Today I had to opportunity to ride along with the Notarzt(in), the emergency medicine doctors. To those that don't know the EM system here in Germany is different than that of the US. There is no real emergency room as we have in the states. The EM doctors ride in their own car, and respond to accidents and calls.
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| Prepared in all my "Sicherheit Kleidung" (Safety clothes) |
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| Our Ride! |
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| Of course we ride only German made autos! |
Our first call was around 8:40a to a electrical accident at a manufacturing plant. The worker was on a ladder with a tool in one hand and moving wires in his other. Although we don't know the full details, as he was moving the wires an electrical shock of ~400V ran from one hand to the other. At this point he fell backward off the ladder (<10ft) onto the concrete ground. No one was a full witness to the event. The first response ambulance, fire department, and police was already on the scene when we arrived. We were a team of a Notaerztin (Female EM physician), a Rettungsdienst (EMT/Paramedic) and I. The scene was inside a manufacturing plant in an industrial park. The notarztin and myself went to see the patient, while the rettungsdienst followed behind with the equipment. With the sounds and smells of an active manufacturing plant roaring in the background, we quickly found the patient with a half-dozen people surrounding him. He was lying on his left side, and the first i quickly noticed was his black hands, particularly on his fingers. My immediate reaction was that this was a severe burn on his hands. However on closer inspection it was actually oil/grease. He did have what appeared to be a full thickness burn <1cm diameter one of his fingers, with another area on his other hand of similar size. He was awake, speech unimpaired, and had no signs of a heart arrhythmia on initial 3 lead EKG. Quickly asking the patient, he does remember exactly what happened as he was moving wires with his one hand and then felt a shock and woke up on the ground. Quickly working, a primary survey with head/neck immobilization was done. An IV was inserted and a small amount of midazolam was given. The patient didn't complain of any pain except his feet, but only with movement. As we were examining him, a friend of his walked up and they started speaking in French. With my 4 years of French from high-school, I could only understand that they were speaking French. After hooking him up to a larger EKG monitor, we got ready to transport him to the stretcher. Being at the head, I initiated the transfer. We used a contraption that I could only describe as a bean bag used in the operating theater. Basically it is a flexible bean bag that is in the form of a mattress. Once vacuumed of air, the mattress folds into whatever shape you make it, securing the patient. I have never seen these used in the field, but it seems like a great idea, as it allows it to act as a hard board, without being the straight hard board that typically is used.
After transfer to the ambulance, a secondary survey was done. I attempted to place an IV line into the forearm, but unfortunately was not successful. Rather than attempt once more, I asked for help from the Notaerztin. By this point, the adrenaline was rushing through my system. My hands were shaking. My heart and blood were pumping. I could basically feel my blood pressure working, and my kidneys filtering. Due to his continued agitation and complaints of pain, we gave him ketamine. That was an interesting idea, as he started to blabber even more. He started to talk about how he is German, his family is half german, and his has been working here for a long time. To me it sounded like a man high on drugs, which was exactly what it was.
After roaring through the streets of Heidelberg, we arrived at Heidelberg Chirurgische Klink in the Schockraum (Trauma room). There a team was waiting to receive the patient, and continue with his care. The Notaerztin presented the patient, and care was transferred to the receiving team. The surgical department continued with the examination of the body. Radiology did a fast ultrasound exam. Anesthesia inserted IV lines and handled the airway. Once sign-out was completed we proceded back to the vehicle to finish gathering our things and get ready for the next call.
We had a few more calls later that day; a question of seizures from a nursing home patient; an older gentleman with a history of COPD with progressive difficulty of breathing.
We even got a chance to see the "Notaufnahme" which is the emergency room at the Medizinische Klinik (Medical Hospital). It was a small room, with enough beds for 12 patients or so. It is usually handled by junior physicians with occasional oversight from an attending. According to my colleagues, when they built the hospital they forgot to account for the emergency room. This just displays how little importance is placed on a receiving emergency room. However the next surgery building, which should be built by 2018, will have a state of the art emergency room. Though it is hard to tell what that entails because the definition of emergency room ranges from hospital to hospital and region to region.
All in all my first experience was fantastic. Of course this is only an observation based upon a single experience, my take on having a physician on the scene of these cases was positive. I hope to learn more as time progresses.
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| Energy blast!!! |
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