# EMS in Spain



## jlc

Greetings from Spain!

*About Spain:*
Spain is a member of the European Union located in southwestern Europe. In 2008 the population of Spain officially reached 46 million people. Its total area is 504,782 km2 (194,897 sq mi).  According to the World Bank, Spain’s economy is the ninth largest worldwide and the fifth largest in Europe.  (wikipedia )

*EMS:*
There are 17 autonomous communities (autonomous regions) in Spain (like states in USA). Each region has their own Public Health Service (with hospitals, health centers and regional EMS). So there are 17 regional public EMS (they depend of the Regional Government). Furthermore, some cities has a local EMS (it depends of the city council), and some Fire Department has ambulance service too.
In addition, there are non profit organizations like Red Cross or DYA who provide BLS ambulances (rarely ALS ambulances) with volunteers for special situations (music or sport events, support to public EMS,…). There are more private companies too.
Regional EMSs are public services (they depends on Regional Health Services).  Each region manages the service differently.   Some have their own vehicles and staff. Others outsource (subcontract) the vehicles and some staff to private companies (usually the vehicles and the BLS staff are contracted out and the ALS staff are civil servants –public EMS employees).

*Emergency dial: 112*
The emergency dial is 112 in all regions, but in many regions, each agency have their own dial too (national police: 091, local police: 092, firefighters: 080, EMS: 061…). So in some regions, the 112 dispatchers send the ambulance (or the firefighter engine, or the police car…), but in others the 112 dispatcher call the 061 dispatcher (or the 080 dispatcher, or the 092 dispatcher,…), and then this sends the ambulance (firefighter engine, police car,…).

*There are diferent kinds of ambulance:*
*- Non assistant ambulance* _(ambulancia no asistencial)_ For dialysis, rehabilitation, non emergency patients transport. 
*Staff: A driver and sometimes an assistant (first aid course or similar). 
*Skills: Only transport/first aids. Usually, this kind of ambulance doesn't attend emergencies.
*- BLS ambulance *_(ambulancia de SVB )._ 
*Staff: 2 EMT-B (one of them a driver)
*Skills: BLS+AED (non-invasive techniques: splints, cervical collars, spinal board, Kendrick extrication device, first aids, oxygen,…) 
*- ILS ambulance *_(ambulancia de SVI or SVE or Sanitarizada)._ 
*Staff: 1 or 2 EMT-B (one of them a driver) and 1 ambulance nurse. 
*Skills: addition to above, nurses can apply invasive techniques (IV, NG tube, vesical catheterization, laryngeal mask…). They can use ALS skills based on protocols (like US paramedics) or phone/radio orders) like drugs or intubation. This type of ambulance is newly created (end of 90s) and not all region do.
*- ALS ambulance *_(ambulancia de SVA or UVI móvil)._ 
*Staff: 1 or 2 EMT-B (one of them a driver), 1 ambulance nurse and 1 doctor. 
*Skills: ALS techniques.
*- HEMS.* Staff: 1 or 2 pilots (or 1 pilot and 1 mechanic), 1 flight nurse and 1 doctor 
*- Rapid response unit *_(VIR)_. Staff: 1 driver-EMT-B, 1 doctor (and/or 1 nurse)

*Training:*
- *EMT-B* _(TES)_. Before 2007 there was not a national standard, so each region had their own rules (courses from 60 to 600 hours, sometimes only a first aid course). Since 2007 there is a 2 years training occupational course (vocational-Community College).
-* Nurse* _(Enfermero)_: University degree (3 years until 2009, now 4 years). In some regions nurses need a Master in Emergency Nursing (or experience in ER, ICU,…) for EMS jobs.
- *Doctor* _(médico or doctor)_: University degree (6 years). If they want to work for the public health service they need to be a Specialist (4-5 years more: Intensive Care Medicine, Family Medicine, Anesthesiology, Cardiology…)
- *Volunteers* _(voluntarios)_: Red Cross, DYA, Civil Defense… Courses from 40 to 300 hours (first aids, patient transport assistant, life guard,…)   

*Non-assistant/non-emergency ambulance/patients transports (private company):*






*Red Cross- BLS Ambulances (Volunteers):*





*BLS ambulance (061 Aragón: EMS - Autonomous Community of Aragon):*





*ILS Ambulance (SUC: EMS - Autonomous Community of Canary Islands):*




Sorce:http://sanitarizada.blogspot.com

*ILS Ambulance (Emergencias Osakidetza: EMS - Autonomous Community of Vasque Country):* 




Source: http://www.e-mergencia.com

*ALS Ambulance and HEMS (SUMMA 112: EMS- Autonomous Community of Madrid): *





*ALS Team (GUETS SESCAM 112: EMS -Autonomous Community of Castilla-La Mancha):*




Source: http://ucienf.blogspot.com

*ALS Team (SAMUR - EMS City Council of Madrid):*





*ALS Ambulance (SAMU Asturias: EMS - Autonomous Community of Asturias):*





*ALS Ambulance (Bomberos Navarra: EMS - Fire Department, Autonomous Community of Navarre):*





*Rapid Response Unit -VIR- (SUMMA 112 Madrid):* 





*HEMS (Emergencias SACYL 112: EMS - Autonomous Community of Castilla-León):*


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## jlc

My second photo-link (BLS Ambulance - Aragon) doesn't work, so I upload it again:


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## Don Gwinn

Very cool photos, I'm glad you shared them. I was going to comment on the iron of the ambulances in the first few photos with one yellow light bar, while the one I drive has lights of every color on every part of the truck with a control panel that looks like it takes a college degree to control them (hey, this is the USA, and overdoing it is what we do.)  But in scrolling down I see that some of your autonomous regions do the same thing.
But, hey, more is better, right?


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## jlc

Don Gwinn said:


> Very cool photos, I'm glad you shared them. I was going to comment on the iron of the ambulances in the first few photos with one yellow light bar, while the one I drive has lights of every color on every part of the truck with a control panel that looks like it takes a college degree to control them (hey, this is the USA, and overdoing it is what we do.)  But in scrolling down I see that some of your autonomous regions do the same thing.
> But, hey, more is better, right?



In most countries of Europe, the lights are blue for all emergency vehicles (police, firefighters, ambulances,...) and yellow/amber for slow vehicles (large trucks, crane trucks, tractors...). However, in Spain, traffic code prescribes that only police cars can use blue lights. The rest of emergency vehicles must use yellow (amber) ligthts (like tractors :wacko. This code is very old, so we are trying to change it.  
Many EMS have ambulances with blue lights or with red lights (or red-blue, red-yellow, blue-yellow) but it's lawless. We hope change it soon... so some have already change the colour, anticipating the new code.

In addition, there are differences between the types of ambulances. Non emergency ambulances usually carry two lonely yellow lights (beacon lights). However, emergency ambulances  (BLS, ILS and ALS) usually  carry, at least, a yellow bar (code 360, federal signal, excalibur,...), and they usually carry various white and yelow perimeter lights (lateral) and an arrowstick in the back.  Often they carry oscilaser, led reflectors,... in the front, too.

Typical amber lights in Spanish ambulances:





Source: http://www.e-mergencia.com

Other colours (lawless at present):
Red and White (SAMUR Madrid):





Blue and Amber:





Blue and Amber, blue and red,...


Sorry for my English


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## Don Gwinn

Su ingles esta muy bueno.  Mi espanol no esta muy bueno.  Espanol de escuela.

Your English puts my Spanish to shame . . . and I never did learn to understand a native speaker; it's just too fast.


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## firetender

In Hawaii, we say "Mahalo!" ("upsidedownexclamationpoint gracias!), though I'm not Hawaiian. Happy to see how you're helping to expand our community and looking forward to hearing more of your experience!


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## jlc

Don Gwinn said:


> Su ingles esta muy bueno.





firetender said:


> In Hawaii, we say "Mahalo!"




Thanks to you both.


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## jlc

*video*

This is a link to a video of a TV show (in Spanish) which shows the response of several Spanish emergency teams.

