# Another German guy...



## Dr.T (Jan 28, 2011)

Hey guys!
I'm a probie here and would like to introduce myself.

I'm Christian, 28, from Bonn, Germany!
I spent my senior year in a private Alabama highschool.
Maybe that's why my English should'nt be too bad 
I currently attend medical school to become a M.D.
I've been a Rettungsassistent (s.th. between EMT-B and EMT-P) since I was 20 y.o. 
It's the highest EMS qualification you can get over here, but we're not to happy with the term "-assistent" which means - yea, you guessed right - assistant.
When the term came up in the late 80's, the Rettungsassistent was merely considered a "doctor's help" in EMS.
Yes, we do have doctors in EMS, they are all emergency physicians (mostly anaesthesists w/special qualification).
We do not have them with us on all calls, though. We can radio for a doctor if we need certain procedures done or if the patient is really unstable.
Still in 80+ % we work by ourselves.
I think it's great to have the possibility to call for "backup" when things get tough.
On the other hand, many invasive procedures are reserved for the doctors.
According to protocol at my EMS company (small rural town near Bonn) non-doctors (that's us!) are allowed the following ALS procedures:

-i.v. stick + ringer's
-i.v. glucose 10%
-GTN spray
-salbutamol inhaler
-salbutamol nebulizer
-diazepam rectal tube(ped)
-lorazepam s.l. (epileptic fit)
-lasix i.v.
-epinephrine i.v. (CPR or anaphylactic)
-metamizol i.v.
-laryngeal tube (LT-D)
-oral e.t. intub w/o meds (basically CPR only)

We would love to have a more efficient analgesic besides metamizol, but I don't think that's gonna happen any time soon.
Also we are not allowed i.o. access, which sometimes is a shame.
But that's the way it is... <_<

Anyways, I'm looking forward to sharing experiences with you guys.
If anyone would like to learn more about stuff over here, feel free to post 

Christian


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## Dr.T (Jan 28, 2011)

Here's an example of a typical german type c ambulance.






Note the interior. German ambulances all have emergency respirators ("Medumat" above the LP12)
The stretchers are all roll-in type by either Ferno, Stryker or Stollenwerk (Cologne). Stretchers are mostly fastened on a ramp/tray which can be moved hydraulicaly to all different positions (e.g. legs up, head up etc.).
Ambulance safety is a big issue here, so every piece of equipment on the rig must withstand a force of at least 10G in every direction to meet the high crash safety standards.
Also, employee's safety is important.
That's why we wear reflective clothing (bright orange or yellow)
Examples:


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## usafmedic45 (Jan 28, 2011)

Welcome to the forums.  I've got a great deal of interest for the German EMS system since I'm studying German language as part of my undergraduate studies and part of my family is originally from Germany (Halle specifically) originally.


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## 8jimi8 (Jan 28, 2011)

Welcome.

I noticed that the title on the back of the picture of the "assistant" is different than what you posted, what does this other word mean?


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## Tanker299 (Jan 28, 2011)

8jimi8 said:


> Welcome.
> 
> I noticed that the title on the back of the picture of the "assistant" is different than what you posted, what does this other word mean?


 
Literal translation, "Rescue Service", comprised of two words, "Rettungs" = Rescue and "Dienst" = Service.
Akin to stating EMS in the back of someone's jacket.

P.S. I am not German but after 13 years there I managed to learn the lingo.

First word that gave me a seizure: *Bundesgesundheitminister*, that's three words that esentially mean Surgeon General, or, Federal Health Minister 

Ja?

:blush:


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## Dr.T (Jan 28, 2011)

Hey Tanker!
That is a good translation and well explained!
Were did you live during those 13yrs. over here?

To the others: "Rettungsdienst" is a protected term for all public EMS in Germany. It is usually worn across the back of the jacket 
Private companies have to use "Notfallrettung" instead, which literally means "emergency rescue".
The term "rescue" in this context should not be confused with what rescue means to you (technical rescue, mv rescue, etc.)
Rescue (German: "Rettung") here is considered any form of saving somebody's life, be that in a medical way or saving him from drowning, out of a burning car, etc., etc........

In contrast to the U.S. EMS, German EMS is mostly not provided by private companies, but by mostly public services: counties and cities assign EMS to different organizations.
Mainly in the West of Germany, EMS is provided by the fire departments, while in the South the German Red Cross (DRK) ist the biggest EMS authority.
But the other big aid organizations, the "Malteser", the "Johanniter" (equivalent to St.John's in UK) and the "Samariter" are also widespread EMS providers. Private companies are rarely involved in 911 (or should I say 112) EMS but mostly transport only...

Need to know more?
I'll be glad to post more info or pics......

Bis bald!
Christian


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## byoung57 (Feb 20, 2011)

Very impressive.  It looks like you have lots of room to work.  Do you have some type of restraint system for the medic in the back to protect them in case of a sudden stop?

Bill


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## MrBrown (Feb 20, 2011)

Oh Brown loves the Germans, they are so highly efficient whether waging Blitzkrieg, hosting Oktoberfest or providing emergency medical care!

It sounds like your at the level of our Paramedic +/- one or two things.  We also have Intensive Care Paramedics who in the last 20 years have mostly replaced Doctors on scene here although we do still have a small group of Doctors who respond on behalf of the ambulance service, mostly to provide ALS in rural areas much faster than a ground unit is able to.

Anyway here in New Zealand its like this, 

*Paramedic* (three year Degree)
OPA, NPA, LMA, oxygen, entonox, methoxyflurane, paracetamol, aspirin, GTN spray, salbutamol, IM glucagon, oral glucose, ondansetron, IV cannulation, IV fluid administration, adrenaline, morphine, naloxone, cardioversion, manual defibrillation, 12 lead ECG interpretation.

