Bernhard

As others have said, there is a whole of idealistic assumptions in this sentence. Try not to learn it the hard way. Neither EMS nor firefighting is like that, what is seen on TV or in movies. You asked personally, so you get my opinion on the following questions. Others may vary. Act respectfully, comfort the relatives, organize something (left kids?!?!), then clean up our own stuff. Death is part of life, we're not there to change fate or save lifes, just to assist a human beeing to have a chance to recover enough to make it to a hopefully better level of care (AKA hospital). If he/she doesn't take this chance or is not able to, it's not my fault. It helps, if you're pretty sure, that's not your fault - try to get top education and experience (this never stops - and there is a real conflict in the mix of professions such as EMS and firefighting). Never. Thought of some of them later on, yes. Especially if there was some lesson to be learnt. "Haunted"? No. That drama I leave to TV and movies. Not because of the death. More because of the living (and that mostly doesn't involve customers/patients). Religion may help. At least it gives you rituals. A silent prayer, the ability to comfort people (be neutral!), beeing confidential in some greater plan - sure helps yourself to cope even with really sad calls. They exist, yes. Don't assume to constantly saving or loosing lives. That's not the thing with EMS (and it's not the thing with firefighting). In EMS you have a very close relationship for a short time to someone in need and may be the one who can help a little bit to ease a pain or simply be there. Sometimes the patients or the scenarios are disturbing, for some reason (not all people are seeing the world with normal eyes/brains, leaving alone what's defined as "normal"). Sometimes you get a smile as a reward or a "thank you" or the feeling, that you made a difference. Mostly it's "just a job". It is the same in every other job - there are good moments, there are bad. It helps to see it as an opportunity to make a change to the better for someone, even if this won't be so every time. Good luck for your classes. Try to get street experience as much as you can, preferable with a good mentor!

But it obviously worked. That instantly makes it a good one. Honestly: If I would have been asked by some random (and maybe inexperienced) assistant and clearly not by the team leader and/or I see a bunch of weird things going on in this particular case which I don't want to be part of, I would've backed out as well. I even can imagine the medic willing to help when asked outside the ER, then steps in and sees, what's going on and decides that he doesn't want to get really involved in some stupid thing. I already did things like that (even in duty!). However, with better excuses or with a very clear statement: "That looks like your mess...handle it yourself" or maybe a little more polite. As long as we don't know the real situation (and the original poster seems to share only his point of view), it's not really legitimate to judge the off-duty medic's behaviour. His excuse was not very creative, yes - but that's all what we can say. A more interesting question now would be: "What would you've said in such a situation, if you want not to get involved for any reason?"... (Not to be misunderstood: I already assisted even off-duty in calls, which were not mine, if it was needed). EDIT: schpelling