Full TV show (35.2 minutes). External Link: 
http://play.cuatro.com/on-line/#/callejeros/ver/socorro

The full video shows different emergency services:
- SAMUR-Madrid (ALS teams/ALS ambulances and Rapid Response Units), Firefighters and Local Police responding to a severe burn patient.
- SAMU-Gijón (ALS team/ALS ambulance) responding to a man with hypoglycemia.
- Firefighters-Granada responding to a broken water pipe.
- SAMUR (ALS and RRU) and Local Police responding to a child with traumatic brain injury (hit by a car).
- SUMMA-Madrid (ALS team/ALS ambulance) responding to a man with syncope (probably due a gastrointestinal bleeding). 
- SAMU-Alicante (ALS team/ALS ambulance) responding to a bicycle accident.
- DYA-Elche (BLS ambulance volunteers) and Local Police responding to a woman with minor injuries and alcohol poisoning.
- SAMUR-Madrid (ALS and RRU), Local Police and National Police responding to a traffic accident (with alcohol poisoning).
- DYA-Bilbao/Vasque Country (BLS ambulance volunteers), Local Police (Udaltzaingoa in Vasque Languaje) and Regional Police (ertzaintza in Vasque Languaje) responding to woman with drugs poisoning.
- DYA-Bilbao (BLS-volunteers) and Local Police responding to a girl with alcohol poisoning. 
- SUMMA 112-Madrid (ALS) and Firefighters responding to a young man (traffic accident)
- SUMMA 112-Madrid (ALS and RRU) responding to a woman who had an attempted sexual assault.
- Madrid 112 Dispatch Center.
- SAMUR-Madrid (ALS and RRU) and National Police responding to a cardiac arrest.
- Rescue ski patrol (Sierra Nevada, Granada).
- SUMMA 112- Madrid respondig to a man with minor injuries (traffic accident).
- SUMMA 112- Madrid responding to a woman with a syncope. 
- SAMUR-Madrid (ALS and RRU) and Local Police responding to a man hit by a motorcycle.   
- SAMUR-Madrid (ALS and RRU) and Local Police responding to a driver who had a cardiac arrest and after he had a car crash. 
- SUMMA 112- Madrid (ALS) and Local Police responding to an old man with minor injuries (for a fight).

TV show summary (30 seconds)
[YOUTUBE]nJuoAzilAv8[/YOUTUBE]

I hope you enjoy it.


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## diprinz2

muchos gracias para la informacion no pude encontrar informacion sobre vuestro systema de ambulencias hasta encontre este post. pero tengo algunos preguntas para usted. Trabajo para una compania ambulencia privada, En mi ciudad todos de los bomberos son EMT Intermidiates (es una nivel entre un paramedico y EMT-B, pueden intubate (no se como se dice en espanol) emprezan IV y dar algunos drugas por IV) .Y ellos responden a casi todos de las llamas de emergencinas. En espana los bomberos responden a las llamas tambien o solo una ambulencia? Y piensa k es necesario para un doctor y un enfermero estar en una ambulencia, o los doctors y los enfermeros serian un mejor uso en los hospitals. In Reno the hospitals are always short nurses and are constantly hiring new nurses, i do not think that if the city requiered a nurse to staff the ALS units they would have enough to do so. Sorry about the spanish but i do not get to speak it much and like to try and practice when ever i get a chance. This is all very interesting to me to see the differences between how different countries do EMS aswell as the similarites (we have the exact same monitors as the crews in your video do). Thanks for all the great information


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## jlc

Hi! Hola!



diprinz2 said:


> pueden intubate (no se como se dice en espanol)


"intubar" or "entubar". Se usa más "intubar" que "entubar".



diprinz2 said:


> En espana los bomberos responden a las llamas tambien o solo una ambulencia?


EMS don't rely on Fire Departments. EMS usually dependent on Health Department. However, some F.D. have their own ambulances (BLS, ILS with f.d. nurse or ALS with F.D. doctor and nurse), for fires, accidents,... Then, the firefighters on ambulances have an EMT-B course.

F.D. Catalonia. Ambulances:








diprinz2 said:


> Y piensa k es necesario para un doctor y un enfermero estar en una ambulencia



Is it necessary? No, it's different. Each system has its advantages and disadvantages.

Each country has developed its system in different contexts. 
U.S. had a shortage of doctors/nurses and created the profession of EMT-paramedic. This profession has grown in many countries. In many of them, there are different levels of EMTs. The higher level of EMT are moving to university degrees/bachelors in paramedic (Australia, some countries in South America, NZ ,...) because people demand more and better professionals. In the future, many of the countries that use the Anglo-american system have a bachelor in paramedic sciences or emergency sciences for their paramedics.

Here, in Spain, there have not been a shortage of doctors or nurses (now beginning to be a shortage of doctors), so our system has developed differently than the American system. We have well-trained nurses, and here they are accustomed to seeing the prehospital work as part of their scope of practice. So, here, it is not necessary to create a university degree of paramedic sciences. It's easier (and cheaper) to train postgraduate nurses in PH.

For example, in Netherlands, all paramedics are RN trained in prehospital; in Sweden, all emergency ambulances have, at least, a RN; in Finland, when someone is studying for a paramedic degree, get a double degree in paramedic and RN (It's valid throughout European Union as a RN).

In many countries of Europe, the role of the paramedic has been assumed by the prehospital nurse.  They are not “hospital nurses” who are coming out. There are nurses inside and outside the hospital.

e.g. If someone wants to work in an ambulance and starts a IV line…
…In US (Canada, Australia, NZ…), he will become a paramedic.
…In Spain (Netherlands, France, Belgium,…) he will become a prehospital nurse.

Every country has their professions with their scope of practice (not only in prehospital; in hospital too). 
E.g. here there is no phlebotomist or respiratory therapist or physician assistant. But there’s x-ray technician and laboratory technician and occupational therapist… The nurses do not usually move wheelchairs/beds/strechers in hospitals. Here, there are orderlies who are responsible for it (and carry the samples/tubes/documents to laboratory/departments,…). There are nursing assistants who are responsible for basic tasks (hygiene, nutrition, mobilization,...), allowing nurses (R.N.) to deal with more advanced tasks.

And doctors?
Here, people prefer that doctors attend the most serious cases. In our system, many cases are resolved in the patient's home. Not all cases are transferred to hospital. For example, a doctor may decide to treat supraventricular tachycardia in that place and if resolved, may decide not to send him to hospital (depending on the clinical history). In addition, doctors are free to choose drugs, dosages and treatment, without being limited by a protocol (We have the same drugs in an ALS ambulance than in ER… but we haven’t X-ray in the ambulance yet ).

Due to the shortage of doctors, some predict that in the near future this type of response will be sent only for extremely serious cases, while the intermediate level with nurses will continue to develop, developing a mixed model medicalized (with doctors and nurses) and non-medicalized (with nurses), and, of course, a basic step (BLS) with EMT-B.



diprinz2 said:


> Sorry about the spanish but i do not get to speak it much and like to try and practice when ever i get a chance.


You have a good level of spanish. ^_^. However my english level... :blush: is worse :sad:


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## NJmedic3250

jlc- what would an American trained Emergency Room Nurse need to do in order to work in Spain as an EMS Nurse?


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## jlc

NJmedic3250 said:


> jlc- what would an American trained Emergency Room Nurse need to do in order to work in Spain as an EMS Nurse?



First, you must obtain equivalence on your American nursing credentials. Query, the Spanish Consulate or visit the website of the Ministry of Education:
http://www.educacion.es/educacion/universidades/educacion-superior-universitaria/titulos/homologacion-titulos.html  (in Spanish)

To do this, you must speak Spanish.

