids and such) anyway. I personally have a blanket and an additional small jump bag in my car, no fancy things, just a little band-aid, good gloves, pharyngeal tubes and i.v./fluid (which is good for cooling burns and flushing eyes as well), but i can make it even without such stuff. A safety vest is obligatory in a neighbouring country where I'm occasionally drive through, so I can justify the 5 EUR for buying it. Even in private clothes I usually carry one pair of gloves. Already came in handy, when some bloody or disgusting situations arise. Or when my dog has a special problem on our walk out. Even if someone already called 112 (european emergency number) I maybe call again, just to give a situation report update - or to be real sure, help is under way. All in all I came across several occasions where I rendered aid beeing off-duty, from "nothing happened" (or just a dying deer) over occasional kid party injuries, passing out pedestrian, epileptic bycyclist, vehicle crashes up to multiple victims incidents and even one HAZMAT truck crash (just in front of me, boy were I scared!). I can't see a "hooray attitude" or sth. like this as long as I'm acting professional, calm and kind of effective until handing over the scene to the arriving regular EMS. To be not misunderstood: I surely don't strive around to get to scene first, it really just happens to me from time to time. It's so cheap and easy to do at least something. And scenes calm down a lot if someone with experience takes care, sure at least this helps the people a bit. I don't really understand why someone wouldn't do it, especially with a professional emergency education, but I won't judge. And it's some kind of fun seeing fellow on-duty EMS responders from the very beginning of them approaching a scene, makes me wondering how I do it when seen from another point of view (assuming this even helps me becoming a better provider!).

Sorry, 2c4 I totally missed your reply somehow, not wanting to ignore you. I'm really sorry. Well, I would argue the same way with the MAST (never saw one in real use and knowing it seems to be deprecated now anyway) and would be interested, what the real reason of the GI bleed was and if the leg raising really helped there. But, unfortunately, you stated this: Beeing (still) a new member here does not necessearily imply I'm totally new to EMS or EMS-related internet discussions. In both fields I have a good chance to outnumber several valued members of the EMS & the internet community. Which, in itself, doesn't imply that there is some value in what I write (it sure only implies that I'm rather old...). The value comes from the content and it's up to the reader (you) to judge it. So I would feel more comfortable If I could read your judgement and answer my direct question but I'm OK with not having the chance. Maybe as a non-native english reader I misunderstood some of your statements but I'm still not yet convinced of raising some legs for shock treatment, I still don't see any exceptions to this rule (simply due to functional reasons) and I think this thread won't get the job done. See you in another discussion...

Not long enough here to know Robert/Dustdevil more than the few posts that I read. But what I read (and I just re-read some of his postings now) already built the image of a knowledgeable, straight-on and respectable medic, proud of this profession and willing to push it forward even (and especially) if this involves some really clear words. Well done, Rob! So sorry not having you around any more and missing the opportunity to learn more of you now. Sincere condolences to his family and friends.

Simply GREAT matrix, so true...! God created mankind in his image. Then he wanted to grow a beard to look like Chuck Norris himself, but failed.

Back to topic: here a well made recent video (and here a good one from 2009) about the medical service on the Oktoberfest - wording (mostly) in german but a lot of scenes inside and outside the main medical post. Not my shift, though.

Okaaaaay....well, if someone likes, I really could arrange something. How does this sound: End of September 2012, near Munich, some tourist program through Bavaria including visiting several EMS related places, organizing ride-alongs in EMS for the interested ones, even including one day medical shift on Oktoberfest. And, surely, a civil visit to the Oktoberfest (if I know it soon enough we even may have a chance for a reserved seating, reservation starts next month and is usually full around January). Several days, even a week or two could be filled with action (accompanying families/spouses/kids could have fun, too)... End of September the weather usually is great here, but there is no relevant EMS fair or something in this time frame, though. Only beginning of October 2012 there is a small rescue fair "Retter" in Austria 3hrs away, but I don't know if it's really interesting. Another possibility, including "Rettmobil", the leading European fair for EMS technics & vehicles (but not Oktoberfest) would be May, 9. - 11. In May 2012 I maybe able to organize an additional internship in a large disaster training excercise, but the date isn't clear yet If needed, we even could offer both dates. Munich has a large international airport with connections from almost everywhere, local transport could be organized rather easily, accomodation could be set up in hotels or private rooms (hotels wouldn't be cheap during Oktoberfest but I know some), food is always good here and I know the owner of the local liquor store... Since the best ideas are those quick ones: Anyone real interested? Any date preferences? If there are some interested I will open another thread for organizing this - if only one or two have real interest, it would be no problem as well.