As a dog owner and with a wife knowing everything about dogs plus having multiple scary calls with dogs involved and survived all of them (plus keeping the dogs alive) I would say the following: Dogs are pretty predictable and are very bad poker players. Usually they simply want to keep control over the house if the owner can't do it, that's why they're scared like hell with a lot of unknown people coming to the door. Just keep cool and assume control, use a clear body language and a strict & deep voice, if needed escalate to shouting to the dog all the way long (imagine a Marine drill instructor). instantly be the most respectable beeing on scene (if random firefighters salute to you, you're on the right way). Give the dog clear commands with voice and hand signals (point to indicate direction or flat hand to indicate "to the ground"), the dog will understand them when given with clear intention even if never learned. Try to move the dog into an unused room or hook a leash on them (only if the dog already has a collar on). Be sure to have no distraction nearby, noone should do something out of your control (i.e. start to care for the patient in view of the dog, break a window in the back of the dog or else). To control this may be the hardest thing on such a scene, someone seems to always knows it better and does something silly...with you beeing the nearest one to the dog. That would be my greatest worry. Most dogs and especially the random big dogs soon will be glad to have someone in charge on scene. Their social behaviour is based on a very strict hierarchy, and you have to show you're on the upper side. For a human and especially a medic this should be easy, even when you're not belonging to the pack. Dogs know the difference between other dogs and humans very well, the latter are trusted "in charge" even as a stranger. The trick is to not show any uncertainness - act quick! This won't work with very good trained guard dogs/police dogs, but they're rare (and they wouldn't make a really big noise before getting you). It may be a scary thing with real sociopathic dogs, but even then it works most of the time. However, if you don't have opportunity to practise (own dog, good dog school), then you may be a little bit on the bad chance side... I wouldn't recommend beginning with friendly behaviour ("such a cute dog...won't bite lovely EMT, won't you?") or tricks like dog cookies or else. The dog is in stress and wouldn't pay attention or respect you for not beeing strict or trying to play. Cookies would even signal "good behaviour" and the barking won't stop. If you have a well trained dog with "built in" high hierarchiy level on your side, things are far easier - K9 units are a good replacement for special animal control services. A normal dog most probably won't help unless it's a very good social trainer (that exists among dogs, a lot of dog trainers own such a dog to get sociopathic dogs on the right track). Normal dogs tend to respect the other dog's control area and won't interfer. If you want to try it anyway, get a dog of the other sex. But again, no guarantee with normal, untrained dogs - better try it by having a human getting control over the dog as stated above. Beside that, catching a dog is a completely other business (here you mostly need a good trained other dog or a experienced animal control team). Our dog's trainer often is called for such situations around here, it's cool how she and her dog take control then. Anecdotic, I recall a man dropping dead while walking his german shepheard, who was known to be silly and aggressive (the dog). I was able to grab the line after having the dog literally shouted to the ground, then tied it to a bystanders car. At least we kept one of the two alive. However, the dog didn't like me afterwards and always tried to get on the other side of the street when seeing me (was a neighbour, met the widow including the dog several times). Yes, because that just heated the dogs instincts and showed, that medics are something to chase. You lost all other tries from this moment on. Don't underestimate a dog's several ten thousand years evolution experience with humans... ...instead use human's ten thousand years experience with dogs. See other posting. It doesn't work on humans in stress, it won't work on dogs in stress. Some dog races are literally "built" to never let go even if theyself were severely hurt. A little pepper is nothing compared to the will of a decent hunting dog in defence of it's possession. You most problaby could have saved your time trying the other tricks. Be confident and show you're the boss or alternatively shoot it. Trying several other tricks may be good for press coverage, though, but don't give you the time needed for the patient. Dogs are pretty good in making up priorities. If it's protecting his house or owner, then any bait would be not interesting enough. To be honest, it would make a good show experience, at least. Most probably the leather glove won't distract a motivated dog long enough to wrap something around it. It just sends the signal of "I try to fight it out with you" - instead of "DON'T EVER THINK OF GETTING YOUR MUZZLE CLOSE TO ME!". Spraying air to a dog's muzzle indeed is a valid distraction and hierarchy signal. But doesn't work always. For example, my dog would beg you for getting more air into the face, she really likes it somehow.

I'm too good for this world. But I somewhat like your attitude.

Not likely. The posting just gave me the impression that there is someone who had a training on 3-lead ECG (and probably access to such a model) but not on 12-lead. In fact I just wondered if the patient was hung to any form of cardiac monitoring other than SpO2. I'm not talking about moving electrodes around, but it's quite possible to see infarct signs in a 3-lead ECG (did it all the time when we only had those LP5 or LP10 or even older models). Not as in a 12-lead, though. Hell...I even remember the times not having any ECG as standard equipment on board, just wondered that this may be the case even nowadays in modern industry settings. Thumbs up! That remembers me of myself meeting reality...(that feeling doesn't really stop, though).