In some regions you have to do a master degree in emergency nursing. However, if you have experience and training you can pass this requirement . In Madrid, the Lain Entralgo Agency verifies this (Register of EMS staff: EMTb, nurses, doctors, lifeguards):

http://www.madrid.org/cs/Satellite?c=CM_Tramite_FA&cid=1109168965990&definicion=Inscripcion+Registro&language=es&pagename=ComunidadMadrid%2FEstructura&pid=1109265444835&tipoServicio=CM_Tramite_FA (website of the Agency)

http://www.madrid.org/cs/Satellite?blobtable=MungoBlobs&blobcol=urldata&blobkey=id&blobheadervalue1=filename%3DTransporteHomologacion.pdf&blobwhere=1119161098040&blobheadername1=Content-Disposition&ssbinary=true&blobheader=application%2Fpdf (Form-pdf)

In many communities you don't need special requirements.
In others you will have to consult the requirements with the local EMS office.

There are different types of EMS management:

- In most communities, the service is run by Public Health Department. In this case, nurses are employees of the public sector. There are two types of public employment contracts:


Permanent Employment (which has no time limit): jobs are awarded by competitive examination (exam + merits). 

Temporary Employment: It is awarded by merit list -waiting list, reserve list, holding pool… I don’t know how to say that in English- (experience, training, conferences, research papers...) Used for replacements of workers (pregnancy, illness, holidays, leave of absence...) or until that job is awarded by competition.

- In other communities, the EMS is managed by a public foundation or a public company, which provides requirements for jobs (usually by competitive examination).

- Only in some places part of the EMS is managed by private companies. In this case the nurses are employed by curriculum, personal interview, etc.

There are private companies that perform patient transport for insurance companies (interfacility transport), repatriation, preventive services, etc.
But the most EMS are public services, so most of nurses are public employees (for Public Health Department, or Public Foundation, or Public Company). 



jlc said:


> Each region manages the service differently.   Some have their own vehicles and staff. Others outsource (subcontract) the vehicles and some staff to private companies (usually the vehicles and the BLS staff are contracted out and the ALS staff are civil servants –public EMS employees).




So it is very difficult to get a job as an EMS nurse. When there are multiple vacancies, Health Department announces a competition (exam + merits). This can happen every 2 or 3 years. Sometimes the EMS jobs are announced along with the hospital jobs (ER, ICU...), and employment candidates choose the job in order of score. Only nurses who have studied for the examination who have high experience and training can get a permanent job.

Meanwhile, most nurses begin in temporary jobs to accumulate points (for experience). For that, they sign on waiting list of EMS (reserve list, holding pool…). If you have many points you can work continuously covering vacancies. You can get a long term temporary work (for several years) in newly created jobs until the announcing of the exam competition, or covering a leave of absence, etc. But to get a permanent job (forever) you have to pass an official competitive exam.


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## NJmedic3250

Well first off, thank you so much for getting back to me. This is some great information. I do have to say after reading what you have written, and doing some research on my own, the system you have out in Spain is very interesting. I was just interested in seeing what it would take to become employed out there. Thanks again.


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## Dreadnought

I spent a month in Alicante studying Espanol at the Universidad de Alicante and I absolutely loved almost everything about the experience, city and country included.

Your posts have been extremely thorough and insightful.  Thank you for all of this great information, it is very interesting.

As a quick afterthought, what is your opinion on, for instance, a citizen of the USA relocating to Spain in order to pursue EMS work?  Obviously the person would have to be well versed in the language, but how do you suppose they will be treated within the EMS system?  Would there be a preference for Spanish citizens (as it would be understandable; more understanding of culture, law, and country)?

Thank you!


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## Mex EMT-I

*Alo.*

Gracias por la información, siempre es sumamente interesante conocer los servicios de emergencia de otros paises.
Yo soy de Mexico y aqui nuestro sistema va años luz detras del de cualquier país desarrollado.

Una pregunta, la cruz roja de españa tambien brinda servicio de ambulancias?

Muy buenas fotos.

Saludos desde la tierra del nopal.


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## jlc

Dreadnought said:


> As a quick afterthought, what is your opinion on, for instance, a citizen of the USA relocating to Spain in order to pursue EMS work?  Obviously the person would have to be well versed in the language, but how do you suppose they will be treated within the EMS system?  Would there be a preference for Spanish citizens (as it would be understandable; more understanding of culture, law, and country)?



I'm sorry I did not reply soon. :blush:

Public Jobs:

There are no privileges for Spanish Citizens. The scoring matrix is public and objective. Nobody gets more points for being Spanish. 

The scoring matrix doesn't score the nationality, it only score experience and training.

e.g. Scoring Matrix (temporary nurses jobs recruitment for the public EMS of the Autonomous Community of Aragon): 
 Experience: 
- ICU or EMS in Public Services (Spain or EU): 0.25 points per month 
- ER or Urgent Care in hospitals or in Primary Care Centers (Spain or EU): 0.20 points per month 
... 
Training: 
- Certificates or training courses accredited by the National Training Committee of the Ministry of Health (or by Universities or by Public Health Offices): 0.20 points per credit (1 credit = 10 hours) 
- CEN (by Spanish Society of Emergency Medicine): 4 points. 
... 
etc.

About nationality, there are general requeriments for public jobs (for all public departments): 

- Be a citizen (Nationality / citizenship) of the European Union. 
http://en.wikipedia.org/wiki/Citizenship_of_the_European_Union 

Article 45 of the Treaty on the Functioning of the European Union states that
1. Freedom of movement for workers shall be secured within the Union.
2. Such freedom of movement shall entail the abolition of any discrimination based on nationality between workers of the Member States as regards employment, remuneration and other conditions of work and employment.

Or

- To be a citizen of a state that has established a treaty with the European Union and ratified by Spain which is applied the free movement of workers.


Private Companies
The most doctors and nurses are Public EMS employees in Spain. However, many EMT-B are sub-contracted by private companies, so in that case the company has its subjective preferences for employed workers and they could prefer Spanish workers. But I think there isn't discrimination based on nationality because I know some EMT from Romania or Africa, nurses from Portugal and doctors from South America working for private EMS companies in Spain. 



Mex EMT-I said:


> Gracias por la información, siempre es sumamente interesante conocer los servicios de emergencia de otros paises.
> Yo soy de Mexico y aqui nuestro sistema va años luz detras del de cualquier país desarrollado.
> 
> Una pregunta, la cruz roja de españa tambien brinda servicio de ambulancias?
> 
> Muy buenas fotos.
> 
> Saludos desde la tierra del nopal.



Hola, es un placer encontrar aquí a alguien que habla mi mismo idioma.



jlc said:


> In addition, there are non profit organizations like Red Cross or DYA who provide BLS ambulances (rarely ALS ambulances) with volunteers for special situations (music or sport events, support to public EMS,…).




In all regions there is a public EMS with professional staff (not volunteers). However in some regions non-profit organizations as Red Cross provides emergency ambulances  permanently as support for the public EMS. These ambulances are usually BLS units, because Red Cross usually hasn't ALS personnel (nurses and physicians) permanently. Red Cross provides ALS ambulances only for special situations.

In most regions, the Red Cross provides ambulance service as a booster to public EMS on holidays and weekends (no permanently, only when volunteers are available), and for preventive services (music concerts, sports, festive events, etc.).


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## jlc

Mex EMT-I said:


> Una pregunta, la cruz roja de españa tambien brinda servicio de ambulancias?
> 
> Muy buenas fotos.



Fotos/photos de voluntarios de Cruz Roja Española / Spanish Red Cross volunteers:


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## Mex EMT-I

*Hey.*

Hola JLC.

Muchas gracias por tu respuesta, y por tus fotos, estan increibles. Trataré de subir algunas de la cruz roja en México esta semana.

Saludos.


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## llavero

Also exists another corporation dedicated to the same thing, that my friend jlc has not mentioned, is the Volunteers' Group of Civil Protection (Civil Defense).

As his name indicates, it is a group of support to the forces of the State, acting when these need them like in floods, catastrophes, accidents, and also for preventive services (music concerts, sports, festive events, etc.). They possess services of ambulances, extinction of fires, lifeboats, helicopters, and more.