You surely will see it if he was it, the scars will last a bit. If he tells something about six strong Bavarians polishing his teeth and he knocked off three of them, don't believe it - it was only the flat street suddenly coming somewhat up close to his face. For more details I'm bound to professional confidentiality. Say hello to him, though. The best part with this guy was, he was accompanied by a civil first aider, drunk, too. That one offered to translate the canadian english to german. The patient himself offered to talk in very broken german. Another patient (drunk italian) offered to translate between broken german and english as well. I refused all offers, because I'm fluent in english, but noone heard. So we talked in all available languages completely mixed up, even sometimes I'm talking english and someone translated it to english for the patient who responded in somewhat german which promptly was translated to english for me. Simply great comedy! Until I threw both translators our of my station (after beeing properly treated, though). Such things only happen on Oktoberfest. @Vorenus: It's that strange mix of patients and emotions which make working there fun. Plus a lot of pretty girls.

Expect most of the naked to be Australians, for some reason I don't know (I suspect the beer has something to do with it). I want not to sound like an advertising agent and it doesn't have something to do with the medical field, but there even are some special events organized by the Munich gay community: "Gay Sunday" and "RoslWiesn" at the following monday (a kind of pun on "Pink Meadow", where "Wiesn"=meadow is the bavarian slang term for the festival grounds and meanwhile for the whole festival, "Rosl" is a girl's name and part of the name of the beer tent the happening takes place) plus some other special gay/lesbian events more. See http://www.rosawiesn.de/ (only in german language as it seems). Watch out for the real bavarian gay folk dance group, the Schwuhplattler (english page). Hey, this is Munich. You're all welcome, if you let your money here... Any other questions more related to my original report above?

Therotically: yes. In real: no, but for technical reasons. Usually, the drunks need one or two hours to recover fully enough to crawl out of the medical station. If you're not one of the real early ones, then the beer tent you want to get back usually has closed gates until then - they are overfilled at early afternoon, on weekends even short after opening. If you leave, you have lost. BTW: it's not a tent anymore (was, when I started working there). Since several years they have a fixed building as central post, kind of a emergency hospital. Drunk's monitoring room is special tempered and cleanable...(and the best EMT training area for practising i.v. access). Some are. Sometimes the women also. But that's not a medical problem, so I don't see much of them. Flirt factor is high in the medical station, though. If you come over, just drop me a note. Next year Oktoberfest starts at September,22nd (til October, 7th). Well, don't ask the medics at 02:00 in the morning if they want to come again...but, a year later, they'll be there. Yes, it's fun to work there and to see the festival from the other side. The most astonishing is, that you have not only drunks but much more emergencies of all kinds, through the book, you almost never see in the field elsewhere - plus the alcohol. Which makes things not easier. It's fun to visit Oktoberfest without working there as well, but pretty high priced - there are cheaper ways in Bavaria to just get drunk. For tourists it's a must see, though. So, you don't have an excuse anymore not coming over here!

