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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?
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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).
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The most doctors and nurses are Public EMS employees in Spain. However, many EMT-B are sub-contracted by private companies
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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. [...]
Do you know if they recognize any training from other countries?
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- 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).
How is the status from Paramedics in Spain ?
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)
What is a average wage ?
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?
Sounds like y'all have a lot more doctors and nurses than we do...or some fairly deep trust issues.
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?
Sounds like y'all have a lot more doctors and nurses than we do...or some fairly deep trust issues.
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.
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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.
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).
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?
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.
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.