Not in all regions exists this corporation, and is managed by the Headquarter of Civil Protection and Emergencies (Department of the Interior, Government of Spain) followed by other minor corporations, and in some cases (not in all) Red Cross.



 

 

 





 

 



Sorry about the english but i do not get to speak it much.


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## MrBrown

Brown is highly impressed with prehospital medicine in the EU; it's so gosh darn sophisticated and you have really awesome looking uniforms! 

Here in New Zealand (as of this year) we have three levels of prehospital emergency medical provider (the generic term is "Ambulance Officer" but I am trying to get away from using it as it is rather outdated).

*Emergency Medical Technician*
Diploma in Ambulance Practice (6-10 months)

- Oxygen, OPA/NPA, LMA, AED, aspirin, GTN, salbutamol, glucagon/oral glucose, ondansetron, paracetamol, methoxyflurane, IM adrenaline (consult)

*Paramedic*
Bachelors Degree in Health Science (Paramedic) (3 years)

- IV cannulation, 12 lead ECG interpretation, manual defibrillation, syncronised cardioversion, adrenaline, morphine, naloxone

*Intensive Care Paramedic*
Post Graduate Diploma in Intensive Care Paramedicine

- Ketamine, midazolam, atropine, amiodarone, pacing, frusemide (probably being withdrawn), rapid sequence intubation

Midazolam IM and IN will probably make it's way down to Paramedic level eventually.  Some areas have cortisosteriods and CPAP but not all.


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## JeffDHMC

Spain, just about my favorite place in the world.

Jeff


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## llavero

Well Jeff, I change with you, I move to Texas and you come here to Spain. Ok?


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## moondancetom

Hello from Canada,

thank you very much for your information about EMS in spain, I live in Canada at the moment but we are thinking about if we would like to move to the canary islands. 
We are original from Germany, where I was full time working in EMS for 20 years, now I have done my canadian training up to the EMT - A level. Could you provide me with contacts for the Canary Island EMS provider? Do you know if they recognize any training from other countries? How is the status from Paramedics in Spain ? Can you make a living ? 
What is a average wage ? 
Any information you could give me would be awesome.

Looking forward to hear from you soon, have a awesome day.

Thomas


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## jlc

Hi Thomas!



moondancetom said:


> we are thinking about if we would like to move to the canary islands.
> We are original from Germany, where I was full time working in EMS for 20 years, now I have done my canadian training up to the EMT - A level. Could you provide me with contacts for the Canary Island EMS provider?



Sorry, but I don't live in Canary Islands :sad:.



jlc said:


> [...]
> Regional EMSs are public services (they depends on Regional Health Services). Each region manages the service differently. Some have their own vehicles and staff. Others outsource (subcontract) the vehicles and some staff to private companies (usually the vehicles and the BLS staff are contracted out and the ALS staff are civil servants –public EMS employees).
> 
> [...]
> 
> The most doctors and nurses are Public EMS employees in Spain. However, many EMT-B are sub-contracted by private companies
> 
> [...]
> 
> There are different types of EMS management:
> - In most communities, the service is run by Public Health Department. [...]There are two types of public employment contracts:
> 
> Permanent Employment (which has no time limit): jobs are awarded by competitive examination (exam + merits).
> Temporary Employment: It is awarded by merit list -waiting list, reserve list, holding pool… I don’t know how to say that in English- (experience, training, conferences, research papers...)
> 
> - In other communities, the EMS is managed by a public foundation or a public company, which provides requirements for jobs (usually by competitive examination).
> 
> - Only in some places part of the EMS is managed by private companies. [...]



*GSC is the public/government company/agency* that manages *SUC- Servicio de Urgencias Canario (Canary Islands EMS Service)*. This public company subcontracts private ambulances companies. EMT-basic and vehicles are usually hired by theses private companies.

GSC- Servicio de Urgencias Canario (EMS Service).
http://www.c4bweb.com/gscfinal/laempresa_suc.php?opp=2&ops=3

*Private Companies (Canary Islands)*:

Ambulancias TASISA.
http://www.ambs-tasisa.es/5.html

Aeromédica Canaria.
http://www.aeromedica.com/transporte-sanitario/transporte-sanitario-terrestre/

Ambulancias Tenerife.
http://ambutfe.blogspot.com/

ISSCAN.
http://www.iscantss.com/

Insular de Transporte Sanitario.
http://insulardetransportesanitario.com/index.php?ver=servicios&idioma=es

Ambulancias Vecindario.
http://www.ambulanciasvecindario.es/?page_id=5

I do not know which of these companies are subcontracted by SUC (EMS Service). Perhaps some only engage in non-emergency private transport (insurance companies, interfacility,...).



moondancetom said:


> Do you know if they recognize any training from other countries?



Sorry, I don't know.
About EMT-b training, I wrote:


jlc said:


> [...]
> 
> - EMT-B (TES). Before 2007 there was not a national standard, so each region had their own rules (courses from 60 to 600 hours, sometimes only a first aid course). Since 2007 there is a 2 years training occupational course (vocational-Community College).



Still this official certificate (TES) is not mandatory in most of regions (will be in the future; maybe in 5 years). So each region has it owns rules at this moment (different courses and qualifications: TTS, TEM, Auxiliar de Transporte Sanitario ATTS, ATA,... from 60 to 600 hours).

I think the training center that recognizes EMT courses in Canary Island is ESSSCAN:
http://www.essscan.es/



moondancetom said:


> How is the status from Paramedics in Spain ?



In Spain there are not EMT-paramedics. Only TES/TTS (like an EMT-basic). Advanced Life Support are provided by physicians and nurses (like other European countries).



			
				jlc said:
			
		

> - *Non assistant ambulance* (ambulancia no asistencial) For dialysis, rehabilitation, non emergency patients transport.
> *Staff: A *driver and sometimes an assistant* (first aid course or similar).
> *Skills: Only transport/first aids. Usually, this kind of ambulance doesn't attend emergencies.
> - *BLS ambulance* (ambulancia de SVB ).
> *Staff: *2 EMT-B* (one of them a driver)
> *Skills: BLS+AED (non-invasive techniques: splints, cervical collars, spinal board, Kendrick extrication device, first aids, oxygen,…)
> - *ILS ambulance* (ambulancia de SVI or SVE or Sanitarizada).
> *Staff: *1 or 2 EMT-B* (one of them a driver) *and 1 ambulance nurse*.
> *Skills: addition to above, nurses can apply invasive techniques (IV, NG tube, vesical catheterization, laryngeal mask…). They can use ALS skills based on protocols (like US paramedics) or phone/radio orders) like drugs or intubation. This type of ambulance is newly created (end of 90s) and not all region do.
> - *ALS ambulance* (ambulancia de SVA or UVI móvil).
> *Staff: *1 or 2 EMT-B* (one of them a driver), *1 ambulance nurse and 1 doctor.*
> *Skills: ALS techniques.
> - *HEMS*. Staff: *1 or 2 pilots* (or 1 pilot and 1 mechanic), 1 *flight nurse and 1 doctor*
> - *Rapid response unit* (VIR). Staff: *1 driver-EMT-B, 1 doctor (and/or 1 nurse)*





moondancetom said:


> What is a average wage ?



There are many differences between regions (higher in northern Spain / lower in southern Spain). The average wage is lower in private companies (ambulances companies) too. Public employees(health services) have higher salaries. 
For example, an ambulance nurse may charge € 1800 per month (gross income) in a private company (sometimes 40 or more hours/week) and € 2500 per month in a government agency (35 hours/week). 

*Public Services:* Higher salaries, less hours.
*Private Services:* Lower salaries, more hours.

EMT-b are usually poorly paid jobs. Ambulance nurses and physicians are better paid jobs.

It is difficult to estimate salaries because there are different bonus in each region or service: danger money, relocation allowance, extra pay, Christmas bonus, holiday bonus, extra pay for unsocial hours, seniority bonus, productivity bonus,...