At least my duty day is over. Oktoberfest in Munich is "the largest festival of the world", yearly celebrating the anniversary of the marriage of King Ludwig I. of Bavaria to Princess Therese on 12th October 1810. Sixteen to eighteen days (depends on yearly holidays) long, starting end of each September. Fourteen large beer tents (large = approx. 4.000 to 10.000 seats) and some little ones. Around 6 million visitors in two weeks, this makes between 200 and 400 thousand visitors each day - the size of a city in it's own. Sometimes around seven persons per square meter, if tents are populated (which they are each early afternoon), dancing and chanting. They will intake more than 7 million litres of beer, half a million chickens ("Hendl"), over 100 oxen, 40 tons of fish and around 120 thousand portions of pork sausages ("Bratwurst") plus a lot more of beverages and sweets. A lot of rides and attractions will serve those who are willing to have fun outside a beer tent. Each day, 120-150 volunteer Red Cross medics, EMTs and doctors take care of the festival visitors, accompanied by the normal Munich city EMS which is reinforced by approx. 10 ambulances around the festival grounds. From 09:00 a.m til 02:00 am the next day, they staff a large central medical post, three outside medical aid stations (container) and ten mobile stretcher teams. This year, again, I was one of them. The central medical post consists of six emergency treatment cabins, one intensive care unit, two stitching cabins, a 16 place monitoring unit for drunks and two resting areas for male and female guests. There, a medic and a doctor will triage the incoming patients, more doctors and medics/EMTs will treat those in need (or monitor until getting better) and - if needed - request transport to a hospital. The stretcher teams are the ones responding on the festival grounds, by foot. At least one tactical team leader, one responsible medic and two EMTs per team take over primary care and transport to the central medical post, if applicable. Often, they will call in direct help from an ambulance, if patient conditions are worse. Medical equipment is a jump bag, oxygene and an AED, the stretcher is carried on wheels and covered with a special designed weather (and view) protection. The small outside aid stations are containers, equipped with the same as the stretcher team plus a closet full of band aids and stuff. One medic and one or two EMTs try to make their best there, assisted by called in stretcher teams or ambulances. Personally I had 61 treatments this day. My patient's nationalities (and languages) were: italian, canadian, united states, england, denmark, norway, austrian, australian, irish, spanish, german and some more (in no special order). The usual thing are blisters from shiny new lady shoes. Others involve head aches (non-alcohol related, since the other type usually comes the day after) and small flesh wounds. A young gentlemen accidentally tried to sit in a broken bottle and took a deep cut in his thigh, loosing a lot of blood, sputtering over his new pair of "Lederhosen" (and the floor of our post), needed i.v. access and a fast ambulance ride into an OR. Two girls had severe migraine pain, nearly relevant to their vitals, needing i.v. fluid and medical pain control. One cutting his finger to the bone, a lot of previously taken alcohol saved him a lot from pain. Some more straightly fell on their nose, not aware, that Munich Oktoberfest beer is stronger than usual and served in 1 liter mugs - one probably broken nose, several severe cuts and the loss off some teeth were the results. Two bee stings needed our attention, but only with local allergical reactions. A kid tried to run fast in a mirror maze, always a bad idea - resulting in a large bulge and a slight commotio. Some people just couldn't stand the wild roller costers and carousels, needing a timeout under blood pressure monitoring. One gentleman was brought by two of his friends, their diagnosis was clear: "He's drunk!". Yes, just like anybody else here, except us service workers. "But he walks funny!". Well, should I really explain to some 50 year old dudes, what alcohol can do to the human body's equilibrium sense? And that it's all OK as long as he generally knows where the sky is? "We'll take you by your word!" - yes, but take him with you, we simply don't have spare place for over 100'000 of his kind... Only one real drunk (without any additional medical condition) was to be taken care for. Just couldn't make his way home alone, constantly fell to sleep. A stretcher team eventually brought him to the monitoring unit... Then finally a nice little old lady with dementia, lost on the Oktoberfest (but not worried about) was handed over to the police. And that were only some of my patients this year, out of approx. total 700 this day - nothing but a normal shift on Oktoberfest. At least I wasn't attacked this year, no one tried to actively bleed or vomit on me and no drunk australian girl screamed name-callings in my ear at 5 centimeter distance (as last year). One day and night of sleep and all is bright again, forgetting blood and vomit, remembering only the nice talks, short lady "Dirndl" skirts, "Bratwurst" and "Hendl" smell, light shows and all the fun we had in our team. Let's see, what next year brings... Greetings to the visiting EMS fellows from the U.S., Canada and Denmark I found some minutes to talk to (actually wishing good luck to the canadian guy). And thanks to the colleagues of Italian White Cross, officially supporting us with their italian language skills, for their great help. Some links: Oktoberfest on Wikipedia official Oktoberfest homepage (english) Red Cross homepage of Oktoberfest medical coverage (german) Hope you enjoyed this report...

