Bernhard

Exactly this mix was my idea, too. However, noone was able to confirm, she was unknown to the folks who picked her up. "K.O. drops" or drug use were on my list, too, but not very common in the given setting (but you'll never know). All in all she had luck to end up in the home of some nice guys, sons of a friend of mine, who called 112. In short: 18 y/o girl, unknown intake (new years party at local villages market square, multiple bars and self brought beverages), went home with some newly found friends (guys and girls) to the home of my friend for an after-party, appeared rather tired, suddenly got up from the table and dropped in front of the others without apparent cause including no visible seizures. Then was totally asleep/unconcious. Friend of mine (ex red cross member) instantly called 112. Dispatch made an "alcohol intoxication" out of this. Beside an GCS of 3 we found vitals OK and stable so far: deeply breathing at normal rate, SpO2 up to 98%, pulse 60/min, blood pressure 90/60 mmHG (small girl), glucose 120 mg/dl. No reaction to loud voice and pain, testing of falling hand hits her face, however didn't tolerate an oropharyngeal airway. Eyes closed, when opened: cross-eyed, left pupil mid-wide, right pupil small, both react to light. No smell of alcohol or smoke/dope, no puke/urine/feces. Normal ECG. We contacted her grandma by her cellphones "private home" contact number (actually first time I used this to get some info...), she stated no specific medical history, but "That already happened to her some months ago at another party...!". From this small base I wouldn't expect alcohol to be the lone problem. Given the age, appearance and eye direction/inconsistency/reaction plus the small bit of history ("already happened") I expect a juvenile seizure maybe triggered by alcohol/lack of sleep, now in a post ictal coma. Would be typical and as well as Arctickat states, I've seen my share of exactly this chain of symptoms ending up in an epilepsy diagnosis (and a lot of them don't have "typical" seizures, just as here). She was transported to a hospital with neurological capacity. I'll try to follow up, but may fail, since she's not from my hometown, noone really knows her and the hospital is out of my area. Sorry to turn this in a medical thread. But, hey, in EMS you'll never know how something turns out...

After washing my sons eye short after midnight (got some wood dust into it) the first real emergency call on new year was at 02:56 a.m.. Came in as "female, 18 y/o, drunk", but probably was some neurological problem / epilepsy, triggered by a bit of alcohol and lack of sleep. Happy new year everyone! Stay safe.

We have three psych specialised hospitals here, within 30-45 min away. Plus a tox center including psych ward. That tells a lot about the people here... We're required to transport there in isolated psychiatric issues, but they can't handle medical/trauma problems, so if there is one, we go to next ER instead. They will take care of interfacility transport afterwards. "Out of service" isn't an issue, dispatch will call another unit from out of area to cover ours (mutual help between countie EMS is required by law here). Police is able to force someone into psychiatric care in case of "danger for others or self", a judge has to be informed not longer than 24hrs after that time and has to make a decision not later than 48hrs after the person was forced to (this is state dependent in Germany, I describe the legal situation in Bavaria). Our paperwork is the same for any transport, police has to do a bit more (so they often refuse to force someone if not really needed - in their view) and judges/psychiatrists are used to it. So, my suggestion: get a totally clear understanding of your local laws and protocols regarding this issue. Don't let you be fooled by someone who may have read them - or not. If your law and protocols support the way it is now, then you may get further on in improving care. The strategy depends on your standing, the frequency of such issues and the one or other problem that is caused by those situations. Ask colleagues, superiors and ER staff. If noone else sees a need to change things, check your position twice...

Here, it's the reliability of the receiving hospital to take care of such issues. Pediatrics usually are very sensible to this matter and know what to do (and how to do it). Preclinical providers are supposed to report their suspicions to hospital staff/receiving doctor. Anonymous, if that's not the case for your system or you're unsure with that, I'd suggest to report to your superiors. Most likely they already have dealt with such situations and either can point you to appropriate ressources or take action themselves. At least they should know the quality management process flowchart for these cases or now feel the urge to create one. Would I step up to help this one poor girl at any costs (her life security, mine, my job...) with my limited power, other than trying to get the ones involved that should be in charge? Most likely: no. Choose well. But don't do nothing. Those are your nightmares.

