Baveria(Germany) Standard Ambulance and System description

[krumel]

I'm sorry, but I don't know if I understand you right. Do you refer to the paramedic education or the general "advanced education?

For the paramedics: because doctors fear if they educate us more, they could be driven out the prehospital emergency care (as the insurance companies want since decades due to the high costs)...Doctors have the only real lobby here...

For general education: You have school much longer. For your A-Level normally you have 12 or 13 years of school...Especially the last years are very very hard... Much longer that you do...And afterwards simply go directly to an university... But so for example med school here takes up to 6 or 7 years...

(and also remember: The school system is for free. The university were until a few years, but now they are still very chep about 1000€ a year. And every student with poor parents gets financial aid by the feds AND a student loan as well)

[itku2er]

Ok that clarified that I thought you meant right of High School they could be medics. So the doctors over there run on the acutal ambulances. How are the Emergency Depts staffed over? Are the ambulances run out of the hospitals or they private services like in the US?

[krumel]

Yes and no...

The doctors only come to the "ALS calls" with their own vehicle (they are normally stationed at the hospitals)

The paramedics come with the Ambulance..

For the Paramedics the "minimum education way is: Basic high school degree (after the 9th grade), waiting till youre 18, then doing your Training (2 years normally), then...Being an EMT-P...

The EMS is never runned by the hospitals. The biggest provider is the red cross (which is an charitiy organization, not an company), the St.Johns Order, the Order of Malta and the "Workers Wellfare union" . The F.D's, municpal EMS-Systemsand the private Companies take only minor rules...

I would say nation wide it's about 75% Red Cross, 7 % Order of Malta, 7% Order of St.John, 5% Muncipal EMS, 4% F.D. and 2% private Companies.

[itku2er]

That is interesting... thanks for sharing this. Does the red cross pay you all to be medics or is it on a volenteer basis?

[krumel]

Differs...The main part of the medics get payed, but sometimes there are so called "volunteer shifts" when volunteer medics work part time... For example the Red Cross here gets money to get an additional ambulance running friday and saturday night. Would be difficult to find a full time medic for this so they run it with volunteer medics...

[itku2er]

Are Friday nights bad call nights there or just people not wanting to work the weekend?

[krumel]

Both....

Friday and Saturday (remember, weekends start fridays here)can be really "bad as days" for you...

I'm fearing my late shift today...They gonna hurt me....

[itku2er]

What standards do you guys go by for ALS we use the American Heart Association.

Well tell them ITK said they cant hurt you they will leave you alone! I am an international influence lol

[krumel]

No Standards at all..

Yeah..Not really.

Arrest and Chest pain is (kind of) standardized by ERC or AHA (the EMT-P in charge decidedes), some use PHTLS in Trauma..

But generally medics and doctors are very free in what they do...

We're trained to find "the reason which fits best". We're trained to decide by our background knowledge, not by the book..So if you the right way to explain it you're free to do what you want...

There's no "procotol" or "book" you use and none's gonna say anything as long as you can explain it by your background knowledge..

(Example: Last shift: Normally we give midazolam -as well its written nowhere it became a habit for everyone- in epilepsia... Well... I had medical reasons for an epilepsia call not to do so and to use diazepam... Ain't no problem...My decision)

For outsiders this may look strange but it's the effect of the very strange law system here...

There's no federal oder state law that says "you are allowed to do what your chief of medicine says.." or "you are allowed to do this, this and this"...

There's only one law that says "Medicine is only to be done by Doctors or alternative healers". (BTW: The last law in modern german law which was signed by Hitler.... One more reason to hate this..)

Then there's a federal law that defines the hours of training an EMT-P gets..And additionally it says: "The Paramedic has to learn everything he might need to save a life when an doctor isn't available"...

How much is really "everything" differs from county to county... Here in Downtown Munich we're allowed to do a lot more than some medics in rural settings. (for example of course we do i.V.'s without a doctor being enroute, of course we use non opioid analgetics* and a much wider range of drugs we give...

*Opioid analgetics are handeld very strict here.. Only trained doctors might use them

And overall, there's another federal law that says: "In case you safe a life (or limb or health, etc.) with out you're allowed to break other laws"....

So: Later, when I will do an i.V. on my patient I'm gonna break a law..because another law tells me to...

Crazy? Indeed......

[itku2er]

That is crazy but interesting.

So who gets sued for neglience when you break this law but that law tells you you can. Who decides who is accountable when something goes wrong?