Which kind?

Sorry for the long post, it's a topic that is really interesting for me - if you want to skip the whole story behind my interest, just jump to the end of this posting, where the real question is... As most of the people on the world I still remember very well, what I did when the terrorist attacks on the USA happened. Even beeing here in Germany, we had a lot of media coverage of this horrible events. Now, ten years later, a lot of this memories came back (with the media coverage...) - and I tried to recall, what has changed for me since then. First of all it was the thought "I never could stand on top of the tower any more" (beeing in NYC in 1997 including a visit to the top of the WTC) and "Those pictures I have from the skyline of New York wouldn't be the same today". But it even had an influence of my engagement in EMS and disaster response. Beeing a medic, I thought of the fellow responders immedeately when I saw the flames there - and I understood what it meant when I saw the towers falling. What would I have done? A question, that hopefully never needs an answer. The German EMS/disaster response community was horrified as well. Since over ten years there almost was only a basic awareness of disasters. In the cold war, Germany had a very sophisticated civil protection and disaster response structure, with defined civil medical platoons all over the land, equipped by federal funds and staffed with trained volunteers (I started there). In the 1980ies the equipment and structure of this platoons were laughed at by the "real" EMS folks, since EMS developed a professional attitude and noone saw any use for the disaster response - in a war we would have been nuked anyway, so why bother? A highly influencing incident then was the 1988's disaster at Ramstein Air Force Base with at least 450 (hospital treated) or up to over 1000 (ambulatory treatment on scene included) injured people (and 70 death). This leads to local establishment of medical response groups to assist EMS, but this still was very unstructured and just based on the engagement of some "silly" individuals. The large structured and federal funded platoons still were laughed at by "modern" EMS folks, since they were considered slow and lacking modern equipment. However, they were the standard structures in German disaster response, since the east-west (cold war) conflict was at a height. With the more or less unexpected drop down of the eastern block this argument was gone and so noone really missed all the federal structures in disaster response going away soon. German EMS finally really grew up to a modern system with highly educated professionals and a dense net of responders. The unification of Germany following the break down of the east German Democratic Republic needed a lot of tax money which wasn't spent on disaster response. Some incidents with around 100 injured/100 deaths (i.e. derailment of a high velocity train in Eschede and else similiar events) lead to a slighlty more structured attempt to build up volunteer response groups for assisting EMS in multi victims situations. German Red Cross proposed a unifying structure for medical groups, some german federal states regulated their own disaster response (often inherited a lot from the Red Cross' suggestion). That was OK for the "usual", we thought of that time... Then September 11th, 2001 stroke. German (and european) EMS and disaster response experts were stunned. What would we do? All concepts were completely reduced to some 10-20 victims, barely able to handle 100 or so. Now we were talking about thousands! Things calmed a bit, discussion about 9/11quickly turned into debates about military involvement, not about EMS and disaster response. But the EMS/disaster experts pushed the topic forward and tried to alert politicians. The overall topic was: "How would we handle a 1000-victim-disaster, needing large distance response". The ones arguing that would be simply not very probable became silent, when a "100-year" natural disaster hit: the flooding of the Elbe River in August 2002 affected several cities, one of them Dresden. More than 30'000 people had to be evacuated. A lot of things have to be improvised, political leaders don't came out very good. Therefore a respected member of the German parliament, a former german army General, was appointed to analyse the response and propose improvements. This report (and a lot of discussions in the aftermath of the flooding) lead to a new understanding of inter-state mutual aid in Germany. It resulted in a new federal concept of disaster response units and - more surprising to me - into the awareness of the EMS community on maybe beeing a part of even larger multi victim incidents. The forthcoming world soccer championship 2006 in Germany, including several terrorist threads (if real or just suspected) sped up the process a lot. Now in Germany we have: a federal agency for civil protection and disaster response (we had one before the cold war ended, but this died with the iron curtain) several modern communication media implementations (internet...) and information connecting points (federal disaster situation center with laws/regulations about the information flow and inter-authority work) concepts of civil medical task forces covering whole Germany on federal funds with modern equipment most of the larger states actually implementing these concepts, sometimes even with additional own ideas (however, some other states still waiting for the federal funds flowing) a strong understanding of EMS beeing part of disaster response some kind of awareness of EMS providers maybe beeing attacked by terrorists some awareness of CBRN issues including federal funding for protective wear for EMS providers / disaster responders (actually including the development of a complete new set of equipment, not bad at all). a more and more scientific approach to EMS/disaster response topics large state/federal wide disaster exercises (however, mostly table top but with some real elements) a network system of mutual help in/outside the European Union (http://ec.europa.eu/...l/prote/mic.htm) and some details (equipment, training, ...) else - feel free to ask, if you want to know more All in all this was a more or less direct result of the terrorist attacks on USA at 9/11, which clearly served as the initial wakeup call for the disaster response community in Germany. I think, we're pretty good prepared now, compared to the 1990ies (however, I could think of more). Thankfully, it has not to be proved yet. I personally grew up in a lot of this recent german EMS/disaster response history, starting as young volunteer in the cold war civil protection system, seeing the GDR and eastern block collapse from the point of view of a Red Cross volunteer organizing refugee camps at the soon-to-be-former border, seeing the professionalisation of german EMS, then beeing part of Bavarian response force to the Dresden flooding and now am active in a planning/leading group of statewide disaster response. From this point of view, I'm just curious: How did 9/11 affect YOUR countrie's/area's disaster response concepts? Did it anyway (or other large incidents, like the New Orleans flooding) or would you do things today as have generations before? Any personal experiences? Again, sorry for the long post (I was inactive a while, so I had some letters/words in spare). I hope you at least enjoyed the reading about german disaster preparedness history. Just a plea: keep it on a technical level, any political/religious/ideological debate would fit better in the Non-EMS discussion board. Thank you!

