Florian Breitenbach

Rettungsdienst und mehr

Learning styles

A post provoked by uni studies and listening to podcasts. I wanted to post this on the facebook wall of the EMS EduCast, but it wouldn’t let me. So I decided to publish it here!

Hello EMS EduCasters,
In one of your episode you mentioned different styles of learners. It reminded me of an EM Crit podcast (Weingart, 2013), where a study by Pashier, McDaniel, Rohrer & Bjork (2008) is brought up. The authors conclude after their experimental trial that the concept of different learning styles doesn’t exist in such a way that common knowledge may have led one to believe. Weingart bluntly puts it in his recording that there is no such thing as an audio or a visual learner, and that books are hard to read for a reason – because study is difficult!.

I believe he makes a good point. I like to watch a video and listen to podcasts, and sometimes shy away from reading the hard stuff – but at the end of the day, reading gets you through a lot more information, but it is hard work. A mix of all ways of parting information is ideal in my opinion.

What does everybody think – are you surprised? I was initially, as I just took what I had heard about different learning styles for the bare truth, without having any credible sources to back me up.

Keep up the good work, and autumnly (chilly) greetings from London, UK,




Pashier, H., McDaniel, M., Rohrer, D., & Bjork, R. (2008). Learning Styles: Concepts and Evidence. Psychological Science in the Public Interest December 2008 vol. 9 no. 3 105-119, doi: 10.1111/j.1539-6053.2009.01038.x

Weingart, S. (2013). Podcast 105: The Path to Insanity. Retrieved from

Museum: Anaesthesia Heritage Centre, London

Semester is over. It’s been a particularly hard slog. What better way to sit back on the couch with some chips and an episode of Top Gear? That was last night. Can’t stay indoors all day, especially when its 20 degrees (Celsius, for everyone in the US) and a beautifully sunny day in London! So I continued on my “Museum Mission”, aiming to visit all of London’s Museums of Health & Medicine.

Today, I visited the Association of Anaesthetists of Great Britain and Ireland (AAGBI) – more specifically, the Anaesthesia Heritage Centre. A small museum, nonetheless with some interesting exhibitions and very friendly and helpful staff.

As George Santayana wrote over a hundred years ago:

Those who cannot remember the past are condemned to repeat it.

In other words: learn from the past. And we may as well learn from other peoples pasts while we’re at it. Apart from all the early forms of pain management (and their abuse), airway management and tools, one single thing struck me on this visit: Anaesthesia was initially poorly regarded amongst the medical profession for the first decades since its modern inception in the 1840s. Until 1935, when the Diploma of Anaesthetics was introduced, there was not even a formal way of qualifying as an Anaesthesiologist; indeed, many people who stated they were specialists in the field were ‘optimistic novices’, as Henry Featherstone, the founder of the AAGBI (in 1932) was quoted.

How do you regard the field of Anaesthetics today? Quite a complex and respectable part of medicine, I would hazard a guess.

If modern anaesthesia only began in the 1840s, that makes the entire (sub)profession approximately 170 years old. In the 1930s, when training became formalised and the AAGBI was founded to support its cause and standing, the profession had been around for around 90 years.

Let’s switch over to what this blog is all about: The wonderful world of Paramedicine. Although the concept of out of hospital care dates back to Dominique Jean Larrey in the Napoleonic Wars (around the 19th century), the first modern on road paramedics were trained in the early 1970s. That makes our profession less than 50 years old. And boy, don’t we have similar issues around the world: poorly regarded amongst other health professionals (and governments), and still some ‘optimistic novices’, amongst the unregulated profession. Sure, this was a generalisation, but parts of it are true in very many services – dig deep enough and I’m sure you will find evidence of it near you.

“So what?” I hear you say, “Time will sort it out!”. Well, time and a fair bit of effort – remember to support your profession, and the best way of doing that is by joining your professional body.

I’ll leave you with my favourite display item, a resuscitator from the 1960s. See if you can identify similarities and differences to our commonly used Bag Valve Mask from today!



Instructions for Use.

  1. Lay the patient on his back.
  2. With a finger covered with a handkerchief clear his mouth and throat of mucus and any foreign matter
  3. Kneel or stand behind his head, place the face mask on his face with the lower rim under his chin so that his jaw is lifted up. This is important.
  4. Work the bellows steadily at about 16 strokes a minute. The thrust of the bellows should be upwards on his face so that his jaw is kept up.
  5. Watch the patient’s chest. It should rise with each down stroke of the bellows and fall during each up stroke.
  6. After about every 50 strokes of the bellows, clear the patients mouth and throat of mucus with a finger covered in a handkerchief.
  7. Continue resuscitation until the patient breathes naturally, or for at least 2 hours.

The Paramedic’s ABC

The Paramedic’s ABC has launched, a website promoting discussion and knowledge amongst Paramedics and interprofessional colleagues.

And we want YOU!

Join us at The PAD. Our very first discussion topic will be on Cardiac Arrest, on Sunday 1900hrs GMT (London) on twitter with the #ParamedicABC hashtag.

