EMS in Spain

[jlc]

First, they have to get a degree in medicine (6 years). Then, they have to approve the MIR exam to choose a medical specialty (4-6 years). In Spain there is not emergency specialty yet, so they can choose other specialties that perform in the ER: Internal Medicine, Family Medicine, Intensive Medicine...
Most of ER in Spain are managed by family doctors or Internal Medicine doctors because they spend several years of their specialty residency in ER.
The residents in Family Medicine work during their residency in several services: ER, Health Centers, Trauma and sometimes in the ambulance service (under supervision).

Most of EMS are public services in Spain. Here, a medical specialty is mandatory for all public service physicians (since 1995). So most of ambulance physicians have spent several years in an ER. Some of them have worked several weeks or months under supervision during their residency on an advanced ambulance.
There are anaesthesiologists and intensive medicine physicians in EMS ambulances too.

In several regions (like Madrid Autonomous Community) a 1-2 years Master in Emergency Medicine (with a practical period in ambulance service) is mandatory for ambulance physicians.

So, ambulance physician: 6 years (Degree in Medicine) + 4-6 years (medical specialty) and/or 1-2 years (master in emergency medicine)

The medical specialty is not mandatory in private companies, so the employer can hire a physician without medical specialty or without master degree, however they prefer to hire more experienced physicians (I suppose so). Anyway, most of EMS are public services instead of private services.

 

[VFlutter]

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?

Just because "y'all" are allowed to do a procedure does not mean that you should be allowed to do it....as far as crikes in the military it is only out of pure necessity and lack of more appropriate options.


Hmmm requiring providers to have quality advanced education before allowing them to perform invasive procedures. What a crazy concept. Blasphemy!!!!:blink:

 

[jlc]

Last June, the Spanish government approved a new royal decree RD 836/2012 that replaces a 1998 decree (RD 619/1998) . The main changes are as follows:

- According to the European Standard EN 1789 the types of road ambulances are:

• Type A: Patient Transport Ambulance (for the transport of patients who are not expected to become emergency patients).
  1. type A1: suitable for transport of single patient;
  2. type A2: suitable for transport of one or more patient(s) (on stretcher(s) and/or chair(s))
• Type B: Basic Life Support
  
• Type C: Advanced life support / mobile intensive care unit

- The road ambulances shall comply with the requirements of UNE -EN 1789 (Spanish Standard -UNE- based on European Standard).

- The minimum staff are:

• Type A: 1 or 2 technicians with a Professional Certificate or with an EMT-B (TES) certificate.
  The Professional certificate is a certificate for former employees who had worked some time before the new EMT-B certificate was adopted and have some experience and other certificates (Patient Transport Assistant, Ambulance Technician...).
  
• Type B: 2 EMT-B (TES: Técnico en Emergencias Sanitarias)
  
• Type C: 1 EMT-B/driver and 1 Emergency Nurse (and also a physician when the type of service so requires).

Until now, type A and type B staff was regulated by regional rules, so each region had their own requirements:"First Aid" course, "Patient Transport Assistant" course, "Patient Transport Technician" course, "Ambulance Technician" course... from 50 or 60 hours to more than 600 hours.

Some regions had ILS (Intermediate Life Support) Ambulances with a technician and a nurse. But according to the 1998 Decree, these ambulance were legally BLS ambulances (now, according the new decree, are ALS ambulances).

Since 2007 there is a national standard for all EMT-B: the TES certificate, a two years training course (vocational college).
Now TES is mandatory for all BLS ambulance new staff.

The technicians who are currently working in BLS ambulance (and don't have TES certificate) keep their jobs. But a TES certificate is mandatory for new employees.

Previously, ALS ambulances are staffed at least by an emergency physician, an emergency nurse and a technician/driver. Currently, only an emergency RN and a EMT-B/driver is mandatory for all ALS ambulances. A physician is optional, (mandatory only for severe emergencies).

 

[Jmurillo]

¡Información tan útil!

¡Hola! ¡Muchas gracias por tus mensajes!

Ahora estoy tomando la clase para ser un EMT-B, y lo que ha explicado es que quería saber, pero hay más, y por eso mis preguntas. En casi un año me voy a mudar (quizá definitivamente) a Barcelona. Al lado de estudiar para ser un EMT-B, estoy estudiante de prémedicos (y filosofía) aquí el los EEUU. Cuando me mudo seguiré con el graduo en medicina en la UPF (creo). Ahora quiero saber si puedo trabajar como un EMT-B en España con mi diploma de EMT-B de aquí. Ó si crees que no, ¿sabes donde puedo obtener lo que necesitaría?
Yo también voy a decir “lo siento“ porque mi español no es tan bueno, tampoco! Espero que puedas ayudarme! Muchas gracias, otra vez!