That's why he's the Captain... Don't hesitate, happens all the time. I encounter this when I'm the first responder: until the other team steps in, the patients history has changed somehow. On the other side it happens that when I was the supervisor, the patient tells me more than anyone else. There is no special sign identifying me as such, but somehow there is some magic. May be the patient needs some unexpected time to think, so the next provider gets answers to questions the first provider asked. It helps if questions are very clear (basic language, no single technical term). The suggestions of asking the patient to do something instead of if he can do something works often, too. For the medication I have near 100% success rate if I simply ask "Where is your medication?" instead of trying to find out if there is any medication at all. Still, such things happen. Beating the patient doesn't help much, though (I guess, rarely tried).

Here we have the possibility to refuse transport and turn the patient over to a general practioner making house calls (24/7 service available throughout the state). Generally, a non-emergency transport has to be prescripted by a doctor anyway, so if no prescription is given we don't transport - unless it's an emergency. This is filtered by dispatch, but the EMT/medic can do it as well (and point the patient to the next general practioner service). it sometimes is a fine line, but calling a general practioner usually gets you well out of the way of beeing liable. Last year there even was a case in next big city where dispatch refused to send an ambulance to an obvious "only drunk" patient (17 year old), his father filed a law suit which resulted in a clear verdict of "not gulty" because of "EMS is no taxi service for drunkards". There are some general practioners acting very loosely on whom to give prescriptions for an ambulance transport, so there may be the occasional patient waving with his prescription and demanding transport which could easily be done by a taxi or private/public transport - BTW, the doctor could have prescribed a taxi transport as well. That tends to be reduced, since health insurances seem to keep an eye on this. So the real "BS" calls here are mostly reduced to "kind-of-emergency-but-not-really" types (drunks, helpless), when a certain probability exists that a medical condition could exist and/or police refuses them. We have to live with that. But from what I read from the U.S., we seem to have a far less share of real BS calls and frequent flyers without any emergency. Wouldn't want to change this (and as well wouldn't want to decide wrong - such cases exist...).

