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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...

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...

What about all indications written in the protocols?

pleuritic chestpain is related with the breathing, breathing in and out causes pain. Fever, pain while palpating, Painfull coughing. I think it is difficult to make a good diagnosis in the field. Chestpain can be AMI, pulmonary embolis, Gastritis, oesophagitis, pneumonia, etc. A lot of options.

Thinking about this subject about ALS or not ALS... Isn't it stupid that there are differences in BLS, ILS or ALS calls? Why not draw a line like this: Interclinical transport, discharge transports: BLS ambulances All 911 calls: ALS ambulances

Well, reading another thread (about a broken arm is an ALS call), i think the system can be more efficient. Sending ambulance to an broken arm? come on!!! You think this really needs an ambulance? When responding to all kind of that sort of calls, you need a lot ambulances and first responding...

Diclofenac i.m. works perfect at a 75milligram dose. this in combination with paracetamol can help. We always try oral meds in our hospital: We mostly use paracetamol 1000mg and diclofenac 50mg mostly together. This in combination with tramadol 50mg or oxycodon 10mg. Well, in the Netherlands...

Well, what about a coldpack or something the patiënt has in his freezer for cooling. Let the patient lie down on the stretcher with the painfull leg above. This in combination with a pain-drug? Isn't there any med in your kit like a NSAID? Paracetamol/Perfalgan?

The dispatchers are mostly (former) ambulancenurses, (former) ambulancedrivers or former ER/CCU/ICU-nurses. They have authority to triage over the phone and can deny the caller an assessment by ambulance-crew.

Well, I can tell you that the ambulances don't show up for only a broken arm in the Netherlands. (Only when an ambulance is dispatched to an accident on the streets (by emergency call), an broken arm will be seen by the ambulancecrew.) A broken arm isn't life-threatening and the dispatcher will...

It's not always correct, but we use it as guide in the field when no equipment for BP is available. When not feeling it, the patiënt can have a good pressure (v. radialis can be located deeper or when people are overweight). When feeling radial pulse, it is plausible to say systolic BP is >80mmHg

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.

But when talking about money... It is a lot cheaper to have an ambulance with an ambulancecrew than have a large fire engine with a couple firefighters... I mean: an ambulance, completely equiped costs about €150.000,= MAX! An fire engine costs €1.000.000,= minimum! When EMS is in the FD...

I think in many other countries outside US there is enough proof that FF and EMS can be split in two different professions. Well, i'll take the Dutch system for example again :wacko:... Only towns and cities with a higher residence than 70000 have a professional fire department. That means that...

Yup... Got only 3 lead?

Big differences i'm reading here. Not to offend the fire fighters, but when I'm looking at working with sick or wounded patiënts vs fighting fires, cutting cars and do other technical work, i see two different specialities. That's why in Europe the EMS and FireDepts are two different...

When i look at series like paramedics, I see even by a "chestpain" call a fire truck at the scene. Here (in the Netherlands) a fire truck only responds to medical calls when there is a resuscitation goïng on. In the cities with professional fire fighters the crew drives out at each of these...

Looking at the P waves, they look multiform. Also the baseline is very freakish. The P waves are followed by a QRS complex. Also P-Q is >0,2 sec. QRS shows in one lead a R-R1. But the complex isn't wider than 0,12msec. But i'm missing the 12 leads.

With that i fully agree! It's a disaster for a vein. Ofcourse we use glucagon as well... When leaving a patiënt at home, always the GP will be called to see his patiënt and deal with the care after the ambulance-care

Glucose 10%? Why not glucose 50% 20cc i.v.? When effect is zero, than again 20cc glucose 50% i.v. After giving glucose flush with NaCl 0,9% 5cc. effect within a couple minutes. In Netherlands all ambulances have glucose 50% in 50cc bottles.