_Wage= basic wage + bonus_ (sometimes bonus are 10 to 40% of total wage)
Net income/take home pay (post-tax wage) is about 65-85% of gross income (depending on your income). 
Salaries in Spain are lower than other countries like UK or Germany, but buying is cheaper (and, as in other European countries, unemployment benefit, health and education are public). Guaranteed minimum wage is about 800 €/month. Medium gross income is about 23000 €/year (about 12x1650€/month + 2 extra pay/year). However, because this financial crisis/recession, many people earn less than 16000 €/year (about 12x1200€/month + 2 extra pay/year) 

Average wages (gross income) per month:

TES or TTS Conductor / EMT-Driver: from 1100 to 1800 € (usually [private companies]: 1300; with overtime: up to 2000 €)
TES or TTS Ayudante / EMT-basic (no driver): 1000-1700 € (usually [private companies]: 1100; with overtime: up to 1800 €)
ATS/DUE – Enfermero / Nurse: 1600-3000 € (usually [public companies]: 2500; with overtime: up to 3000 €)
Médico / Physician: 2100-4000 € (usually [public companies]: 3000; with overtime: up to 4500 €)


----------



## jlc

*SUMMA 112 promotional ad. *

SUMMA 112 is the public EMS service in the Autonomous Community of Madrid.

[YOUTUBE]pcp07BTI7Ek[/YOUTUBE]​


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## HMartinho

Just quite similar to portuguese EMS system. When I got more free time, I'll put some pics and videos too.


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## RocketMedic

MrBrown said:


> Brown is highly impressed with prehospital medicine in the EU; it's so gosh darn sophisticated and you have really awesome looking uniforms!
> 
> Here in New Zealand (as of this year) we have three levels of prehospital emergency medical provider (the generic term is "Ambulance Officer" but I am trying to get away from using it as it is rather outdated).
> 
> *Emergency Medical Technician*
> Diploma in Ambulance Practice (6-10 months)
> 
> - Oxygen, OPA/NPA, LMA, AED, aspirin, GTN, salbutamol, glucagon/oral glucose, ondansetron, paracetamol, methoxyflurane, IM adrenaline (consult)
> 
> *Paramedic*
> Bachelors Degree in Health Science (Paramedic) (3 years)
> 
> - IV cannulation, 12 lead ECG interpretation, manual defibrillation, syncronised cardioversion, adrenaline, morphine, naloxone
> 
> *Intensive Care Paramedic*
> Post Graduate Diploma in Intensive Care Paramedicine
> 
> - Ketamine, midazolam, atropine, amiodarone, pacing, frusemide (probably being withdrawn), rapid sequence intubation
> 
> Midazolam IM and IN will probably make it's way down to Paramedic level eventually.  Some areas have cortisosteriods and CPAP but not all.



Wait...y'all can't intubate or use non-opiate analgesics or even adenosine without being an ICU paramedic? How do y'all you know...break status-epilepticus or anything?

Dude, I could crike as a _basic_ as a military medic, and as a paramedic here in Texas, I can do literally all of what you've mentioned, including CPAP and corticosteroids. And yes, I know how to use all of them, why, what they do, and when not to use them.

So why is NZ/ the European model so restrictive?


----------



## HMartinho

Yes, our model is restrictive.

In Portugal, for example, only nurses and doctors can intubate, give drugs, start IV's lines, give fluids, monnitoring with EKG, pacing etc.

Both models (american and portuguese/european models), have positive points and negative points.


----------



## RocketMedic

Sounds like y'all have a lot more doctors and nurses than we do...or some fairly deep trust issues.


----------



## Tigger

Rocketmedic40 said:


> Wait...y'all can't intubate or use non-opiate analgesics or even adenosine without being an ICU paramedic? How do y'all you know...break status-epilepticus or anything?
> 
> Dude, I could crike as a _basic_ as a military medic, and as a paramedic here in Texas, I can do literally all of what you've mentioned, including CPAP and corticosteroids. And yes, I know how to use all of them, why, what they do, and when not to use them.
> 
> So why is NZ/ the European model so restrictive?



Does anyone think that EMT-basics (anywhere) outside of a combat zone should be performing a crich?


----------



## HMartinho

Rocketmedic said:


> Sounds like y'all have a lot more doctors and nurses than we do...or some fairly deep trust issues.



the problem is not only that...

Here, there is a lot of lobbys in health area. Medical and nursing procedures are very well delimited. Recently, the health ministry and the national institute of medial emergency, made a proposal to create a paramedic carreer, but the portuguese nurses council and some doctors, refused the proposal, saying it would be usurpation of doctors and nurses scoop of practice.


----------



## MrBrown

Rocketmedic40 said:


> Wait...y'all can't intubate or use non-opiate analgesics or even adenosine without being an ICU paramedic? How do y'all you know...break status-epilepticus or anything?



We do not have adenosine prehospitally here- it was introduced as a trial but not introduced due to lack of use.  We don't touch stable SVT, for people who are Super Crook™ regardless of origin of rhythm we cardiovert them.

Our volunteer Technicians have paracetamol, entonox and methoxyflurane.  Intensive Care Paramedics have ketamine.  These are all non opiate analgesics.

Midazolam is an Intensive Care medicine, although watch this space, like in Australia it is likely to be bought to the Paramedic level soon.


----------



## jlc

Rocketmedic said:


> Sounds like y'all have a lot more doctors and nurses than we do...or some fairly deep trust issues.



I wrote some time ago:


jlc said:


> Each country has developed its system in different contexts.
> U.S. had a shortage of doctors/nurses and created the profession of EMT-paramedic. This profession has grown in many countries. In many of them, there are different levels of EMTs. The higher level of EMT are moving to university degrees/bachelors in paramedic (Australia, some countries in South America, NZ ,...) because people demand more and better professionals. In the future, many of the countries that use the Anglo-american system have a bachelor in paramedic sciences or emergency sciences for their paramedics.
> 
> Here, in Spain, there have not been a shortage of doctors or nurses (now beginning to be a shortage of doctors), so our system has developed differently than the American system. We have well-trained nurses, and here they are accustomed to seeing the prehospital work as part of their scope of practice. So, here, it is not necessary to create a university degree of paramedic sciences. It's easier (and cheaper) to train postgraduate nurses in PH.
> 
> For example, in Netherlands, all paramedics are RN trained in prehospital; in Sweden, all emergency ambulances have, at least, a RN; in Finland, when someone is studying for a paramedic degree, get a double degree in paramedic and RN (It's valid throughout European Union as a RN).
> 
> In many countries of Europe, the role of the paramedic has been assumed by the prehospital nurse.  They aren't hospital nurses who are coming out. There are nurses inside and outside the hospital.
> 
> [...]
> 
> Every country has their professions with their scope of practice (not only in prehospital; in hospital too).







HMartinho said:


> the problem is not only that...
> 
> Here, there is a lot of lobbys in health area. Medical and nursing procedures are very well delimited. Recently, the health ministry and the national institute of medial emergency, made a proposal to create a paramedic carreer, but the portuguese nurses council and some doctors, refused the proposal, saying it would be usurpation of doctors and nurses scoop of practice.



Here, in Spain, there is no plan to create a paramedic career, because, here, each profession has its own scope of practice.  
That's not "some fairly deep trust issues". We work as a team. Each one (EMTs, nurses, doctors) has its function or role.  In the same way that in some countries fire departments and firefighters have roles in EMS, while in others, ambulance companies are those that have that function. Each country has developed its system in different contexts.

In fact, a national standard curriculum for EMT was recently created. It establishes the TES functions (similar to the US basic EMT). In the same way that US basic EMTs can't intubate or use ketamine or adenosine without being EMT-Paramedic, TES can not, either.

In US, for that, you need to be a Paramedic. It's not  trust issue in basic EMTs. Here you need to be a nurse or a doctor. It's not trust issue in TES, either.



jlc said:


> *Training:*
> - *EMT-B* _(TES)_. Before 2007 there was not a national standard, so each region had their own rules (courses from 60 to 600 hours, sometimes only a first aid course). Since 2007 there is a 2 years training occupational course (vocational-Community College).