We're with you! Stay safe!

Rarely I would irrigate wounds anyway. Larger pieces of dirt may be mechanically removed by soft dabbing, but if this doesn't work or is too time consuming I simply leave the dirt in the wound and let the hospital/physician do their work. If a small wound has a little bit of dirt in or close to it, and the patient doesn't need to see a doctor anyway for this cut, I use non-alcoholic wound desinfectant (contains chlorhexidine) to clean. Along with an advise to see a doctor if wound gets irritated or if tetanus vaccination is too old. No water. Only for private use (kid, wife, dog, myself), I may additionally use clean water from the tap, knowing we have almost sterile water here, even without treatment.

Sure - you don't? A Tricorder App lives on my Palm III since a decade before the word "App" was even introduced. And concerning transporters I'm not so sure (even having developed systems for public transport companies), but I remember some instances, I suddenly was in one place and did not know how it came. Technology seems to need revision, though, because I always have had severe head aches after such appearances. Or: just try to read the statement about "not so nerdy". The concept itself was what they discussed. OK, even without the skateboards (but see my previous pointer to the medic-skaters on roller blades)... ....ooOO( I wonder if they had got the idea through when they would have brought skateboards into discussion )

I stated that if I let them go on their own, I most probably would bandage. Not if I can have an eye on it. Exceptions etc are in my posting above. Agreed, no need to damage your shift key. I meant contamination in a more general sense - the microbiological infection is treated by the clinical handling and/or the patient's immune system anyway. What I meant is to be contaminated with real dirt or coming in contact with something other than air - as opposed to "an forearm calmly lying on the patients belly". This means I tend to pad even a minor wound if it's in a dirty setting, where I would leave it open if it's just a hop from the street to the ambulance. Because I always (sic!) get suspicious if I read "always". If it helps in patient care and it's needed to protect from real dirt, then I would tend to bandage/pad it, yes. I wouldn't do it just for precautional bleeding control (original statement was: it does not bleed at the moment) and not for microbiological protection (it won't help anyway). And this given a short transportation time under my supervision. In a field setting (no transport needed or available for hours), with prolonged transportation time, or self-transportation I would give more care to a non-bleeding wound. But not in any case or "always". I can't deny this completely. But regarding wounds and as said by others, I can't see any real issue with bandaging a non-bleeding wound in the given boundaries. It won't prevent infection (as it already happened) and a clear non-bleeding wound rarely starts bleeding from nowhere. In reality, the non-bleeding wound in my ambulance would be accompanied by some more trauma which needs my time more. In fact, with minor wounds which I don't see a need to get to a doctor, I normally advise the patient to open my bandage when at home and let it heal on fresh air. My bandage then is only a protection until they get home. But that would be out of scope here, because the original poster gave "needs to be stitched" as a criteria.

Sorry to say - even this is an old concept, already discussed in Bavaria. Really! Ok, the technology was not that nerdy. But the concept of having much more single providers out on the street who first determine if an expensive ambulance transport is really needed was in focus for a while, 10-15 years ago or so. Target was to reduce ambulances. Thankfully after some serious political discussion this went down the drain and they implemented detailed statistically based calculations in bavarian EMS. Resulting in more and/or better placed ambulances. Common sense won...

Well, if it starts bleeding "later", then control bleeding at this point. I don't bandage every single cut. But it depends highly on circumstances. Assume a small but deep cut, not bleeding. I may not even transport this to a hospital (if no other reason exists) but send the patient to a doctor on their own transport medium. For this I even would bandage it. But when the patient has an indication for ambulance transport, then likely because of other more severe injuries, then I won't loose time on the non-bleeding cut. Again, there may be exceptions: if the wound is likely to be contaminated during transport (contact with dirt or equipment) or may contaminate staff/equipment, then I most probably would put a pad on it. Usually I even wouldn't do a complete bandaging, a pad and some stripes of tape mostly are enough for the needed purpose in short transportation times (<20 minutes here). Do you really really cover each single wound? My time/benefit calculation doesn't see much sense in this.