You would wonder - the office now is a work environment and the people...well...are people. Sorry to hear, get well soon (or whatever you suffer from) and always look on the bright side of death. This year started as my & my families worst even after the ones before were not so good as some of you may know and ended in pure but happy chaos. I really enjoy the time and calm of this days now. Buddy, at least I now have rebuild my stock of good memories and therefore can send you some strong thoughts and good wishes, may they help you!

OK, so far: between the usual chaos in transporting school kids I experienced one heart attack direct in front of me (one of my bus drivers collapsed in my office) and a "mass care event" at last school before christmas holidays day when our special school forgot to tell us they intended to close 1hr earlier, leaving 30 handicapped kids in the cold rain, just the day when five crew members called in sick and one vehicle dropped out of service due to motor damage - not to brag about beeing alone in the office because my colleague had a week off... ...without my EMS background and disaster training I think I would have gotten a significant higher pulse. Result: driver was saved and the kids did not wait longer than 20 minutes. Merry christmas (or whatever you feel good with) everyone!

Hey! I just try to keep up with the city and now I have to read this? I don't like your decision and hope it will be reviewed soon, but it's your's alone and so: AK, good luck on all your ways!

Party? BTW, regarding "party": y'all missed (the real) Oktoberfest this year...when I find time over the holidays I will write a short report about my shift.

Just my thoughts: It's funny in a way, but not effective for the general public. It transports a subtle message of "Zombie after CPR", even if that's not quite the story line. Already dealing with a lot of bad TV shows and bad media coverage here I wouldn't want to explain the twists of such an offical CPR awareness video to the general first aid course attendent. I much better like that one:

Most impressive thing for our young ones: we had no roll-in stretchers, really had to lift and carry them. When the new EMS chief ~1990 introduced the Ferno roll-in system here, the colleagues were totally against it. Even the union collected reasons for not using the roll-in stretcher. Some years later the left-over old ambulance with no roll-in-stretcher didn't collect kilometers because noone of the career EMTs wanted to use it - the volunteers were more or less pressed to get it on the street until it was sold. Only one ambulance had an ECG, a really heavy thing, totally water proof but you could use it even to stand on. We washed E.T. tubes, naso/pharyngeal tubes in water after using. A little later we at least gave them to sterilization in the nearby hospital. Resuscitaion was a totally uncoordinated event, everyone sticked some tool into something and gave medications of all kinds (yes, I know the Alupent approach) occasionally interrupted by defibrillations (if available, not all units were equipped) and high-dose suprarenine or low-dose suprarenine, depending on actual medic involved. No wonder I had only two or three long-term saves the first 15 years of my EMS life. We often transported two lying patients per ambulance (they were equipped for that), no need to call assistance. Every station had it's own phone number, however they were dial-throughs to a central dispatch. The time we dispatched ourselves ceased just before I started in the service. So, I had to watch the phone line only two or three times when the dial-through was broken. The introduction of a unique phone number for EMS was around mid 1990ies ("19222"), only since a few years the european standard emergency number "112" is active here for EMS. Lousy white trousers and scrubs were standard "protective equipment" on the street. Red jackets without reflective stripes just resembled the old white leather (!) jackets. Labels on the backside ("EMS") were not velcroe'd but fixed with four strings and a knot. I think I even was the first one here to use safety shoes, just after I stepped into an oil track with my brand new sneakers. The usage of gloves was a new thing when I started. A lot of the old folks didn't need them - until HIV was in the media. We used to have humidifiers for our oxygene supplies. The fixed ones got a water change every week or so (or not). Then we changed to one way humidifiers, only that they were used as the old fixed ones - and changed every other week (or not). I don't want to imagine the bacteria collection inside them... Desinfection was a rare event and done by only one medic who had the equipment/training. I remember a lot of self-built and improvised tools, every ambulance was a special one, often "improved" by every shift. Next hardware store was a major supplier for "emergency equipment". Imagine toilet paper rolls as supply holders for tape. Every thing was drilled into the ambulance body. There were a lot of boxes and holders of any size (originally used for screws and such, see "hardware store" above). You had all in reach, but it was a horror to clean, and therefore rarely done. Infusion warmer was a standard electric blanket, just in one of the drawers. Hard case emergency kits, where "hard" was discussable. I broke more than one of them plastic kits until we got aluminium cases, heavy and uncomfortable to carry. Some still use those over here (especially older units mainly for disaster response), but our service switched to backpacks some years ago. One case for each topic: "Circulation emergency box", "Airway emergency box" plus seperate "Intubation kit", "Children emergency box", "Birth emergency box", "Drug box", "Trauma kit", "Tox box", "Burn kit", ...At least, in those days we had civil servicers (who circumvent mandatory military service in social work) to carry all that stuff. ...and so on...I'm feeling old now, thank you very much.