----------



## HMartinho

jlc said:


> I wrote some time ago:
> 
> 
> 
> 
> 
> 
> Here, in Spain, there is no plan to create a paramedic career, because, here, each profession has its own scope of practice.
> That's not "some fairly deep trust issues". We work as a team. Each one (EMTs, nurses, doctors) has its function or role.  In the same way that in some countries fire departments and firefighters have roles in EMS, while in others, ambulance companies are those that have that function. Each country has developed its system in different contexts.
> 
> In fact, a national standard curriculum for EMT was recently created. It establishes the TES functions (similar to the US basic EMT). In the same way that US basic EMTs can't intubate or use ketamine or adenosine without being EMT-Paramedic, TES can not, either.
> 
> In US, for that, you need to be a Paramedic. It's not  trust issue in basic EMTs. Here you need to be a nurse or a doctor. It's not trust issue in TES, either.



I totally agree. Here we work as a team too, and doctors and nurses are REALLY important in prehospital care.

Just one question: In Spain, the nurses that staffed intermediate life support untis, can intubate, use manual defibrillators and administer some emergency drugs and opioids as in Portugal?


----------



## jlc

HMartinho said:


> I totally agree. Here we work as a team too, and doctors and nurses are REALLY important in prehospital care.
> 
> Just one question: In Spain, the nurses that staffed intermediate life support untis, can intubate, use manual defibrillators and administer some emergency drugs and opioids as in Portugal?



Hi!

ILS Ambulances are newly created, so there are few written protocols at the moment. And, furthermore, only some regions have still got these ambulances (Canary Islands, Catalonia, Basque Country, Andalusia). The trend is to create more of them.

The Emergency Dispatch Center (with medical regulation) usually sends ALS ambulances (with doctor, nurse and EMT) to seriously emergencies that need intensive techniques (intubation, chest tube, crico... or some drugs: fibrinolytic therapy, antiarrhythmic drugs, opioids,...). 

ILS ambulances (with nurse and EMT) are usually sent to intermediate emergencies that only need some advanced techniques or drugs (IV line, fluids, EKG, analgesics, iv glucose, antiepileptic drugs, NG tube, laryngeal mask,... and CPR drugs or defibrillator if it's necessary). 

But if all ALS ambulances are engaged, the Emergency Center sends ILS ambulances to seriously emergencies. Then the doctor of the Dispatch Center can authorize the nurse to do necessary techniques or to use necessary drugs (by radio or phone), although some doctors are still reluctant to accept it.

If no advanced care is necessary, they send a BLS unit (2 EMTs). EMTs perform non invasive techniques (cervical collar, Kendrich Extrication Device, wound cleansing, oxygen... and some oral drugs under a doctor order -by radio or phone-) .). If it's necessary, they can perform CPR+AED+Oxygen until ALS or ILS  ambulance arrives.


----------



## HMartinho

jlc said:


> Hi!
> 
> ILS Ambulances are newly created, so there are few written protocols at the moment. And, furthermore, only some regions have still got these ambulances (Canary Islands, Catalonia, Basque Country, Andalusia). The trend is to create more of them.
> 
> The Emergency Dispatch Center (with medical regulation) usually sends ALS ambulances (with doctor, nurse and EMT) to seriously emergencies that need intensive techniques (intubation, chest tube, crico... or some drugs: fibrinolytic therapy, antiarrhythmic drugs, opioids,...).
> 
> ILS ambulances (with nurse and EMT) are usually sent to intermediate emergencies that only need some advanced techniques or drugs (IV line, fluids, EKG, analgesics, iv glucose, antiepileptic drugs, NG tube, laryngeal mask,... and CPR drugs or defibrillator if it's necessary).
> 
> But if all ALS ambulances are engaged, the Emergency Center sends ILS ambulances to seriously emergencies. Then the doctor of the Dispatch Center can authorize the nurse to do necessary techniques or to use necessary drugs (by radio or phone), although some doctors are still reluctant to accept it.
> 
> If no advanced care is necessary, they send a BLS unit (2 EMTs). EMTs perform non invasive techniques (cervical collar, Kendrich Extrication Device, wound cleansing, oxygen... and some oral drugs under a doctor order -by radio or phone-) .). If it's necessary, they can perform CPR+AED+Oxygen until ALS or ILS  ambulance arrives.



Hi

Thanks for the reply.
Two neighboring countries and with a pre-hospital emergency so similar.


----------



## systemet

I think a lot of people are missing that it doesn't really matter if you call the person on the ambulance who gives drugs, intubates and performs traditionally physician-level skills a paramedic or an ambulance nurse.  It's the same role.

A lot of European countries have chosen to educate their ALS practitioners as specialty RNs.  Often this means getting a Bachelor's degree in Nursing, working for a year or two in the ICU / ED and then going on to some sort of graduate training in ambulance transport.

I think if people are willing to take a step back from the "paramedic" as a non-nurse, there's a lot of benefits to this system.  Not least of which, is that if you burn out of the road, you can move to another area of nursing.


----------



## jlc

systemet said:


> I think a lot of people are missing that it doesn't really matter if you call the person on the ambulance who gives drugs, intubates and performs traditionally physician-level skills a paramedic or an ambulance nurse.  It's the same role.
> 
> A lot of European countries have chosen to educate their ALS practitioners as specialty RNs.  Often this means getting a Bachelor's degree in Nursing, working for a year or two in the ICU / ED and then going on to some sort of graduate training in ambulance transport.
> 
> I think if people are willing to take a step back from the "paramedic" as a non-nurse, there's a lot of benefits to this system.  Not least of which, is that if you burn out of the road, you can move to another area of nursing.



I agree. That's what I mean. No matter how the profession is called. It's the same role, adapted to the circumstances of each country.


----------



## Katy

I think it is a good idea. I mean, the RN's would have to get some type of additional training to function at the best ability pre-hospital, but overall they have a more general education. They would be better educated to handle psych calls, more in depth understanding of nutrition, etc. If they get the proper education, I see no problem with it, in fact, I actually support the idea.


----------



## Steveb

Cuantos anos los doctores en las ambulancias estudian?
HOw many years do the doctors in the ambulance study?


----------



## jlc

First, they have to get a degree in medicine (6 years). Then, they have to approve the MIR exam to choose a medical specialty (4-6 years). In Spain there is not emergency specialty yet, so they can choose other specialties that perform in the ER: Internal Medicine, Family Medicine, Intensive Medicine... 
Most of ER in Spain are managed by family doctors or Internal Medicine doctors because they spend several years of their specialty residency in ER.
The residents in Family Medicine work during their residency in several services: ER, Health Centers, Trauma and sometimes in the ambulance service (under supervision). 

Most of EMS are public services in Spain. Here, a medical specialty is mandatory for all public service physicians (since 1995). So most of ambulance physicians have spent several years in an ER. Some of them have worked several weeks or months under supervision during their residency on an advanced ambulance.
There are anaesthesiologists and intensive medicine physicians in EMS ambulances too.

In several regions (like Madrid Autonomous Community) a 1-2 years Master in Emergency Medicine (with a practical period in ambulance service) is mandatory for ambulance physicians.

So, ambulance physician: 6 years (Degree in Medicine) + 4-6 years (medical specialty) and/or 1-2 years (master in emergency medicine)

The medical specialty is not mandatory in private companies, so the employer can hire a physician without medical specialty or without master degree, however they prefer to hire more experienced physicians (I suppose so). Anyway, most of EMS are public services instead of private services.


----------



## VFlutter

Rocketmedic40 said:


> Wait...y'all can't intubate or use non-opiate analgesics or even adenosine without being an ICU paramedic? How do y'all you know...break status-epilepticus or anything?
> 
> Dude, I could crike as a _basic_ as a military medic, and as a paramedic here in Texas, I can do literally all of what you've mentioned, including CPAP and corticosteroids. And yes, I know how to use all of them, why, what they do, and when not to use them.
> 
> So why is NZ/ the European model so restrictive?