*Intensive Care Paramedic*
All of the above + endotracheal intubation, cricothyrotomy, atropine, pacing, ketamine, midazolam, amiodarone, frusemide, intraosseous, chest decompression, rapid sequence intubation (select Officers only)


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## Dr.T (Feb 21, 2011)

@byoung57

Yes, of course we do.
All seats in the rear have the same 3-point seat belts as the seats in front.
In fact, they can swivel in any direction so you can actually remain restrained during patient care if necessary.

@MrBrown

Thanks for your compliments on efficiency 
Unfortunately we do not have entonox or any other inhalant.
We would love to be allowed ketamine + midazolam, because that is what's most used by EMS docs over here...
The problem is, the doctors don't want to be excluded out of EMS care, and unfortunately they are the ones who decide about our protocols.
So they simply won't allow us certain things to make themselves "irreplaceable"..... :wacko:


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## MEDIC802 (Feb 22, 2011)

Glad to see someone with ties to the state of Alabama, what part of the state and where did you go to school.


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## lampnyter (Feb 22, 2011)

Your trucks look really nice! They seem extremely roomy.


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## Dr.T (Feb 23, 2011)

@MEDIC802

Graduated from WCA in Huntsville, AL...
You from Alabama?
Kinda learned to love the south, despite all those radical baptist folks  No offense!
I still have contact with my host family from time to time.
"Dad" was a retired USN, "Mom" former CIA h34r: now also retired.
Would love to go there again some day *sigh*

@lampnyter

Yup, them boxes have plenty of room for hysterical family members and other important stuff :wacko:


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## tao (Feb 23, 2011)

What sort of education is required in Germany to be involved in EMS?  Do you require a college education like other European systems or is it military-style technician training like the US?  (Though most medics around here have a two-year degree)


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## Dr.T (Feb 24, 2011)

To be the driver you have to be Rettungssanitäter (RS), which is a 3 month training at an EMS college with an oral, written and practical test in the end.

To do patient care (ride in the back) you have to be Rettungsassistent (RA), which used to be a 2-year EMS college education. But it is slowly being changed into a 3-year term now.
It ends with oral, written and practical exam.

Most RAs start with becoming an RS, gain some experience and then upgrade to RA...


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## medicRob (Feb 24, 2011)

Welcome.


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## Bon-Tech (Feb 25, 2011)

Great info, keep it coming!


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## Dr.T (Mar 4, 2011)

Bon-Tech said:


> Great info, keep it coming!



Anything particular you guys are interested in???


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## MrBrown (Mar 4, 2011)

How do standing orders or delegated authority work in Germany eg under what framework can you administer controlled or prescription only medications and perform clinical procedures eg IV cannulation?


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## Dr.T (Mar 4, 2011)

@MrBrown:

Best question to ask as this is the most discussed issue among ems workers here.

As I have written before, emergency doctors set up our protocols.
The medical supervisor of the county where I work has set strict standards for invasive procedures such as med administration or iv's.
In German EMS all invasive medical procedures are "doctors only" procedures by law!
Thus, before performing any of these as a non-doctor, an emergency doctor ("Notarzt") must be called in excl: not in all of Germany, but it is pretty much the standard in most places here :sad
After the doctor's response vehicle (NEF) has been radioed for, we have the authority to perfom the procedures referred to in my 1st post, until the doctor arrives and takes over patient care.
This authority is called "Notkompetenz" (could be translated: "hardship authority").
To gain these authorities, county paramedics have to go to a 30 hour class every year. It ends with a written and a practical test of all procedures and is certified for one year.
Again, other places may have different rules and regulations.....


As the paramedic education and the EMS laws (yes, we do have actual federal and state EMS laws!) are slowly undergoing changes, EMS workers here are hoping for a change and the introduction of the "Regelkompetenz" (regular authority) which would legalize invasive procedures to paramedics by law and render the doc call obsolete (at least for most cases)

But until then, myself will only be allowed to stick the i.v. into the patient when the NEF is en route....


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## MrBrown (Mar 4, 2011)

Sounds interesting, is a NEF dispatched automatically with an ambulance for certian kinds of calls to 112- eg say cardiac arrest, cardiac chest pain, resipiratory distress etc?

We would dispatch a regular ambulance (which most likely has two Paramedics - see my post above) in it but if its an actual or possible life threat we send an Intensive Care Paramedic as well.

Brown hopes a NEF comes along when Brown has too much barvarian sausage and larger at the Oktoberfest, Oktoberfest das gut ja!


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## Dr.T (Mar 4, 2011)

@MrBrown:
Well, I have to admit, I have never been to Oktoberfest :unsure:
Shame on me....

As for your question:

Yes, NEFs are automatically dispatched to certain emergencies as you've already guessed above. There are certain lists according to which dispatchers send the adequate vehicles.


@all:
BTW: We distiguish between three types of EMS vehicles:

NEF (Notarzt-Einsatz-Fahrzeug): doctor's response vehicle

RTW (Rettungs-Transport-Wagen): ALS unit w/1 Rettungsassistent minimum

KTW (Kranken-Transport-Wagen): BLS unit (transport and minor stuff)

In some areas there is also the NAW (Notarzt-Wagen) which is basically an ALS box ambulance with a doctor on board. Some counties have special pediatric NAWs with a pediatrician or neonatologist on board.


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## Dr.T (Mar 7, 2011)

If anyone would like to get a little impression: 

http://www.youtube.com/watch?v=-OuXO8k0oJM

No interesting cases, though :sad:

1. dog bite to K9 police officer
2. unstoppable nosebleed

Sorry, all in German, but just let the pictures give you a general idea....


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