 

[jlc]

Ahora quiero saber si puedo trabajar como un EMT-B en España con mi diploma de EMT-B de aquí. Ó si crees que no, ¿sabes donde puedo obtener lo que necesitaría?

Hi,
You need to have your diploma validated by Education Department (Ministry of Education).
Until last year, there was not a national standard for EMTs, so each region (or each ambulance company) established its own rules. In some regions only a basic course from 40 to 300 hours (Red Cross courses or Private courses, not official courses) was mandatory for basic technicians. You didn't need to have a diploma validated by the Government. However, last year the Spanish Government approved the new decree, so TES certificate is mandatory for new employees.
TES (Técnico en Emergencias Sanitarias) certificate is a 2-years community college title. So you must go through the accreditation process.
Although that course has been taught since 2007 in several regions, there is a lack of technicians with this certificate, so many companies employ technicians without certificate (with former courses) for the moment. Some regions and voluntary ambulance organizations have request a moratorium (delay) for the new law and some changes.

About the title validation, visit the website of Spanish Ministry of Education (in Spanish):
- Puntos de información: http://www.mecd.gob.es/educacion-mecd/areas-educacion/sistema-educativo/convalidaciones/titulos-no-universitarios/puntos-informacion.html
- Normativa: http://www.mecd.gob.es/educacion-mecd/areas-educacion/sistema-educativo/convalidaciones/titulos-no-universitarios/normativa.html
- Títulos extranjeros susceptibles de homologación o convalidación: http://www.mecd.gob.es/educacion-me...os-no-universitarios/titulos-extranjeros.html

Browse through the web menu on the left, under "Títulos no universitarios": Solicitud, tasas, requisitos, documentos, etc.

Other way to gain a TES certificate (when you live here, in Spain):
- Take a 2 years course in a community (vocational) college: Institutos o Centros de Formación Profesional de Grado Medio.
- You can take the exams as a private candidate/external candidate (a person who enters an examination but is not enrolled as a student at the centre). Some schools teach theory subjects on line so you only need to attend to practical classes, exams and internship at an ambulance company.
If you are a medical student, maybe the center would recognize some of your subjects (anatomy, etc).

TES course subjects:
- Anatomy, physiology and patology (basic level)
- Initial Care in emergencies
- Special Care in emergencies
- Patient transport
- Logistic in emergencies
- Mechanical maintenance of the vehicle
- Psychological support
- Emergency plans and prevention
- Tele-emergencies (emergency dispatch)
- Entrepreneurship
- Career counseling
- Internship at ambulance companies
(some centers can add some subjects like English, etc)

When you gain your physician degree you would work as an ambulance physician (maybe you'll need a master degree or a specialty). Remember that in Spain only nurses and physicians are able to perform advanced support (all ALS ambulances have, at least, an emergency nurse or an emergency nurse and an emergency physician).

Good luck!

What's UPF?? Universidad Pompeu Fabra?

 

[Jmurillo]

Great!

Wow! Thank you so much! That was all great information! (As your English is really good, I'll just write in English to spare my self some time today!)

I will be going in about a year, so I'm guessing that by then, most companies will be hiring people that have a 2-year TES degree. That's good to know though! This way I can start planning to take that course.

Do you think that experience (hopefully by the time I get to BCN I'll have worked about 8months as an EMT-B) counts towards any adjustment in the validation of my degree by the ministry of education? I will definitely take a look at those sites and email around to see what I need to do.

Yes, UPF is la universitat pompeu fabra

Thanks so much for the great information!!

 

[jlc]

Do you think that experience (hopefully by the time I get to BCN I'll have worked about 8months as an EMT-B) counts towards any adjustment in the validation of my degree by the ministry of education?

I think that the validation of a degree by the ministry only refers an academic validation (studies, not experience). But I don't sure about that.

However, I suppose that the vocational center (Instituto de Formación Profesional) can validate your experience so you don't need to take the internship in an ambulance company.

In fact, former technicians that are taking that certificate don't need to take the internship.

 

[Jmurillo]

I think that the validation of a degree by the ministry only refers an academic validation (studies, not experience). But I don't sure about that.

However, I suppose that the vocational center (Instituto de Formación Profesional) can validate your experience so you don't need to take the internship in an ambulance company.

In fact, former technicians that are taking that certificate don't need to take the internship.

Wonderful! This all sounds great! Thanks again for all this information! I really appreciate it!

Is it unheard of for med-students to work in general or as something more intense like an EMS responder, in Spain?

 

[jlc]

Is it unheard of for med-students to work in general or as something more intense like an EMS responder, in Spain?

Most university students do not work because studies require full dedication. However I know some students who are working while studying. Some work in part-time jobs (waiters at fast-food restaurants or weekend-bars/pubs, doorman at discos,..), and I know an EMS nurse who is a medical student, too.

When I was a nursing student at university, I worked as an ambulance technician/driver. However I was so lucky to have a good boss and colleagues (to change shifts).

Furthermore, you can study as a part-time student and take fewer credits per year, too.

 

[Jmurillo]

Most university students do not work because studies require full dedication. However I know some students who are working while studying. Some work in part-time jobs (waiters at fast-food restaurants or weekend-bars/pubs, doorman at discos,..), and I know an EMS nurse who is a medical student, too.

When I was a nursing student at university, I worked as an ambulance technician/driver. However I was so lucky to have a good boss and colleagues (to change shifts).

Furthermore, you can study as a part-time student and take fewer credits per year, too.

Okay! That looks hopeful! Thank you for all the time and effort you've put into answering my questions! I really appreciate it!

Que te vaya bien!

 

[jlc]

You're welcome!

 

[Tom Gural]

Greetings from Spain!

About Spain:
Spain is a member of the European Union located in southwestern Europe. In 2008 the population of Spain officially reached 46 million people. Its total area is 504,782 km2 (194,897 sq mi). According to the World Bank, Spain’s economy is the ninth largest worldwide and the fifth largest in Europe. (wikipedia )

EMS:
There are 17 autonomous communities (autonomous regions) in Spain (like states in USA). Each region has their own Public Health Service (with hospitals, health centers and regional EMS). So there are 17 regional public EMS (they depend of the Regional Government). Furthermore, some cities has a local EMS (it depends of the city council), and some Fire Department has ambulance service too.
In addition, there are non profit organizations like Red Cross or DYA who provide BLS ambulances (rarely ALS ambulances) with volunteers for special situations (music or sport events, support to public EMS,…). There are more private companies too.
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).

Emergency dial: 112
The emergency dial is 112 in all regions, but in many regions, each agency have their own dial too (national police: 091, local police: 092, firefighters: 080, EMS: 061…). So in some regions, the 112 dispatchers send the ambulance (or the firefighter engine, or the police car…), but in others the 112 dispatcher call the 061 dispatcher (or the 080 dispatcher, or the 092 dispatcher,…), and then this sends the ambulance (firefighter engine, police car,…).

There are diferent kinds of ambulance:
- 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)

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).
- Nurse (Enfermero): University degree (3 years until 2009, now 4 years). In some regions nurses need a Master in Emergency Nursing (or experience in ER, ICU,…) for EMS jobs.
- Doctor (médico or doctor): University degree (6 years). If they want to work for the public health service they need to be a Specialist (4-5 years more: Intensive Care Medicine, Family Medicine, Anesthesiology, Cardiology…)
- Volunteers (voluntarios): Red Cross, DYA, Civil Defense… Courses from 40 to 300 hours (first aids, patient transport assistant, life guard,…)

Non-assistant/non-emergency ambulance/patients transports (private company):

Red Cross- BLS Ambulances (Volunteers):

BLS ambulance (061 Aragón: EMS - Autonomous Community of Aragon):

ILS Ambulance (SUC: EMS - Autonomous Community of Canary Islands):

Sorce:http://sanitarizada.blogspot.com

ILS Ambulance (Emergencias Osakidetza: EMS - Autonomous Community of Vasque Country):

Source: http://www.e-mergencia.com

ALS Ambulance and HEMS (SUMMA 112: EMS- Autonomous Community of Madrid):

ALS Team (GUETS SESCAM 112: EMS -Autonomous Community of Castilla-La Mancha):

Source: http://ucienf.blogspot.com

ALS Team (SAMUR - EMS City Council of Madrid):

ALS Ambulance (SAMU Asturias: EMS - Autonomous Community of Asturias):

ALS Ambulance (Bomberos Navarra: EMS - Fire Department, Autonomous Community of Navarre):

Rapid Response Unit -VIR- (SUMMA 112 Madrid):

HEMS (Emergencias SACYL 112: EMS - Autonomous Community of Castilla-León):

Dear JLC,

Thanks for this interesting post. I am wondering if you could help me. I am temporarily in Madrid for half a year - working as and engineer. On the other hand I am also a paramedic with 7 years of experinece in ALS ambulance in Poland. Is there any chance to get on the an ambulance in Madrid as a volunteer during this time?

 

[UVAEMTB]

Dear JLC,

Thanks for this interesting post. I am wondering if you could help me. I am temporarily in Madrid for half a year - working as and engineer. On the other hand I am also a paramedic with 7 years of experinece in ALS ambulance in Poland. Is there any chance to get on the an ambulance in Madrid as a volunteer during this time?

Did you ever find work as an EMT in Madrid?
I'm an EMT-B looking for a paid internship in Spain. I'd *love* to work as an EMT in Spain. My Spanish is fairly solid; I'd also bring a bachelor's degree and 4 years of experience on Rescue Squad in a small city.
Do you have any suggestions regarding where to begin searching?

 

[ffemt8978]

Closed for bump and new thread already started.