Just because "y'all" are allowed to do a procedure does not mean that you should be allowed to do it....as far as crikes in the military it is only out of pure necessity and lack of more appropriate options. 


Hmmm requiring providers to have quality advanced education before allowing them to perform invasive procedures. What a crazy concept. Blasphemy!!!!:blink:


----------



## jlc

Last June, the Spanish government approved a new royal decree RD 836/2012 that replaces a 1998 decree (RD 619/1998) . The main changes are as follows:

- According to the European Standard EN 1789 the types of road ambulances are:

*Type A: Patient Transport Ambulance *(for the transport of patients who are not expected to become emergency patients).
      type A1: suitable for transport of single patient;
      type A2: suitable for transport of one or more patient(s) (on stretcher(s) and/or chair(s))

*Type B: Basic Life Support*

*Type C: Advanced life support / mobile intensive care unit*

- The road ambulances shall comply with the requirements of UNE -EN 1789 (Spanish Standard -UNE- based on European Standard).

- The minimum staff are:


*Type A: 1 or 2 technicians with a Professional Certificate or with an EMT-B (TES) certificate.*
The Professional certificate is a certificate for former employees who had worked some time before the new EMT-B certificate was adopted and have some experience and other certificates (Patient Transport Assistant, Ambulance Technician...).

*Type B: 2 EMT-B *(TES: Técnico en Emergencias Sanitarias)

*Type C: 1 EMT-B/driver and 1 Emergency Nurse* (and also a physician when the type of service so requires).
Until now, type A and type B staff was regulated by regional rules, so each region had their own requirements:"First Aid" course, "Patient Transport Assistant" course, "Patient Transport Technician" course, "Ambulance Technician" course... from 50 or 60 hours to more than 600 hours.

Some regions had ILS (Intermediate Life Support) Ambulances with a technician and a nurse. But according to the 1998 Decree, these ambulance were legally BLS ambulances (now, according the new decree, are ALS ambulances).

Since 2007 there is a national standard for all EMT-B: the TES certificate, a two years training course (vocational college).
Now TES is mandatory for all BLS ambulance new staff. 

The technicians who are currently working in BLS ambulance (and don't have TES certificate) keep their jobs. But a TES certificate is mandatory for new employees.

Previously, ALS ambulances are staffed at least by an emergency physician, an emergency nurse and a technician/driver. Currently, only an emergency RN and a EMT-B/driver is mandatory for all ALS ambulances. A physician is optional, (mandatory only for severe emergencies).


----------



## Jmurillo

*¡Información tan útil!*

¡Hola! ¡Muchas gracias por tus mensajes!

Ahora estoy tomando la clase para ser un EMT-B, y lo que ha explicado es que quería saber, pero hay más, y por eso mis preguntas. En casi un año me voy a mudar (quizá definitivamente) a Barcelona. Al lado de estudiar para ser un EMT-B, estoy estudiante de prémedicos (y filosofía) aquí el los EEUU. Cuando me mudo seguiré con el graduo en medicina en la UPF (creo). Ahora quiero saber si puedo trabajar como un EMT-B en España con mi diploma de EMT-B de aquí. Ó si crees que no, ¿sabes donde puedo obtener lo que necesitaría?
Yo también voy a decir “lo siento“ porque mi español no es tan bueno, tampoco! Espero que puedas ayudarme! Muchas gracias, otra vez!


----------



## jlc

Jmurillo said:


> Ahora quiero saber si puedo trabajar como un EMT-B en España con mi diploma de EMT-B de aquí. Ó si crees que no, ¿sabes donde puedo obtener lo que necesitaría?



Hi,
You need to have your diploma validated by Education Department (Ministry of Education). 
Until last year, there was not a national standard for EMTs, so each region (or each ambulance company) established its own rules. In some regions only a basic course from 40 to 300 hours (Red Cross courses or Private courses, not official courses) was mandatory for basic technicians. You didn't need to have a diploma validated by the Government. However, last year the Spanish Government approved the new decree, so TES certificate is mandatory for new employees.
TES (Técnico en Emergencias Sanitarias) certificate is a 2-years community college title. So you must go through the accreditation process.
Although that course has been taught since 2007 in several regions, there is a lack of technicians with this certificate, so many companies employ technicians without certificate (with former courses) for the moment. Some regions and voluntary ambulance organizations have request a moratorium (delay) for the new law and some changes.

About the title validation, visit the website of Spanish Ministry of Education (in Spanish):
- Puntos de información: http://www.mecd.gob.es/educacion-mecd/areas-educacion/sistema-educativo/convalidaciones/titulos-no-universitarios/puntos-informacion.html
- Normativa: http://www.mecd.gob.es/educacion-mecd/areas-educacion/sistema-educativo/convalidaciones/titulos-no-universitarios/normativa.html
- Títulos extranjeros susceptibles de homologación o convalidación: http://www.mecd.gob.es/educacion-me...os-no-universitarios/titulos-extranjeros.html

Browse through the web menu on the left, under "Títulos no universitarios": Solicitud, tasas, requisitos, documentos, etc.

Other way to gain a TES certificate (when you live here, in Spain):
- Take a 2 years course in a community (vocational) college: Institutos o Centros de Formación Profesional de Grado Medio.
- You can take the exams as a private candidate/external candidate (a person who enters an examination but is not enrolled as a student at the centre). Some schools teach theory subjects on line so you only need to attend to practical classes, exams and internship at an ambulance company.
If you are a medical student, maybe the center would recognize some of your subjects (anatomy, etc).

TES course subjects:
- Anatomy, physiology and patology (basic level)
- Initial Care in emergencies
- Special Care in emergencies
- Patient transport
- Logistic in emergencies
- Mechanical maintenance of the vehicle
- Psychological support
- Emergency plans and prevention
- Tele-emergencies (emergency dispatch)
- Entrepreneurship
- Career counseling
- Internship at ambulance companies
(some centers can add some subjects like English, etc)

When you gain your physician degree you would work as an ambulance physician (maybe you'll need a master degree or a specialty). Remember that in Spain only nurses and physicians are able to perform advanced support (all ALS ambulances have, at least, an emergency nurse or an emergency nurse and an emergency physician).

Good luck!

What's UPF?? Universidad Pompeu Fabra?


----------



## Jmurillo

*Great!*

Wow! Thank you so much! That was all great information! (As your English is really good, I'll just write in English to spare my self some time today!)

I will be going in about a year, so I'm guessing that by then, most companies will be hiring people that have a 2-year TES degree. That's good to know though! This way I can start planning to take that course. 

Do you think that experience (hopefully by the time I get to BCN I'll have worked about 8months as an EMT-B) counts towards any adjustment in the validation of my degree by the ministry of education? I will definitely take a look at those sites and email around to see what I need to do. 

Yes, UPF is la universitat pompeu fabra  

Thanks so much for the great information!!


----------



## jlc

Jmurillo said:


> Do you think that experience (hopefully by the time I get to BCN I'll have worked about 8months as an EMT-B) counts towards any adjustment in the validation of my degree by the ministry of education?



I think that the validation of a degree by the ministry only refers an academic validation (studies, not experience). But I don't sure about that.

However, I suppose that the vocational center (Instituto de Formación Profesional) can validate your experience so you don't need to take the internship in an ambulance company.

In fact, former technicians that are taking that certificate don't need to take the internship.


----------



## Jmurillo

jlc said:


> I think that the validation of a degree by the ministry only refers an academic validation (studies, not experience). But I don't sure about that.
> 
> However, I suppose that the vocational center (Instituto de Formación Profesional) can validate your experience so you don't need to take the internship in an ambulance company.
> 
> In fact, former technicians that are taking that certificate don't need to take the internship.



Wonderful! This all sounds great! Thanks again for all this information! I really appreciate it! 

Is it unheard of for med-students to work in general or as something more intense like an EMS responder, in Spain?