Googled it: (post-)micturition syncope Sit down when peeing! That's what my wife tells me anyway. Didn't know she did this for medical reasons...

Motorbikes are not a critical issue, I agree. They have their advantages and their disadvantages, just as about any other thing in EMS (and whole life). If they solve an issue with acceptable costs, then OK (and sometimes you have to add "public relation" to your cost/benefit sheet as well, just with any other business). It's not more complicated than that. Thus said, I see following real disadvantages of motorbikes against cars: far more weather dependent (in snowy/icy winter settings they're not really applicable) can't transport (this restricts them to first responding or additional tasks not involving transport) need additional/cross-training as EMT/medic and motorcyclyst (but usually the drivers are experienced motorcyclists of their own, not having to go through basic training by the organization - additional safety training should be provided, though) not much capacity for things, equipment has to be reduced in number, weight and space Clear advantages over cars are: small agile speedy public relation aware Now simply calculate this up (include purchasing, maintenance and operational costs), then decide. That's really not so special. I'm only rather angry when someone states having found something "completely new" and the "ultimate solution" or something like that in the world of EMS, having to accept that it's obviously a part of the public relation thing above. I have my share organizing several things that someone else sold as completely new years later getting the publicity and more important, the funds I was too dumb to claim (knowing that even I was not the first). Sh** happens... Thinking of other special (first responder) EMS-"vehicles". I know following do exist beside ambulances and simple chase cars: horse (example) Personal Transporter/Segway (see http://www.youtube.com/watch?v=41Owv0IN2qE, there even exists an extension for patient transport, scroll down on this supplier's webpage) roller skates (example) Not to mention other special equipment for rough terrain (ATV, amphibious, Hoovercraft), mountains (motor sledge/Skidoo, crawler-mounted ATV, see article about several mountain rescue special vehicles in germany), water (image) and railroad track (picture series of a german Rescue Train). There even are medic/physician helicopters (with NO patient transport capacity) in germany.

More questions: Did this ever happen before? Kind and location of chest pain (sharp, oppressive, exact location, wandering, radiating, changing with chest movement)? Known allergies? Illnesses/symptoms the last few days (infect or else)? Recent injuries, accidents? From the medications: known diabetis -> is this correct? Since when? Last time to see a doctor about this? Your normal blood glucose level? Last checked (time, value)? Other known medical problems: high/low blood pressure? Smoker? No alcohol/drugs at the moment -> do you normally (ab)use alcohol/drugs? Since in hotel/travelling: from where (maybe remote places with infection risk)? How long on the road/plane? Stress? Last meal/beverage (contents, time)? Last urine normal or unusual (smelly, red, ...)? Last defecation (time, something unusual)? More measurements/inspections: Blood glucose level (in mg/dl please...)? ECG, 12 lead -> anything to see? Temperature? pharyngeal inspection (signs of infection)? lung sounds? bowel movements/sounds? Abdominal pain/abnormalities (palpation)? too bad you can't provide information about your pupils, so I'm assuming nothing unusual there (-> adequate reactions, no unusual visual effects) short neuro check #1: follow my finger with the eyes (up, down, right, left) -> reduced movement? short neuro check #2: stretch and lift arms in front of the chest, close eyes, try to hold them straight -> muscle tonus, sinking of one or both arms? short neuro check #3: close eyes, try to touch your nose with index finger of both hands (successively) -> muscle tonus, side consistent? short neuro check #4: lift arms/legs (successively) against my pressing -> muscle tonus, side consistent? Preparing transport: "Sir, you have some medical problem, most probably with your circulation (won't rule out neurological or other at this stage, but I won't say that). We can't be sure that you don't pass out any time again in a not so harmless environment. Considering that and you having a known history of at least diabetis, it should be checked and maybe adjusted. We want to take you to the hospital to have more possibilities for a diagnosis and care. Do you agree?" Get appropriate lifting tool (stretcher) near the room/bed. Intentionally let patient step up (slowly, controlled) to get to the stretcher to test if there may be an orthostatic problem. Get him see a hospital with more tools and a lab. Anything else: If not something special on the ECG or things change: no. Just monitoring. Personally I don't even see a reason for an i.v., others may do. Possible diagnosis on my call protocol would be now "situation after beeing unconscious for unknown time, poor general condition, known diabetis", differential diagnoses (depending on findings in above additional measurements): orthostatic disregulation of unknown reason diabetis disregulation (blood glucose level?) myocard related circulation problem (ECG?) infection (temperature?) intoxication (last meal?) neurologic related (recent injuries?) On this stage it could be almost anything. As long as he's stable and willing to come with us, I wouldn't try much to figure. Just gather information on scene, put him on monitoring, get him to a hospital following usual hygienic protocols (here: wearing gloves, desinfecting hands afterwards plus all equipment having direct/indirect contact with the patient - that's at least what we do after each call). I recently had a similar patient with several medical and psychological pre-diagnoses nearly passing out after a short hike, turned out he had an acute noro-virus infection. I don't know if it was this patient, but the hospital we brought him into was closed for more than a week due to a burst in noro-virus infections the day after...glad to have cleaned my stuff after patient contact, the hospital probably should've done that, too... Not to forget: surely hope it is better now, Ruff! Get well soon! EDIT: inserted short neuro checks - don't have the proper englis short terms, so described them.