Really bad thing is: you don't have time to post on EMTcity between the calls. My customers now call in all the time and staff/vehicles have all kinds of problems any minute...I miss the quiet of EMS shifts a bit. But my experience in disaster response and scene control helps a lot.

No train, only busses.

Sorry folks, I was away a long time and regret it. But some things in my life have changed. As some of you may know, I am a parttime medic and served as "jumper" on every rig in the county wherever someone was needed. Low pay and no regular shift. This was due to my family situation and besides a small business as freelancing IT engineer. As those "jump-ins" became more and the request for overtaking shifts flow in more regularly, I decided to apply for a regular shift position in EMS. Well, good thing is, they offered me a position. "Bad" thing is, it was not for EMS. I now sit on a management chair in the Red Cross transportation service for handicapped people supervising 25 busses carrying over 100 handicapped childs through the county from home to school and back plus other handicapped people to work and social events, every day. This took me away from EMS (& engineering) a bit, however, I can use all my skills there as well. But the first months now where very stressful and left no time to get involved in EMS discussions. I promise to change this (at least I have regularly days off now...), hoping you still accept an "EMS-wannabe" (while I have to admit, the pay now is significant better than in EMS). At least, I'm still a medic and still a parttime jumper in our EMS system, even my volunteer work in local first responding, covering social events and disaster response etc. stayed the same. See you!

We usually dont leave equipment at the hospital. Patients are passed over directly and taken care of immedeately. This involves getting rid of splints and such, under control (pain control, other immobilisation). It is possible to have the patient on the vacuum matress until in MRT, then we either wait or leave it there and get it back later. Thats rare. More often we pass a patient on the vacuum matress to HEMS and have to get it back from the trauma center somehow (often by an BLS/transport ambulance of our service that usually drives by there one day or another). Then we use a spare one. I recall a major trauma center where we always had to leave our matresses with the patient and got another one - from a service that left theirs before. This lead to several interesting changes, sometimes new for old and otherwise. At the moment we have only a written policy about not giving our bed sheets away to other hospitals than our local one (where they clean them anyway).

I co-authored two published scientific research articles in my field of engineering, where I was mentioned. Some others I didn't make it to the author's list for some reason. In EMS, it is a bit twisted: since I was responsible for public relation of my volunteer unit and on county level a while back my articles were published without much change in text but mostly with the signature of the paper's journalists. A text mostly written by me on Wikipedia made it in the statewide disaster response operation book, almost unchanged - and without notifying me or mentioning Wikipedia (thus, infringing Wikipedia license agreements). And just recently I found out some book used an old online script of mine to teach things, without asking me (although my name clearly was mentioned in the script and the given license didn't allow usage of this kind - maybe I should sue?). So, often enough I was published but didn't get the fame for it.

Well, that's a newbie story, but reveals nothing about the book and does not have some morale aiming to the book's intentions, it seems. Do you have a list of contents or an abstract on the book's topic?

Good drill scenario. Despite the other things all others have said, I see another misconception in your assessment: where's the treatment? You can perfectly do diagnosis and starting treatment parallel . Even diagnosis could be done by two providers, but only one should ask questions. So the other meanwhile could place pulsoxymeter and measure RR, silent, just reading the measurings out loud. Then start preparing obvious things like O2, i.v., stretcher, ... Another thing: Arctickat already mentioned the single/focused communication line - try to stay with that. Don't change providers talking to the patient from first assessment to handing over to next level of care. That's not always possible but would be the most calming for the patient (and the scene in general). Nothing worse than multiple providers running by and asking the same questions and doing some random things...especially in a multi casualty scenario. In reality that's not always possible, but it should be the target. Sometimes it's needed to have another medic get into the communication line, especially when things are complicated to diagnose, but this should be done in the most unconfusing way possible.

The founder of the shop is an old school friend of mine, but we have no relation since then, just see him occasionally from the far (and he was not in the shop when I bought this item, I was served by an employee). I know he and his partner are not affiliated to EMS in any way, however I don't know if there is a certain story behind. Maybe I have the chance to ask sometime. Found it cool: I clearly stated that's a private item and not for the service, just dropping by while on duty (the shop is near the station there) - no problem, got the discount.