Me? Always, Dwayne, always. But maybe someone sees it otherwise. However, beside ethics, if speaking alone of scene safety it could be unwise in some US states or other weapon liberal areas. Over here it's rare that someone has a gun in his house. Immedeately after the incident I met a former deputy chief of another vol. fire dept. (in a completely other business, but I couldn't resist to tell him the story) and he told me, that his department was widely known (and dissed) as the only one waiting for the police instead of breaking into houses. So, it seems, that fire depts. may have a completely other view on private property. Not that this had surprised me. To finish this small scenario, my steps were from the beginning: Ignore the silly request to remove my vehicle. Prepare space for the arriving ambulance. Contacting fire chief already on scene (which forced me to climb through the already broken window). Trying to calm the scene and to ensure the complete house was searched in a proper manner ("...you are sure to have looked everywhere if you already trampled through the whole house?"). Finding an alternative entrance (front door was closed) - to be honest, as I mentioned this, it was one of the firefighters who simply opened the porch door, immedeately canceling the need for more people climbing thorugh the window. Ensure, that law enforcement responds to scene (fire chief did this). Questioning the initial caller (the cleaning lady) about why she called, possible problems etc. Remembering I was there already some months before plus the one medic of the meanwhile arrived ambulance remembering having transported the person in question four times this year. Informing dispatch and requesting a search about possible recent calls to this address. Canceling all subsequent actions when beeing informed by dispatch, that the person in fact was transported to a hospital some days ago and is still there. In the answers given, I at least missed step #3 (contact other responders already on scene to gather information) and #7 (get more information from the caller, especially when she's present on scene). So, no patient there, now only a broken window and dirt all around the house (well, cleaning lady already on stage). We left scene, leaving the firefighters there to have things settled with the police department. Would be interested what the owner thinks about this... Would I feel guilty, when the facts were other ones: really a sick person behind a closed door, not known to us (no verbal/visual contact or other)? Probably no - if he really needs medical assistance within minutes it most probably would be too late anyway. If not, then we would have the time to find another way or beeing advised by police. Bad for the patient, but better than breaking into all houses just for the ideas of someone else (even if in good intention). However, main problem I see here is that law enforcement took so long to arrive on scene (I even don't know when, I left before). Nice little scenario, I think I will use it in our first responder training (we have some scenarios provocing such ethical & legal discussions).

Thanks a lot! Then I'd miss the blood glucose level. Yes, i know, the post is not intended as an exact call report. But PCP presented two interesting patients - too bad, that he most probably never had a chance to see them with a better outcome and it happened so short after another in a new job. Well, a (STE)MI could be diagnosed with a 3 lead as well. Was it done? But maybe I misunderstand the concept of a Primary Care Paramedic as a first aid attendant completely ("if trained for it"). Is wikipedia correct here? Ouch...(I sure will steal this line).

I see that you have to vent your feeilings. That's OK, and I don't want to teach you or make you look as you forget something, just want to ask and point out a thing or two: What do you mean with "remarkable" on RBS (= Random Blood Sugar?)? By the way my very first reaction on those symptoms in your first paragraph was: "Think of myocard infarct!". Especially with woman there are a lot of unspecific signs, as a pain in the back compiled with slight significant circulation signs (pulse weak, skin cold). No need to have a clear "chest pain" to ring a bell here. How old was the patient? Did you have a 12 lead ECG? What was the SpO2 before you applied oxygene? However, even if I'm right at the MI suspicion, it most probably wouldn't have affected the outcome. Just something to have in mind with "backpain", expecially if combined with other circulation symptoms. How did he confirmed this and - not so technically questioned - why the hell did he loose time then? Didn't they have surgical capabilities when they're called a hospital? An AAA doesn't have much time to intervene or get a second transport anywhere. I think you hadn't much choice here than to transport to the nearest facility. Maybe a helicopter would have been the initial thing to call on scene but this depends and I agree that it may not seem to be indicated at this time. Had a similar case some months before, 45 y/o mother of three childs, fully alert and in extreme pain with unspecific symptoms. Diagnosis was very difficult, we opted for a helicopter call in (night landing). Until then she had to be defibrillated once, came back conscious and thanked us (just like in a bad movie!!!), then eventually died despite all efforts in the ambulance on the way to the landing zone. Had to comfort the family for a while until more relatives arrived - not easy, since I was the first unit on scene and actually talked to the patient. It was my young partner's first death call, too. Sometimes we simply can't help than beeing there on their last way. Thanks for posting.