----------



## jlc

Jmurillo said:


> Is it unheard of for med-students to work in general or as something more intense like an EMS responder, in Spain?



Most university students do not work because studies require full dedication. However I know some students who are working while studying. Some work in part-time jobs (waiters at fast-food restaurants or weekend-bars/pubs, doorman at discos,..), and I know an EMS nurse who is a medical student, too. 

When I was a nursing student at university, I worked as an ambulance technician/driver. However I was so lucky to have a good boss and colleagues (to change shifts). 

Furthermore, you can study as a part-time student and take fewer credits per year, too.


----------



## Jmurillo

jlc said:


> Most university students do not work because studies require full dedication. However I know some students who are working while studying. Some work in part-time jobs (waiters at fast-food restaurants or weekend-bars/pubs, doorman at discos,..), and I know an EMS nurse who is a medical student, too.
> 
> When I was a nursing student at university, I worked as an ambulance technician/driver. However I was so lucky to have a good boss and colleagues (to change shifts).
> 
> Furthermore, you can study as a part-time student and take fewer credits per year, too.



Okay! That looks hopeful! Thank you for all the time and effort you've put into answering my questions! I really appreciate it! 

Que te vaya bien!


----------



## jlc

You're welcome!


----------



## Tom Gural

jlc said:


> Greetings from Spain!
> 
> *About Spain:*
> Spain is a member of the European Union located in southwestern Europe. In 2008 the population of Spain officially reached 46 million people. Its total area is 504,782 km2 (194,897 sq mi).  According to the World Bank, Spain’s economy is the ninth largest worldwide and the fifth largest in Europe.  (wikipedia )
> 
> *EMS:*
> There are 17 autonomous communities (autonomous regions) in Spain (like states in USA). Each region has their own Public Health Service (with hospitals, health centers and regional EMS). So there are 17 regional public EMS (they depend of the Regional Government). Furthermore, some cities has a local EMS (it depends of the city council), and some Fire Department has ambulance service too.
> In addition, there are non profit organizations like Red Cross or DYA who provide BLS ambulances (rarely ALS ambulances) with volunteers for special situations (music or sport events, support to public EMS,…). There are more private companies too.
> Regional EMSs are public services (they depends on Regional Health Services).  Each region manages the service differently.   Some have their own vehicles and staff. Others outsource (subcontract) the vehicles and some staff to private companies (usually the vehicles and the BLS staff are contracted out and the ALS staff are civil servants –public EMS employees).
> 
> *Emergency dial: 112*
> The emergency dial is 112 in all regions, but in many regions, each agency have their own dial too (national police: 091, local police: 092, firefighters: 080, EMS: 061…). So in some regions, the 112 dispatchers send the ambulance (or the firefighter engine, or the police car…), but in others the 112 dispatcher call the 061 dispatcher (or the 080 dispatcher, or the 092 dispatcher,…), and then this sends the ambulance (firefighter engine, police car,…).
> 
> *There are diferent kinds of ambulance:
> - Non assistant ambulance* _(ambulancia no asistencial)_ For dialysis, rehabilitation, non emergency patients transport.
> *Staff: A driver and sometimes an assistant (first aid course or similar).
> *Skills: Only transport/first aids. Usually, this kind of ambulance doesn't attend emergencies.
> *- BLS ambulance *_(ambulancia de SVB )._
> *Staff: 2 EMT-B (one of them a driver)
> *Skills: BLS+AED (non-invasive techniques: splints, cervical collars, spinal board, Kendrick extrication device, first aids, oxygen,…)
> *- ILS ambulance *_(ambulancia de SVI or SVE or Sanitarizada)._
> *Staff: 1 or 2 EMT-B (one of them a driver) and 1 ambulance nurse.
> *Skills: addition to above, nurses can apply invasive techniques (IV, NG tube, vesical catheterization, laryngeal mask…). They can use ALS skills based on protocols (like US paramedics) or phone/radio orders) like drugs or intubation. This type of ambulance is newly created (end of 90s) and not all region do.
> *- ALS ambulance *_(ambulancia de SVA or UVI móvil)._
> *Staff: 1 or 2 EMT-B (one of them a driver), 1 ambulance nurse and 1 doctor.
> *Skills: ALS techniques.
> *- HEMS.* Staff: 1 or 2 pilots (or 1 pilot and 1 mechanic), 1 flight nurse and 1 doctor
> *- Rapid response unit *_(VIR)_. Staff: 1 driver-EMT-B, 1 doctor (and/or 1 nurse)
> 
> *Training:*
> - *EMT-B* _(TES)_. Before 2007 there was not a national standard, so each region had their own rules (courses from 60 to 600 hours, sometimes only a first aid course). Since 2007 there is a 2 years training occupational course (vocational-Community College).
> -* Nurse* _(Enfermero)_: University degree (3 years until 2009, now 4 years). In some regions nurses need a Master in Emergency Nursing (or experience in ER, ICU,…) for EMS jobs.
> - *Doctor* _(médico or doctor)_: University degree (6 years). If they want to work for the public health service they need to be a Specialist (4-5 years more: Intensive Care Medicine, Family Medicine, Anesthesiology, Cardiology…)
> - *Volunteers* _(voluntarios)_: Red Cross, DYA, Civil Defense… Courses from 40 to 300 hours (first aids, patient transport assistant, life guard,…)
> 
> *Non-assistant/non-emergency ambulance/patients transports (private company):*
> 
> 
> 
> 
> 
> 
> *Red Cross- BLS Ambulances (Volunteers):*
> 
> 
> 
> 
> 
> *BLS ambulance (061 Aragón: EMS - Autonomous Community of Aragon):*
> 
> 
> 
> 
> 
> *ILS Ambulance (SUC: EMS - Autonomous Community of Canary Islands):*
> 
> 
> 
> 
> Sorce:http://sanitarizada.blogspot.com
> 
> *ILS Ambulance (Emergencias Osakidetza: EMS - Autonomous Community of Vasque Country):*
> 
> 
> 
> 
> Source: http://www.e-mergencia.com
> 
> *ALS Ambulance and HEMS (SUMMA 112: EMS- Autonomous Community of Madrid): *
> 
> 
> 
> 
> 
> *ALS Team (GUETS SESCAM 112: EMS -Autonomous Community of Castilla-La Mancha):*
> 
> 
> 
> 
> Source: http://ucienf.blogspot.com
> 
> *ALS Team (SAMUR - EMS City Council of Madrid):*
> 
> 
> 
> 
> 
> *ALS Ambulance (SAMU Asturias: EMS - Autonomous Community of Asturias):*
> 
> 
> 
> 
> 
> *ALS Ambulance (Bomberos Navarra: EMS - Fire Department, Autonomous Community of Navarre):*
> 
> 
> 
> 
> 
> *Rapid Response Unit -VIR- (SUMMA 112 Madrid):*
> 
> 
> 
> 
> 
> *HEMS (Emergencias SACYL 112: EMS - Autonomous Community of Castilla-León):*


Dear JLC, 

Thanks for this interesting post. I am wondering if you could help me. I am temporarily in Madrid for half a year - working as and engineer. On the other hand I am also a paramedic with 7 years of experinece in ALS ambulance in Poland. Is there any chance to get on the an ambulance in Madrid as a volunteer during this time?


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## UVAEMTB

Tom Gural said:


> Dear JLC,
> 
> Thanks for this interesting post. I am wondering if you could help me. I am temporarily in Madrid for half a year - working as and engineer. On the other hand I am also a paramedic with 7 years of experinece in ALS ambulance in Poland. Is there any chance to get on the an ambulance in Madrid as a volunteer during this time?


Did you ever find work as an EMT in Madrid?
I'm an EMT-B looking for a paid internship in Spain. I'd *love* to work as an EMT in Spain. My Spanish is fairly solid; I'd also bring a bachelor's degree and 4 years of experience on Rescue Squad in a small city. 
Do you have any suggestions regarding where to begin searching?


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## ffemt8978

Closed for bump and new thread already started.


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