Hello of an EMT from Paris, France !

[WelshMedic]

Perhaps mentioned on a different string, but if a medical need is there, but not requiring an ambulance, I know some jurisdictions (definitely NOT New York City) can and do send a wheelchair coach, here known as an ambulette, to effect transportation. WelshMedic, are you in one of those jurisdictions?

Hi Rich,

No, I don't work in any of those jurisdictions, I am on the other side of the Atlantic in the Netherlands. I can contact specialist cab companies that deal in wheelchair transport so I guess it's sort of the same thing.

Carl

[Richard B the EMT]

Carl, I'll be easy here. Per your statement, what I'd refer to as an ambulette company is apparently in contract, as a non emergent medical transfer/transport provider, with the medical portion of the Public Safety Answering Point, hence, it's an operating policy within your jurisdiction, and that is Kewl!

[Kiwiology]

Richard, we have the Sierra Project in New Zed where calls that are triaged as "green" (not urgent or life threatening) are going to be sent an alternate resource known as a Sierra unit which is a Paramedic or Intensive Care Paramedic in a jeep who can do more thorough assessment and refer them to an alternate health resource such as GP, medical centre etc

Calls triaged as "grey" (appropriate for telephone advice) will be transferred to HealthLine which is a nurse phone line.

This practice is very common in UK just slightly different.

The days of calling 111/999 etc and automatically being sent an ambulance are thoroughly over at least in some parts of the world.

[Richard B the EMT]

Kiwi, again, not available (yet?) in NYC, some communities in the US are moving some Paramedics to do just that sort of "community medicine". I like the concept, and, again wish they could or would start such here in NYC.

[fab]

Hey Fab,

In France it's 3 years to become a nurse, after that, depending on where you did your internships and where you work (once u get the diploma) you can choose almost any medical field to work in

I have friends who are now official nurses, I'll be happy to answer your questions if you have any.

Welshmedic: thanks! It will be very very difficult, no doubt!

I'd actually be more interested in hearing something about admission for medicine. Is it common to do one of the preparatory courses as it would be for other studies? Is it true that everyone with Bac S (?) gets a spot and filtering is done during the first year? Do you know anything about a programme in English? I'm also thinking about joining the military, even though I have already refused military service (conscription still in place here, well not anymore but 3 years ago...)

Good luck

Hello both,

I am indeed Welsh but I fell in love with a dutch girl and married her. That's how I ended up here. The road to ALS EMS here is indeed only accessible via the nursing route. It's basically nursing school to post graduate critical care qualification and then into EMS. The whole process takes about 6-7 years as we also like candidates to have experience in the critical care field.

I am currently doing a teaching degree (BEd.) in order to teach nursing and EMS at college. I also run the placement program for nursing and medical students so if you are looking to hear more then I'm your man! I can also arrange ride-alongs but you'd have travel a bit far....

Carl

Ja, I know a few dutch girls too, congratulations I'm guessing you worked in EMS before, (in Wales? had a Welsh teacher, interesting language) so did you get reciprocity? Which province do you work in? I'll probably be in Amsterdam for a few days in May or June and I'd be really interested to learn a bit more about your system.

[Secouriste]

In France too we have a very high level of education for our advanced responders who are actual physicians and nurses, and even surgeons now that we have the mobile ECMO unit

The job of the dispatcher is to assess the situation and send the required response. The problem of the seriousness of the calls isn't really an issue for the advanced response so much as it is for the first responders. The problem is that the dispatchers are now more and more afraid of prosecutions if they deny an ambulance. I know the SAMU dispatchers are keen on sending an ambulance only if really needed (otherwise they call a "city doctor" who will attend the patient's home within the hour). The Fire Dept. dispatcher are the opposite. They will deny he response only if there is really nothing relevant (eg: "My heating system stopped this morning").

I give you a blatant example: last week I attended a young woman who got her hand "burnt" by squirt of boiling oil. There was absolutely nothing to be seen. She had put her hand under tap water and called us. When we asked why she called, she said "Because I didn't know what to do..." Obviously she did because she had put her hand under water...

We reminded her of our real missions and then we wondered how the hell the dispatcher could send us on something like that...

So you see, the problem is more related to the EMT's rather than the advanced response. Why? Because to have a straight advanced unit, the situation has to be very clear and serious. Otherwise we get there first and we ask for the doc. And we better be right in our judgement, otherwise the doc will have no qualm about reminding us why he should come, or rather not come.

But of course it sometime happens that the advanced unit is called even if not really needed, because there is such a huge gap between the EMT and the physicians. For instance, a basic-LS ambulance of the fire dept. cannot transport a patient who's got an IV (from a doctor already on scene...) ... They have to call an advanced unit for transportation alone! Why? Because EMT's aren't meant to perform such gesture so they can't manage the patient once he's received the treatment.

We don't have such rules at the Civil Protection, but you see the issue.