OK, let's do this scenario quick, the real life solution wasn't that special to spent too much time on it. Dwayne, I will follow Timmy's solution because you already "did" a lot more than I expected in the first answers. OK. Did this - very friendly. They moved. I can't legally say the fire chief what he does with his ressources (as well as he can't say something about mine). So I let them play whatever they wanted. I even may have use for them later. I'm pretty sure dispatch called out only one vehicle, but they simply went with all they have. Didn't say anything about that, they weren't in the way (on another occasion with the same department I had ONE firefighter EACH two meters pointing me to the house, as if just in case I would have been completely blind). Nice of them. OK, you (both) would break a window if no contact was established? I wouldn't, beeing in such situations often enough. There is no clear evidence of someone beeing in need. I would try to identify someone in need, find a solution without damaging property. Once I watched a professional lock & key service opening a massive entry door just as someone with the regular key. They may need some time to get there but if called by EMS/police they are rather quick. Problem remains: the bill... Wait, till law enforcement is on scene. They can legally advise breaking into someone's property. Only if there is real evidence of someone in need, I would force entry on my own decision. This may be contact to the person over phone (dispatch), through the door (voice) or visual. I did this on some occasions. But in the given call I hadn't this decision anymore: the fire fighters broke a window, smashed a flower pot and started running through the house (five or six of them, including chief). Second fire fighter you meet (the first one was the one with the moving request) informs you about this saying "This now broken window is the only way in. They're inside searching!". Your next move? I here give you some more information (which I had after contacting the fire chief inside the house <- that was my "next move"): a woman identifying herself as the cleaning lady of the person in question. She comes weekly, usually the person opens (she has no keys), but not this time. from outside she saw a prepared snack. she identified the prepared snack on the breakfast table as the one she bought the week before. she states that the person has diabetes and is known to drink too much alcohol from time to time. she called emergency number since she didn't know what else to do. Search in the house still in progress (imagine running firefighters, heavy boots, ...). Law enforcement is on the way, but may still need 20 minutes. Oh, I simply ignored his request and told him in a friendly way that it's his vehicle that blocks the way, not mine. Worked. OK, but in my case there was no patient noticeable from the outside. No problem here. I will post the solution of the real case after some answers on legal & ethical aspects of breaking into possible patient's houses...

What do YOU do, when you're called to someone assumed to lay sick behind the closed front door? Just had a call yesterday, that left a citizen with a broken window, a crashed flower pot, a lot of firefighter's footsteps in the house and several opened & searched beds/closets. The adrenaline vapor may be vanished meanwhile. So I just thought the whole way back to the station, that this would be a nice small scenario here... Specifics (just from reality): thursday afternoon, clear sky, summer, but not very sunny, not rainy dispatch gives "sick person laying behind the closed front door" and address (a single brick house with cellar, ground floor, first floor) your team: ALS first responder unit (1 paramedic, 1 EMT) from neighbouring village with ETA 5 minutes (no transport) other, medical: 1 ALS ambulance (2 paramedics) with ETA ~10 minutes on the way other, technical: local volunteer fire department of the same village few minutes away, coming with two engines, 10 staff including local fire chief. other, law enforcement: police tries to find some available officers, next is more than 20-30 minutes away You arrive short after fire department. Two fire trucks are on the street in front of the fenced garden, blocking the access to the driveway. Some firefighter awaits you and tells you instantly to drive your first responder car further away, because there's an ambulance coming. What would you do from now on...?

Real any? No. But even if I don't consider it as a risk of miscarriage, I would treat pregnant woman with care. As Dwayne stated, simply for scene safety reasons, a rampaging pregnant just because I weren't friendly enough is nothing what I want to have in my ambulance. But I would (and in reality I try as much to real do) treat any patient with enough care to have him comfortable, not more injured and pain free. This should not be restricted to pregnant woman. I mean, what is the business with "cosidering miscarriage"? It most probably will not happen in my hands between scene and hospital. It's my responsibility to take care for any patient, but not to prevent things for anytime in the future even on "special" ones. There may be cases I memorize all emergency birth sections of my book or think of where the newborn equipment is stocked today. It is the same for thinking of probable intubation or any other possible needed intervention with critical patients. If likelyhood for a crisis is higher, than the plan may include more action in the next steps. But not as a general rule "pregnant = horror" - that simple equation is something the soon-to-be-father has to care about, not me... - or even "pregnant and any trauma = risk for miscarriaging in my ambulance". My rule would be "pregnant with abdominal pain or fluids running = think of possible escalation and hope to be in the hospital before things happen" (worked already...). No. Because it's that with all of our actions: risk/benefit calculation. If "benefit" equals zero then the equation blows up, even if "risk" may be low. No fun to have an i.v. go bad (low risk, but well, it happens) just because I "wanted to have a line" without real reason. Usually I'm very restrictive with far too simple "If then" rules, and especially with statements containing "always" or "any".

Visited it once...impressive! My own experience with free meals: They're gone. Several years ago, McDonald's and Burger King offered discount on meals, sometimes up to 100% on beverages, but this ceased since years. I know of one Burger King who stopped it, after a large police station in the near crowded the place on shift change but if an officer was really needed had a very delayed response. On our volly standby duties a free meal is part of the contract and would be billed otherwise to the organisator (mostly it's cheaper for them to have the EMTs fed by their own catering). I remember one McDonald's opening day, we were on medical standby there and really were stuffed with burgers and fries, by those lovely girls. Took a long time I visited a McDonald's afterwards, I simply was too over eaten with their products... Nevertheless, I'm with Vorenus: the main reason to offer a discount to certain groups is to keep business running. Only a few (mostly family owned stores) offer something just as a gift. However, individual discount has ceased as stated above, but locally we have some shops who give our volly group a decent discount or even some of their products for free (usually for a training session or some festivity). I would never demand the discount or even calculate with it, that would be unethical.