Check it out now:

Well hello!

Hope your new year has kicked off well. Been a little quiet in the republic here – I’ve been diverting most of my online brain to a new project: The Paramedic’s ABC.


A website to bring professionals together with the goal of advancing the profession, through discussions and a dedicated knowledge repository.

Launch is this coming Sunday, 1000hrs GMT.

You can keep up to date on Twitter or Facebook.

Emergency Services Show 2012, part II

Whilst gear is cool, it’s the networking that adds the heart and soul to these events. Meeting a bunch of enthusiastic and like-minded people in a country far far (or not so far, depending on your definition) away from home was invigorating and exciting. I’d been in touch with a couple of people virtually but had never actually met them in person before – what a better event to change this?

The first day I met up with Matthew Harris who runs HarrisCPD – a great site (not only for UK Paramedics) to keep on top of the fast evolving field of paramedicine. We explored the halls together for the day, chatted about a few different ideas and thoughts about the current paramedic environment in the UK, and Matthew even managed to sneak me in to his live podcasting of the event! Listen to it here. It was great to have someone to wander around and chat with, gave the whole day a much more relaxed and friendly atmosphere.

Unfortunately Matthew could only come for the one day, but not to worry, there were still plenty of people and stands to visit, for example the College of Paramedics (read their review of the show here). I was also very excited to finally meet TJ (aka @meditude) in person, who then promptly ran away (maybe I should have combed my hair differently? Did I brush my teeth properly?). Alas, no, he was just off to give a lecture on Mental Health from a paramedics perspective, which brings us nicely to the Continuing Professional Development seminars:

Both the College of Paramedics and PhysioControl offered some very interesting (and well attended) CPD events both days. I attended the following (with some key points of interest)

  • Mental Health for Paramedic Professionals: Not much training is provided to deal with patient suffering with mental health issues. Yet it is estimated that 10-20% of all calls in the UK have a component of mental health. A novel idea was proposed by TJ, the presenter: Specialist Mental Health Paramedics. We already have Paramedic Practitioners, Critical Care Paramedics – why not specialise in Mental Health? Some rudimentary calculations and thoughts from yours truly: Critical Care Paramedics are sent to really sick patients, but the call volume equates to approximately 2-3% of all calls. Given that mental health takes up a much larger chunk of call volume – surely one could argue a decent case for the introduction of such specialists? I think a trial is needed.
  • Management of Minor Injuries: Presented by a long time Paramedic Practitioner (PP), an overview was given how PP’s have positively influenced healthcare in the UK. An interesting point made was to leave the patient with enough information if they are not conveyed to hospital – enter the Patient Information Leaflets (these are from the South West Ambulance Service). Great idea!
  • Emergency Childbirth: A situation I’ve been in a couple of times, and a situation I dread again, again and again. I just don’t like it…but that doesn’t help, I need to keep refreshing my mind just in case I come in to such a situation again. Initially the course was cancelled as the midwife couldn’t make it – but then luckily last minute a Paramedic turned up and volunteered to fill in, as she had been a midwife in her previous career. Thank you!
  • Dr Richar Lyon talked about Improving outcome from OHCA: The TOPCAT 2 project – the video is from Resuscitation 2012 on Vimeo. Watch the video, it’s very interesting what one can achieve by analysing the data, getting a structure and education framework in place to then achieve some really good improved results.
  • Mark Whitbread, Consultant Paramedic with the London Ambulance Service (LAS), talked about 12 lead ECGs. Not my strongpoint, but the way he explained it de-mystified the whole approach nearly instantaneously. Impressive. Mark is also the man behind implementing true STEMI care within the LAS, a short video can be seen here.

Emergency Services Show 2012, part I

Well, I was going to present you with these three posts shortly after the actual event, but instead found myself in hospital. Please send your disappointments and hatemail to Mr In.fectious Mononucleosis, 16 Swollen Tonsil Street, Throatland.

Last Wednesday and Thursday (22nd and 23rd of November 2012) I went to the annual Emergency Services Show in Coventry, West Midlands, UK.

Impressions as a first time visitor? Quite large, mainly geared towards fire and rescue services (a lot of big red trucks and fire retardant clothing, but together with law enforcement products there was a not insignificant amount of Paramedic and healthcare-related stands.