Recently had an interesting case about that topic, maybe you have some thoughts to share: We were called to scene of "young man with intoxication of unknown kind". Around 22:00 hrs, warm summer night, dark, rural setting. On scene we found three people from 16 to 20: #1, male, 18y/o: nausea, vomited once, feeling respiratory distress but relieved after vomiting. Known allergy to grass and insect stings. #2, male, 20y/o: mild sore throat ("just like when you smoked a pack of cigarettes at once") #3, female, 16y/o: same as #2 All SpO2 99%, other vital signs perfect. No obvious appearance of alcohol or other drugs at first glance. After some questioning they stated that they walked by a small wood and there was something in it, some large animal or sth. like that. They smelled a substance and then the symptoms started. We offered to call police to protect their rights if there was some attack or prank on them. They denied. After some more questioning they relieved they had built in a new exhaust pipe to one of their cars and tested it, apparently about 1000m away (near the wood). New exhaust pipes may be covered with some protective agent which is burned out on first usage and may smell funny, but should be not dangerous. The owner of the car (#1) was unsure if the modification was allowed and insisted on not calling police. So far, OK for me. There was no public danger just some funny young folks. I called a second ambulance for transporting the three, since I suggested at least a checkup maybe including laboratory blood test) on possible intoxications, where they agreed. That was what got dispatch crazy. They asked if we need police. No. Dispatch: "What's the nature of the intoxication?", Me: "Not known, maybe some raction on the protective agent of a new exhaust pipe". Dispatch: "So, CO/CO2-poisoning?". Me: "Probably not, could even be psychic". Dispatch: "So, you need police". Me: "No, patients deny and there is no public danger!". Dispatch: "Why do you know this?" Me: "I'm here on scene and see no danger!". Dispatch: "What if there is a gas leak?". Me: " I have no evidence of this!". Dispatch: "So, do you need police?". Me: "NOOO!". And so on. Finally the patients were transported, police did not come. I had a talk about that incident with the dispatcher after the call where she suddenly hung up, running out arguments after accusing me beeing guilty if some baby dies the next days. Glad, there wasn't media followup the next days about a major explosion or such, so I guess there wasn't a gas leak... My arguments for not calling police were: I myself had no evidence of public danger. I myself had no evidence of an ongoing crime (a possible illegally modified car is no crime). The patients denied police involvement and I'm obliged to confidentality. Since our dispatch is superior to me in general tactical decisions (as long as no supervisor is on scene) and not obliged to patient confidentality, they simply could have called police without asking me. Still wonder why they simply didn't do it, instead going on my nerves asking me (and the other ambulance) several times over radio... What would you have done? Call police? If so, why: to prevent a possible danger, just CYA or simply to get dispatch calm? EDIT: the "patients" were released after staying the night in the hospital without diagnosis, lab tests were negative.

Cleaning and desinfection issues should be addressed as well unless it's an one-way product. And I don't mean just to define it as one-way only because you are not able to address cleaning/desinfction properly. That's a problem with the Autopulse (the strap is defined one-way and rather expensive!) and the LUCAS2: several straps and the knapsack case simply are not really gettng clean (same is valid for the straps on stretchers/spineboards - THAT would be a real innovation).

Just learned that a local computer shop gives 10% discount to EMS. NOT to FD.

Depends a lot, several reasons already were written here. You need to be sure about the relation the patient is with the other victim he asks about, since confidentiality obligations apply in this case as well. IF you're deciding to tell, two important things: be ABSOLUTELY sure to know the confirmed death first hand; say it with great confidence, straight on, no hedging around the subject. I did it sometimes and it takes a lot of uncertainity away, more calming the process than not. But, it depends, and you have to develop a feeling for this - and take the consequences. Don't tell too much and know what you're doing. If you're not the highest level of medical care on the team, point this question to her/him in charge.