Regarding this, see this cartoon on page 97 (page 2 on the PDF). That's how I feel often... (The cartoon on the last page is brilliant, too...)

Gloves! Just in case, so you don't have to make up lame excuses when called in the ER for a CPR! Seriously: gloves (minimum 3 pairs, better more) and a working pen is the least (and most of the times the only) I carry with me beside the issued pager. Sometimes a flash light and trauma shears. On my volly turn out gear I indeed have a carabiner, just to hold my helmet or the radio, if needed, but never tried that trick with the i.v.'s. I must admit, it took me some time to evolve from the carry-a-lot-of-stuff-in-the-jacket medic I was in the beginning to someone who just knows where those things are and to have them with you when you need them or who to send to grab them.

Quickly calculated, that makes a daily call volume per inhabitant of 0,5 per mill for Henry county and 0,6 per mill for Independence MO. This makes not that much call volume difference in my view, considering that much more people may actually be in the city due to work commuting or else. However, this calculation is not statistically validated. The real most possible cause for the slight difference could be anything, we have no information how these numbers ("approximately") were generated in the first place as well. Subjectively I tend to believe from my experience, that people on the countryside call EMS only short before dying and not beeing able to ride to the next veterenariangeneral practioner any more. Once I had a bus crash in our "backlands" here (public transport bus vs. school bus) with around 20 injured people/school kids - most of them walked home alone. Big city would have called out the disaster plan, we managed this with two ambulances (the third got stuck in some acre, but that's another story). EDIT: typo.

So, one circle round again, because exactly that expression again rises my question. In other words: which circumstances do you see that requires to lift the legs for shock management?

My brain told me that "Raising the legs is an assumed treatment, like many things, it's not covered by our protocols. Just one of many things you're expected to know what to do, and when to do it; as it's needed." means, it's not in the protocol but you (specific you) would do it anyway because it's an "assumed treatment" and "to do it, as it's needed" (my brain added "...even if not beeing in the protocols because it's self evident..."). Therefore my lousy brain wondered, why you think it would be needed, even outside the protocol. Sorry, if totally misunderstood your statement. No reason to personally attack my reading or thinking ability as well in a discussion. It lead us to an important fact for the quiet lay reader anyway: there is no such thing as a life rescuing leg lift in shock, even if some protocols/books/TV shows still say this. As I recently read, the man who applied the Trendelenburg for fighting shock in World War I several years later warned about it himself. However, this detail was lost somewhere in history, lifting legs became famous. BTW: if you have protocols, why aren't there such things as bandaids ("sterile cover") or splintings ("immobilization") covered? Just wondering. Or maybe misunderstanding.

By the way... Did you meanwhile find out, why? I'm vaguely considering to get hands on one of those for our volly squad. I know the "Lucas 2" from a test phase here in our district, already used it in one case and found it quite good (positive outcome!). From advertising information, the Autopulse makes a better impression, but I don't have seen one in real life yet. So I'm interested in some first hand experience. Maybe in another thread?

To the original problem: Dispatch could have relocated another ambulance to cover your area. They do it all the time here. You could have responded to the other call with the first patient inside your ambulance. Depends on relative location, but if it's near the way and you're significantly faster than another unit, I probably would have offered this choice to dispatch. I did it several times when just transporting otherwise stable patients. Surely depends on your actual patient, I just talk here within the scope of the original setting. In the first place you could have told her to go seeing a doctor for herself, after ruling out any probable injuries. Depends on your argumentation skills and law (we are allowed to argue with patients...). Bad choice. If I decide to let her into the "bus" in the first place I won't let her out until she demands or we're arriving to a higher level of care. Especially not "somewhere in no-mans land" (on route). "Rules are there to think before you break them" (Terry Pratchett) Ohoh...if it is THAT close you (general you) don't make it anyway...the thing about saving every minute in driving is a myth (rare exceptions apply). Would be more impressive if s.o. talks about not successfully "intubating" with such one.