In Germany, the EMT-B of volunteer units are trained to operate the Lifepack (ECG...) and the respirator. They can do it only on request (from a physician) and they cannot decide of any setting, BUT they're trusted to have the equipment (and not to use it outside the authorized situation) and operate it. In France, that could never happen. The day you put a respirator in a french BLS ambulance, you'll have a mob of angry nurses and physicians with pikes and torches at your doorstep.

Fab: The medical studies in France are quite special. Many student do what is called a "P0" ("year 0") during their last year of highschool, to get in touch with the subject they'll study the next year. It's a training that comes on top of your "baccalauréat" year. They do not do 1 or 2 year of "classe préparatoire" (preparatory course) like you would to get in an engineer school.

Basically all you need to get into mad school is the Bac, whatever the section (S, L, ES). YET at the end of the year you'll have an exam with a numerus closus that will allow only 10 to 20% of the student to pass on the next year. You can try twice, then you're done with med school.

The working conditions and the competition between the student make it very very hard for someone without strong wit to get through that dreaded first year.

I have tried to register for some med school in the UK but I'm afraid by academic background isn't good enough yet...

[WelshMedic]

In France too we have a very high level of education for our advanced responders who are actual physicians and nurses, and even surgeons now that we have the mobile ECMO unit

The job of the dispatcher is to assess the situation and send the required response. The problem of the seriousness of the calls isn't really an issue for the advanced response so much as it is for the first responders. The problem is that the dispatchers are now more and more afraid of prosecutions if they deny an ambulance. I know the SAMU dispatchers are keen on sending an ambulance only if really needed (otherwise they call a "city doctor" who will attend the patient's home within the hour). The Fire Dept. dispatcher are the opposite. They will deny he response only if there is really nothing relevant (eg: "My heating system stopped this morning").

I give you a blatant example: last week I attended a young woman who got her hand "burnt" by squirt of boiling oil. There was absolutely nothing to be seen. She had put her hand under tap water and called us. When we asked why she called, she said "Because I didn't know what to do..." Obviously she did because she had put her hand under water...

We reminded her of our real missions and then we wondered how the hell the dispatcher could send us on something like that...

So you see, the problem is more related to the EMT's rather than the advanced response. Why? Because to have a straight advanced unit, the situation has to be very clear and serious. Otherwise we get there first and we ask for the doc. And we better be right in our judgement, otherwise the doc will have no qualm about reminding us why he should come, or rather not come.

But of course it sometime happens that the advanced unit is called even if not really needed, because there is such a huge gap between the EMT and the physicians. For instance, a basic-LS ambulance of the fire dept. cannot transport a patient who's got an IV (from a doctor already on scene...) ... They have to call an advanced unit for transportation alone! Why? Because EMT's aren't meant to perform such gesture so they can't manage the patient once he's received the treatment.

We don't have such rules at the Civil Protection, but you see the issue.

In Germany, the EMT-B of volunteer units are trained to operate the Lifepack (ECG...) and the respirator. They can do it only on request (from a physician) and they cannot decide of any setting, BUT they're trusted to have the equipment (and not to use it outside the authorized situation) and operate it. In France, that could never happen. The day you put a respirator in a french BLS ambulance, you'll have a mob of angry nurses and physicians with pikes and torches at your doorstep.

Fab: The medical studies in France are quite special. Many student do what is called a "P0" ("year 0") during their last year of highschool, to get in touch with the subject they'll study the next year. It's a training that comes on top of your "baccalauréat" year. They do not do 1 or 2 year of "classe préparatoire" (preparatory course) like you would to get in an engineer school.

Basically all you need to get into mad school is the Bac, whatever the section (S, L, ES). YET at the end of the year you'll have an exam with a numerus closus that will allow only 10 to 20% of the student to pass on the next year. You can try twice, then you're done with med school.

The working conditions and the competition between the student make it very very hard for someone without strong wit to get through that dreaded first year.

I have tried to register for some med school in the UK but I'm afraid by academic background isn't good enough yet...

Secouriste.

I completely understand your situation. Considering your command of the english language, would it be an option to study medicine somewhere else in the world?

Carl

[Secouriste]

Well, that will be an option if I fail in France.

To be honest, remaining in France allow me to avoid a lot of administrative issues and also to immediately start the medical studies. The french studies are also very very good even if going through the first year is a real nightmare.

I have investigated the UK, the US, Canada, Belgium, Romania...

If I cannot become a doctor, I'll consider another career in health.

[Richard B the EMT]

Just throwing into the mix that a past partner on the FDNY EMS ambulance was from Haiti, and was, in Haiti, the equivelant of an American Physician's Assistant. He stayed at NY State EMT-B level, and not advance to Paramedic, by choice.

[Secouriste]

That reminds me of a colleague who worked in the french Sécurité Civile (part of the army specialized in heavy disaster relief, fire fighting...) who went to Haïti then. As someone trained in medical emergencies, he was given a role much more advanced than he had in France. He wasn't a physician nor a nurse, yet he was trained to help with a lot of medical procedures given the context.

Interesting to see that people's qualifications depend not only on their actual skills or studies but also a lot on the context...