EMS in Spain

[JeffDHMC]

Spain, just about my favorite place in the world.

Jeff

 

[llavero]

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

 

[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

 

[jlc]

Hi Thomas!

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:.

[...]
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,...).

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

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

[...]

- 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/

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).

• - 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)

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]​

 

[HMartinho]

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

 

[RocketMedic]

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]

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]

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]

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]

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:

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).

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.

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]

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]

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]

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]

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?