Not exactly good style to not helping you if specifically asked, but more or less OK since he was 1. off-duty and 2. not really needed, numerically. There obviously were enough on-duty folks there (you won't tell me that a bunch of emergency room staff, two medics and two first responders aren't enough for a code in a trauma room environment?). The "no gloves" argument may just be a fast excuse despite finding some other quick reason, given the glove boxes around. Maybe he had some of the questions in mind I have below... I wouldn't. The obvious counter questions would be like: "Why exactly weren't you enough to work the patient, given the staff already there? Why did you randomly pick people from outside to help in a staffed regular emergency room? Who was in charge in that situation and why didn't you notify this person and/or why was this person not able or willing to get the problem solved? If you were in charge, how comes this, considering you are one of the least qualified people there and obviusly didn't belong to the hierarchy?". Maybe I misunderstood a lot, then please correct me.

I most probably would have considered an i.v. sooner, plus atropine when seeing HR40--, then early intubation instead of bagging an OPA (BTW, you didn't mention O2, did you?). With the possible anaphylaxis in mind it wouldn't be a bad thing to have a second i.v. access and more fluid (what was the blood pressure?) plus epinephrine even before he got an arrest. There would be no real contraindication even if a bee sting wasn't the cause. Cortisone/Dimetindene afterwards, especially if allergic reactions occur. On the other side: sometimes it just happens that patients go into arrest, you seem to were quick and did a proper CPR. I'm soooo glad to have a larynx tube on board... Did they anything about the possible anaphylactic reaction?

A second provider could care a bit for the spine (should be done when turning patients anyway, even if a collar is on). If you're alone: vital functions (CPR including airway) come first. Note: chances are lower than mostly expected that you really do any more harm to the spine than already done by the accident. If you can care for c-spine, do it - if not, don't hesitate to focus on all the other things you can do for the patient.

Since we still are in that situation, I can tell you..: after arriving on scene the driver circles the ambulance locking every single door. No. Just take everything you need with you before locking the door. Our equipment is packed in a way, one provider can take all what a patient may need (since we do single provider first responder calls). It's heavy, though. Stretcher, other lifting aids, and special immobilisation items not included (we don't need them in first responder calls because there would be another ambulance arriving soon). If we need something more, then we have to remember taking the (single!) key to open the door. Since we have a radio only in the ambulance this is true for every message we want to get over radio. So, in a CPR situation I would prefer the phone. If they have the key it's no wizardry, just with any other (old) car. Fire department would have other possibilities, but I wouldn't like them to try on our ambulance. No hidden button, just a key in the trousers of the driver. Or in the side pocket. Or in the jacket. Or there on the patient's side. Or just slipped under the bed. Or...damn! I want to have a central locking system!

Several normal hospitals (capacity: surgical including CT/MRT, medical including cath lab, maternity ward) within 20 minutes driving time, five maximum level care centers (trauma, neuro, cardiac and a whole bunch of special disciplines) within 30-45 minutes, two large psychiatric clinics within 30-45 minutes, four pediatric hospitals within 30-45 minutes, one of the large hospitals has really all what you want including special treatment capacity for multiple CBRN and burn victims, another one with a special toxicology department, both just 45 minutes away if you drive carefully. So. it's not a problem of "how long" but of "where". For the ressources: By law, any emergency scene near a road should be reached within 12-15 minutes by the first ambulance. If we need, we have at least four EMS helicopters within 15 minute range (one of them 24hr available, field night landing ability) and if I really really want then I have up to ~40 within one hour (evaluated last when FIFA soccer world championship took place in the neighbouring big city in 2006). Maximum helicopter number on scene was 4 on two of my calls - and it was a "normal" multi victim vehicle crash, no disaster. Far more than 100 ambulances are available in 1 hour (evaluated last year when a plane had a problem at neighbouring airport, luckily nothing happened beside a large bluelight party). For the flood disaster in eastern Germany in 2002 there were over 1000 responders with their equipment "on the road" within two hours, just from my state not including others (and not including fire fighters/technical rescue).. And they call this "rural" here. I know, I always have to readjust my definitions of long transport times when I hear about distances in other countries... However, winter conditions may multiply arrival and ground transport times a lot.

Really? It helps what? Contraindications are too much to consider this as a treatment plan of severe shock/trauma: painful and disturbing movement of legs/pelvis/spine, pressure on the diaphragma/lung. Plus no real benefit over a flat laying position gives a bad cost/risk ratio.