Here are some interesting products I came across. For the record: I don’t take any money from anyone, everything showcased here are goods and inventions that I found interesting, listed in alphabetical order:

  • The Corpuls 3 monitor sports an interesting concept: it can be broken up in to three parts, namely the monitor, the cable module and the defib module – all linked via Bluetooth. Apparently great when carrying patients down stairs, I’d want to try the system out for myself. Corpuls isn’t a well known brand in the English speaking world (yet?), but is widely established in the German part of the world – the current ambulances in Frankfurt/Main (where I started my EMS experience as a volunteer) has them, and seem to be happy with them.
  • Jones & Bartlett Learning: A new “Emergency Care in the Streets” from Nancy Caroline is supposed to come out next year. They have also taken over the publishing for the UK national JRCALC guidelines, due to come out February 2013. A variety of interesting books, presented with smile. Remember, College of Paramedics members receive discounts!
  • Prometheus Medical Ltd has a new SPHERe (Specialist Pre-Hospital Emergency Resuscitation Course) on offer, based on structured information gained whilst analysing, structuring and vastly improving cardiac arrest outcome in the Edinburgh/Scotland area (more on this on the CPD post shortly)
  • The UK Home Office Centre for Applied Science and Technology (CAST) had a stand too – interesting to know how the government is involved (not having lived in the UK before), and how they help out the emergency Services. For example, it was explained to me all emergency vehicles are checked by them for electrical interference (radios etc). There’s much more to it though, check out their website.

Unfortunately, the stands of JESIP (Joint Emergency Services Interoperability Programme), and the AACE (Association of Ambulance Chief Executives) were unmanned when I walked past. I looked around for anyone in the know, but no show. Disappointing, but there were some brochures with weblinks for more info. Remember, I’m new to the UK, a show like this is a great way to get to know how everything works, and what governing and advisory bodies are in place. An unattended stand (without even a notice) is a bit of a let down, and doesn’t convey a good message.

There was obviously much more stuff at the show, but many of the details unfortunately got lost as my virus started attacking me the minute I was on the train home. To find out more? You’ll just have to come next year!

In the meanwhile, here are some pictures:


There were big cars…


There were little cars…


Cars that look like balloons


Cars so mean they need to be fenced in


Cars Boats so comfortable that Fluffly Huskies rest their tired heads on them


Looks like a normal Firetruck…


…but it’s a rolling Social Media advertisement!


The Royal London Museum

Today, I visited the The Royal London Museum, the…erm…Museum attached to The Royal London. Stop me if I’m stating the obvious here.

The museum documents the hospitals history through the 18th, 19th and 20th centuries; from the idea behind the building it in the first place (1740), carrying through to the future.
It’s an interesting concept: The hospital was built as a voluntary hospital, meaning it was funded by donations only, and available to the sick and the poor. Quite remarkable I believe – we’re talking over two hundred years before the National Health Service (NHS) was born. East London was (is) the poor part of town with a health record lagging behind the rest of the city (and country). Healthcare for the population, mainly made up of immigrants, was direly needed. The Royal London was one of five voluntary hospitals built at the time, and it was only after they were built that the birth rate once again exceeded the death rate in the city; London began to grow and prosper again (now there’s a good argument for public healthcare!).

I won’t rattle on about the whole history – it is already available in book and exhibition form, plus I wouldn’t want to take the experience away from you.

If you’ve got half and hour to an hour, it is well worth a visit to learn about the development of healthcare over the past 300 odd years, what it has achieved, and what we owe to our forefathers (and -mothers). Exciting, interesting, gruesome…you’ll find it there.

Visiting Information
Where: St Augustine with St Philip’s Church, Newark Street, London E1 2AA.
When: Opens weekdays 1000-1630, except Christmas, New Year, Easter and Public Holidays. It’s worth calling ahead, as staff shortage can affect opening hours.
How much: FREE, as all good museums in the UK. (I feel sorry for you American folk). Donations are welcome, though
Web: Official website:

The Royal London Museum is a part of the “London Museums of Health and Medicine“. It is my goal to visit all 25 of them



The above video was recently posted on the International Paramedic google group.

Recommended viewing for all Paramedic and related staff – suggestions on how to deal with psychological trauma.

  • Minimise Exposure
  • Acknowledge the impact of the event
  • Normalise the experience
  • Educate as required
  • Restore or refer
  • Self care

M.A.N.E.R.S. was developed by the Victorian Ambulance Counselling Unit (didn’t realise that vehicles needed counselling…).

Some more information can be found here (search for M.A.N.E.R.S.)

GTN as a diagnostic tool

Last year, I posted about a presentation at the Paramedics Australasia Conference:

[click on picture to download full PDF]

According to the authors reviewing the literature, GTN is rubbish as a diagnostic tool.

I received some comments (on- and offline) of astounded people about this. I followed up with the authors, but forgot to post the reply. Many apologies.

A big thanks to the authors, Lynsey Smit and Laura Roberts (both from Monash University), for allowing me to post their presentation online. They can be contacted via email address: larob7 [at] & lsmi19 [at]

ISBAR Clinical Handover App

I came across this whilst browsing through the web: ISBAR, a joint effort from the New South Wales and South Australian Heath Services.

What is it? A surprisingly simple iPhone and iPad app for clinical handovers, which I wish I had as a student: ISBAR stands for Introduction/Identify, Situation, Background, Assessment and Recommendation. Here are some in-app screenshots:







As you can see, there are specific handovers for different types of patients, and you can even save custom handovers. Brilliant, can’t wait to try it out myself.

More information and download links can be found on the official website: