# The Ambulance-staff in the Netherlands



## Dutch-EMT

In the Netherlands we don't know the different levels of EMS education.
There is always an standard ambulancecrew in the whole country.

An ambulanceteam is always an ambulancedriver and an ambulance-nurse
(in Dutch called Ambulancechauffeur and Ambulanceverpleegkundige).

*Ambulancedriver*
To become an ambulancedriver you must have a First-Aid diploma and a drivers-licence for trucks above 3500kg (called a C-drivers-licence).
Working in the healthcare is recommended.

The ambulancedriver, ofcourse, drives the ambulance.
He assists the ambulancenurse at the scene. Skills the drivers are trained for are for example:
- prepare medication and infusion
- prepare for oxygentherapy, assist by intubation
- Spinal care and stabilisation
- fracture immobilisation
- link the patiënt to the monitor
- in case of an large accident coördinate till an ambulance officer arrives.

*Ambulancenurse*
To become an ambulancenurse you must have finished a nursingschool, wich is in the netherlands a 4-years studie. After the nursing school you must be working for at least one year in a hospital before the nurse can apply to get educated as an ER-nurse (1½ yr study), Intensive-care-nurse (1½ yr study), Coronarycare nurse (1½ yr study) or Anesthetisc-nurse (3 yr study). 
These studies all contain an ALS-training.
When the nurse has been working for at least one year as a specialist-nurse, he/she can apply to the function of ambulancenurse.

The ambulancenurse works mostly together with a ambulancedriver.
Sometimes the ambulancenurse works alone (as rapid-responder on a bike or in a normal rescue car/van).
The ambulancedriver works with protocols and a standard set of medication and equipment. There is no contact with a doctor during the treatment by the ambulance-nurse. When a patiënt is in very bad condition, the ambulancenurse can ask for back-up by a MMT (Mobile medical team).
This MMT (an emergency doctor and emergency-nurse) assists the ambulancenurse. Sometimes the emergency-centre sends the MMT before the arrival of an ambulance, on ground of the emergency call.

*Study and protocols for ambulance staff*
In the Netherlands there is only one educations for ambulance-staff.
Its called SOSA (Foundation of education ambulancestaff). There is also one protocol, used in the whole country (LPA: Countywide protocols ambulancecare). The SOSA-education is a study wich takes a year.

When you want to work as ambulancenurse in the Netherlands it takes 6½ years of studie and 2 years of working-experience after the studies to become an ambulancenurse.


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## Scott33

One of the most advanced EMS systems on the planet as far as educational requirements go. Thanks for posting.


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## atropine

Thats cool there called ambulance drivers, makes sense I think.


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## squrt29batt12

That sounds pretty impressive. It also sounds like a pretty damn expensive operation to run daily lol.


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## Richard

Nice write up!


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## MrBrown

Gosh darn it, Europe is so efficent!

Brown is impressed, now, who wants to go to Oktoberfest?

Rhein Control hello its Medivac, descending VFR, 1200, changing local traffic


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## jjesusfreak01

MrBrown said:


> Gosh darn it, Europe is so efficent!
> 
> Brown is impressed, now, who wants to go to Oktoberfest?
> 
> Rhein Control hello its Medivac, descending VFR, 1200, changing local traffic



Thats all we need, drunk Brown with a drunk pilot trying to medevac a drunk patient from Oktoberfest.


That does sound like a fairly good system over there in the Netherlands. There doesn't appear to be a huge amount of room in the back of that ambulance. Do you have multiple medical personnel in the back with critical patients, like ROSC arrest patients, or is it always just a nurse and the patient?


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## Dutch-EMT

jjesusfreak01 said:


> Thats all we need, drunk Brown with a drunk pilot trying to medevac a drunk patient from Oktoberfest.
> 
> 
> That does sound like a fairly good system over there in the Netherlands. There doesn't appear to be a huge amount of room in the back of that ambulance. Do you have multiple medical personnel in the back with critical patients, like ROSC arrest patients, or is it always just a nurse and the patient?



In the worst case scenario the MMT-doctor drives with the ambulance-nurse to the hospital. During resuscitation a second ambulance-nurse steps in the back of the ambulance. A resuscitation call always needs 2 ambulances.
The back of the ambulance is large enough for two crewmembers.


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## llavero

It is very similar to the work that develops in Spain with the private ambulances.
Thank you for the information.


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## Dutch-EMT

In the Netherlands we see the next ambulances:




Mercedes Benz E-class





Volkswagen with T5 base





Mercedes Emergency Sprinter





Chevrolet GMT series





Mercedes ambulance with BOX-system





Ford Ambulance (the largest one who's driving in the Netherlands)





Volvo V70 Ambulance 

VZA Ambulances (Amsterdam in different collours)




Chevrolet GMT Series





Mercedes Sprinter Box


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## MrBrown

Brown likes box 

New Zealand is moving from the box ....






... to the van 






.... but what Brown really wants to drive around at 120 miles an hour is this:


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## Dutch-EMT

Damn, Brown, What a shame that the box is getting replaced by the van.

Here in NL the chevy's and Ford are all getting replaced by Mercedes Sprinter Van's. Just because repair and servicecosts are much much cheaper and the engines of American cars use a lot of fuel.
It's all about reducing costs!!!


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## RNL

Dutch-EMT said:


> A resuscitation call always needs 2 ambulances.



Sounds expensive...in Poland in case of a resuscitation call the specialized team with doctor on board in usually sent


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## Kthanid

Continental Europes 45-60% income tax rates are what pays for this stuff. Not a misprint, In Denmark for example at the top tax bracket you are losing around 60c in the dollar to the tax man.

I'd take lower taxes and a community college/on-the-job trained paramedic any day thanks.


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## clibb

Kthanid said:


> Continental Europes 45-60% income tax rates are what pays for this stuff. Not a misprint, In Denmark for example at the top tax bracket you are losing around 60c in the dollar to the tax man.
> 
> I'd take lower taxes and a community college/on-the-job trained paramedic any day thanks.



But at the same time you have no medical bills for ambulance, surgery, or whatever you need. You also get PAID time off of work to recover and to make sure you have recovered 100%. Plus you don't have to pay for college.
Sweden has the highest taxes and that's 56%. Denmark is second. So no, you don't lose 60c to the dollar in Denmark.


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## Dutch-EMT

Kthanid said:


> Continental Europes 45-60% income tax rates are what pays for this stuff. Not a misprint, In Denmark for example at the top tax bracket you are losing around 60c in the dollar to the tax man.
> 
> I'd take lower taxes and a community college/on-the-job trained paramedic any day thanks.



In Netherlands we have one of the best social structures of the world.
We know the health insurance laws, so everybody must have ensurance in health. When people retire, the state pays about €750-800,= (when age is 65yrs) and retirement funds make it to about 90% of the last earned salary for the rest of their lifes.
That means that everyone gets €750 to €800,= and everybody with a job must fund in retirement-funds so they have a good salary when retire.
When people don't retire on age of 65, but work till 67yrs, the retirement income will be 100%.


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## SerumK

How is that social system looking longterm financially? Will it be self sustaining? Or will it go bankrupt?


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## Dutch-EMT

SerumK said:


> How is that social system looking longterm financially? Will it be self sustaining? Or will it go bankrupt?



This system is depending on the economy. The funds have a lot of income by investments. And those incomes are decreased. After WorldWar II, there was a babyboom. Those people getting old now, so there are more people use the pensionfunds/retirementfunds.
But it must be selfsustaining. It's not goïng bankrupt.

We are goïng offtopic


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## Kthanid

clibb said:


> But at the same time you have no medical bills for ambulance, surgery, or whatever you need. You also get PAID time off of work to recover and to make sure you have recovered 100%. Plus you don't have to pay for college.
> Sweden has the highest taxes and that's 56%. Denmark is second. So no, you don't lose 60c to the dollar in Denmark.



Figures and opinions and stats vary for all the countries with Denmark ranked 1st, 2nd(the stats you looked at most likely) or 4th just to name a few. Feel free to split hairs with another search if you want. 

The gist is these countries are expensive as hell.

And of course they have a lot of free services, its exactly what the taxes pay for of course. No argument there.

In Denmarks case you can also throw in the free schooling and free adult learning camps the Danes have (like adventure training stuff and just learning stuff for fun) and the huge payouts you get if you are sacked and the countries who have lenghty maternity leave... for the husband(!)

My opinion does not change one jot.

I'll take lower taxes over an exorbitant state funded safety blanket hands down.

One thing the UK is learning and Australia apparently is that the free everything system they enjoy does not work quite as well as we hoped. We have the biggest boom in private medical and private medical insurance ever occurring currently, which is obviously people choosing other than the state funded system.

The 'free college/University' system now requires funding from its huge international student load paying full fees to stay afloat. 25% of student numbers at some Uni's are international(eg $25,000 a year per foriegn student). 

And as we all found if you happen to be retiring just when the stockmarket crashes all the state funded care you amassed can be wiped out forever if your fund fails. Anyone here from Iceland or Greece like to comment 

Europe is only surviving because its so highly networked it can shuffle money fast enough between countries to try and plug gaps. Also we can con the poorer half aka 'Eastern Europe' for huge sums if they want to "get into the European Union" with us.

I don't think the US is actually in as bad shape because at least the wound is lanced and its all its debt is on the table now.

Europe can't say whether its system is self sustaining until the rest of the baby boomers retire.

 Back to the thread, be careful what you wish for yanks with the 'hallowed ground' of 'free care' we Euro's quote. You may just get it...


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## jjesusfreak01

The EMS system in the Netherlands is great, but its hard to compare it to a place like the US. My state (North Carolina) is 3.5x larger than The Netherlands but with 1/6th the population density. When you combine that with the good network of roads across The Netherlands and the fairly flat terrain, you can see how it is possible for the Dutch to have an EMS system that employs more highly educated (and presumably higher paid) emergency workers.


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## MrBrown

jjesusfreak01 said:


> The EMS system in the Netherlands is great, but its hard to compare it to a place like the US. My state (North Carolina) is 3.5x larger than The Netherlands but with 1/6th the population density. When you combine that with the good network of roads across The Netherlands and the fairly flat terrain, you can see how it is possible for the Dutch to have an EMS system that employs more highly educated (and presumably higher paid) emergency workers.



Australia is one of the largest nations in the world with very low population density outside of the eastern coastal cities and a few other places.  They now every Ambulance Paramedic to have a Bachelors Degree.

Canada is many times larger than Australia where something like 70% of the population lives within one hour of the US border.  Primary Care Paramedics require between one and two years of education whereas Advanced Care is either another one or two years.  This includes very rural areas of Alberta, Ontario, BC and Novia Scotia.

In these nations and in the US other allied health professions require a Bachelors Degree (exception noted for some in the US eg an LPN) .... so once agian, that argument is invalid.  Quite simply people do not want to pay for it, the system is not designed to support it and most providers probably do not want to spend that long getting the education that would make it work.

Who do you think has to call for ALS (Intensive Care Paramedic) more often? Two Paramedics 300km from nowhere in Australia who have a wide selection of clinical dexterity including a range of IV drugs or some 100 hour wonder in the rural USA who can give oxygen? Which is more efficent and costs less in the long run? Which ensures better patient outcomes? Nah forget that, which do people want to pay for is probably the more important question


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## EMDispatch

MrBrown said:


> Who do you think has to call for ALS (Intensive Care Paramedic) more often? Two Paramedics 300km from nowhere in Australia who have a wide selection of clinical dexterity including a range of IV drugs or some 100 hour wonder in the rural USA who can give oxygen?



Tisk, Tisk, Tisk...
Also an irrelevant argument, depending on significantly more factors than presented.

Also a point that bothers me, as I understand it from my Canadian counterparts at college, education systems are not all equal in terms of levels. This makes these sorts of arguments very murky, in my opinion. Not that I don't want more education in the US EMS system.


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## sihi

Dutch-EMT said:


> *Ambulancenurse*



Hi,

What do abulance nurce can do on the action? Can he/she intubate, can use anestetics, myorelaxants? Can nurse do cardioversion?


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## Dutch-EMT

sihi said:


> Hi,
> 
> What do abulance nurce can do on the action? Can he/she intubate, can use anestetics, myorelaxants? Can nurse do cardioversion?



Ambulancenurses can intubate, use analgetic drugs like fentanyl and ketamine, in a year denilox returns on the ambulances. 
Also skills like pacing, cardioversion, defibrillate can be done.


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## sihi

Dutch-EMT said:


> Ambulancenurses can intubate, use analgetic drugs like fentanyl and ketamine, in a year denilox returns on the ambulances.
> Also skills like pacing, cardioversion, defibrillate can be done.



It is great. Do you must work strongly  by algoritms or it is allowed to think?
For example patient with regular tachicardia 200 b/min, BP 90, chest pain - do you treat by algoritm or you can decide by yourself --> Amiodarone infusion/sedation and cardioversion?


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## Dutch-EMT

sihi said:


> It is great. Do you must work strongly  by algoritms or it is allowed to think?
> For example patient with regular tachicardia 200 b/min, BP 90, chest pain - do you treat by algoritm or you can decide by yourself --> Amiodarone infusion/sedation and cardioversion?



For each treatment is a protocol.
Protocols are based on rhytm:
Bradycardia, Small complex tachycardia or Wide complex tachycardia.
In the protocols is told wich medication  (yes, we use amiodarone) must be given.
Also treatment like sinus carotis massage and valsalva are in the protocols.


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## exodus

Old thread, but I'm hoping OP is subbed so he'll get an email.

I'm planning on relocating to hoogeveen next year after I get married to a citizen.  How hard are the ambulance driver jobs to get?  I'm also looking into volunteering as a branderweer.


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## Dutch-EMT

exodus said:


> Old thread, but I'm hoping OP is subbed so he'll get an email.
> 
> I'm planning on relocating to hoogeveen next year after I get married to a citizen.  How hard are the ambulance driver jobs to get?  I'm also looking into volunteering as a branderweer.




Those jobs are very hard to get.
But when you've experience in healthcare, C-drivers-licence and are first-aid certified, it can be possible. But it is still hard.
Voluntary fire departments are in some counties screaming for volunteers.
That will be easier.


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## exodus

Dutch-EMT said:


> Those jobs are very hard to get.
> But when you've experience in healthcare, C-drivers-licence and are first-aid certified, it can be possible. But it is still hard.
> Voluntary fire departments are in some counties screaming for volunteers.
> That will be easier.



Any clue what counties are wanting volunteers?  And it looks like there's a lot of openings, are there lots of spots, just hard to get into? -  http://www.vacatures.nl/ambulancechauffeur/


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## exodus

exodus said:


> Any clue what counties are wanting volunteers?  And it looks like there's a lot of openings, are there lots of spots, just hard to get into? -  http://www.vacatures.nl/ambulancechauffeur/



And I was talking to a family member-inlaw. They were saying a busy volunteer can bring in about 900 euro a month, is that true?


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## Dutch-EMT

Nah, i think thats not reality. 600 is a good month. And there will be months with 200...


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## exodus

Dutch-EMT said:


> Nah, i think thats not reality. 600 is a good month. And there will be months with 200...



900 did seem like a lot to me.


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## socalmedic

Exedus, my brother married a dutchie and it was a very long and complicated process for him to even get a work visa he finally gave up and she is moving here. you should investigate how hard it will be for you to immigrate to the netherlands, I know my brother has been married for two years (married in the netherlands BTW) and is still only allowed to be in the country for 6 months at a time and is required to maintain employment in the US.


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## exodus

socalmedic said:


> Exedus, my brother married a dutchie and it was a very long and complicated process for him to even get a work visa he finally gave up and she is moving here. you should investigate how hard it will be for you to immigrate to the netherlands, I know my brother has been married for two years (married in the netherlands BTW) and is still only allowed to be in the country for 6 months at a time and is required to maintain employment in the US.



I just found out my grandparents were born in and were citizens of ireland.  Therefore, I can get citizenship to IE by blood, I just have to register with foreign births. This puts me into the eu so I can live/travel/work in nl   Makes all this much easier!


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