Over here in Bavaria they were introduced in 1983/1984, still performing service during summertime on weekends, when the autobahn are full of tourists (see this link, text in german, lots of pictures, but they even have some information in english) Other bavarian EMS organizations now have motorcycles as well, but not as long and not as regularly on the street. In other german states it's sometimes known, but not common. The service is volunteer, staff are "Rettungssanitäter" (~EMT) und "Rettungsassistent" (~paramedic), setting mostly are the autobahn and nearby villages/roiads, sometimes on stand-by in larger/long-range events (i.e. marathon runs or such). In service they are connected to the various dispatch centers on their patroling way. They not only provide (first) emergency medical care, beeing able to rush through the traffic more easy than an ambulance. They even do some caring for upset people in traffic jams, calming them down and informing them about ways around (for this they carry gift toys and spare maps). In earlier times they sometimes served as pilot for out-of-area ambulances, this now is rare since the use of GPS devices. For our larger disaster response formations we use them as accompanying cycles for traffic control, in disaster situations they're used as messengers and first assesment explorers. I can provide more information on request or get you in contact. However, I'm not a rider myself (and don't want to be). But I know them pretty good and worked with them on several calls. EDIT: link to an emergency ride video (WMV), try this with your average ambulance.

In my own class long ago: no. Meanwhile it's a mandatory topic in classes ("Stress & Coping"). In our district, this topic usually is teached by me . However, it covers only around 30 minutes, more or less as a pointer in the right direction and to further information (next course here starts in September). For our local staff we have an information sheet about stress symptoms/coping/helping possibilities given out and on permanent display, sometimes we will address this issue in our regular training sessions or just before some known stressfull events (hey, Oktoberfest is coming...). Personally I once attended an additional course for crisis intervention providers, just to have some clues about how to deal with left behind relatives. Gave some great insights and I'm more confidential to condole someone on-scene now and to handle the emotional stuff. It sure helped me to deal with it, simply by not beeing emotionally helpless any more when nothing hightech medical is left. We're glad to have a volunteer Crisis Intervention service (experienced EMTs/paramedics with additional training) to take over the relatives, so I have just to bridge those 10-20 minutes until they arrive. They then will stay around 1 or 2 hours, until situation is stable and/or other relatives or social network can take over. My point of view is: I'll give all my best to help the patient survive (and I'm investing a lot of time and effort to be able to do so). If this won't work, then it's simply not up to my decision. After all, in the very first place, it's not my fault that the patient is seriously ill, the heart stopped beating or the patient is victim of a severe accident. That is a lot more difficult with own relatives or friends and neigbours, where I had some more contact before. One of my coping strategies: I never went to funerals of neighbours I worked on myself, would do it and sadly already had to do it only for close friends (and relatives of course).