The language was italian. Permanently interrupted by "ouch", "ahhh", "noooo". Our solution: we (mis-)used our local volunteer crisis intervention team for this. They're EMTs/medics with additional training, primary taking care of relatives in case of frustrane resuscitations/death messages until family or normal social contacts can be activated (normally not more than a hour). So this was a more happy variety in their work. I first made phone contact and asked if the colleague would take this type of call and he agreed (experienced father and career medic). Within 10 minutes, he took over baby sitting until mommy came home (mother and father & kids agreed as well). Usual alternative would be police. Then we have 24/7 access to a supervisor. This night the chief of EMS operations himself had supervisor duty - he surely would have had "fun" to be confronted with the task! Taking two young kids to hospital we would have needed child seats. Those people have no car, so no child seats (our ambulances have child restraint systems, but only for the stretcher which already was ocupied by the father). That would have been on our option list, too, but then we would have needed some organization (and a lot of time)... On the other hand, we're the Red Cross EMS here, so we have the possibility to activate a lot of Red Cross volunteers out of the local and surrounding branches. This would have taken some telephone work (by the supervisor), but I'm sure, a willing babysitter could have been found. At least five alternatives to choose from. You just have to know those... Took one - problem solved.

Pain treatment is done quick here. Especially in the given case the patient would have really suffered when lifting on the stretcher and would have a rough time to hospital without pain relief. We choosed Ketamine/Midazolam to not repress respiration. Morphine and Fentanly would have been available as well, but affects respiration. Blood pressure was not the problem. BTW the small and slim 60kg patient took 50mg of Ketamine to remain more or less pain free (analgesic effect) and still was not sedated very much! For the kids we considered police as well, but, knowing they have only one or two cars available at this night, we took another option.

We have pretty clear rules (I can cite the laws and regulations, but they're in german): If causing an accident en route you're obliged to stop and wait until things are regulated (exchange of addresses and such), even if there are no injuries. You have to inform dispatch who will dispatch another unit to your initial call. If you just come by an incident with injured persons en route to another call, you're obliged to stop and help. You have to inform dispatch who will dispatch another unit to your initial call. If you come by an incident with apparently no injured persons, then you can drive on after assessing the situation. Since we're allowed to rule out injuries (especially neck or such) and if not making a totally crazy error, there is no danger for beeing sued. Causing an accident with a (critical) patient on board: decision is based on actual settings. If there is noone else injured and you can drive further on, you just have to leave your ID number and can go on, notifying dispatch (they will send a supervisor to the scene taking care). If there are other injuries you have to handle them all and call dispatch to get in backup fast. In Germany resources usually are not a problem, see below. Same with coming by an incident with a (critical) patient on board - stop, render aid for all and call for getting help. Usually backup is available within 15 minutes or even sooner. Whole Germany is covered by a dense net of EMS, HEMS and additional volunteer first responder units who may bridge time or even have spare transport capabilities. For example, my district has 4 ALS ambulances and one emergency physician. There is mutual help available from all neighbouring districts (obligation to assist by state regulation!), which makes at least another 14 ALS ambulances and 7 emergency physicians within 15-20 minutes. Additionally we have 2 helicopters within 10 minutes, 3 others within 15-20 minutes. Plus the volly branches alone in our district are available with around 8 ALS/BLS ambulances on short notice, by pager. Not to speak about the MCI squads and some medical trained fire depts (however, no transport just on-scene treatment). One supervisor is available 24/7, even there backup is possible. So, the problem is not whom to call but just to quickly decide what option you want to draw - and even this you can leave to dispatch (they are tactically in charge until a supervisor is on scene)... This said, even there are grey areas in our reality. I already experienced accidents of ambulances within sight of the initial scene. On one occasion, the then injured ambulance driver assisted the opposite injured POV driver, the injured medic took the mobile eqipment and rushed to the house the initial call came from to start treating the patient there. Just after calling in backup forces, naturally. On another occasion there was an ambulance on an interhospital transport with a severe stroke patient. They wittnessed a radio call for another unit stating an emergency just two streets away from where they just were driving. They offered help since their patient was stable and dispatch accepted, advised them to do first responding until the other unit arrives. Sadly, they had an accident on the way there, beeing t-boned by a POV. Both medics injured, patient injured, POV driver injured. Medic#1 cared for injured POV driver and collapsed soon after backup arrived, medic#2 cared for injured patient. Additional help was there within 15 minutes (one of the additional units was mine), however, the interfacility-transported patient died soon after. This did went to court, but they were found not guilty: they HAD lights&sirens on other than the POV driver stated and the death of the initial patient couldn't be directly related to the accident. Most probably I wouldn't have done first responding to another call not direct on my way, having a critical patient on board, even if stable at the moment. And very sure, I wouldn't have driven the high speed in totally heavy rain. The driving medic had luck that this was not addressed in court...