Florian Breitenbach

Rettungsdienst und mehr

A Decade – part five

Needless to say, I got accepted.


Once the lazy, uninterested kid at school, this was different. I dived in to the study. I would be in the library until they kicked me out for closing times. I would relisten to whole podcast lectures, write them out, just to understand and learn the material. I would organise group learning sessions, because I best learn in a group (pure selfish tactic really, but it’s a great social and educational tool too!). I dedicated most of my life that year to my first year of study. And it paid off, achieving highest marks, but more importantly, I knew that I had found something what I want to do, my vocation, my calling.

What followed from there on…well, I don’t really need to write it all down again – because that is when I started this blog.

More than five years have passed since I started as a Student Paramedic, and it is coming up to two years since I graduated as a Paramedic. Nearly a year ago now I gained my UK Paramedic Registration after making the decision to move to London, England. And ten years since I first set foot in an ambulance, which set off a series of events, more than I had ever anticipated.

A big “Thank You!” to everyone who has been, is, and will be on my journey!


A Decade – part four

I returned from my visit with the rekindled desire to join the ambulance service. The camaraderie amongst the staff had impressed me, and together with my memories of  time spent on shift made me rush to the phone and enquire about recruitment. Nine months. Nine whole months! At least that woudl give me time to prepare and think it through. But there was nothing to think through, I wanted to become a Paramedic in Australia.

Work was becoming boring, and I had been offered a place at university in Western Australia, so I moved again. Studying computer science was a backup plan, to be continued until I either graduated, or got accepted in to the ambulance service. The more I studied computer science, the more I loathed it. Maths was just not working out, and programming jsut didn’t make sense. It was boring me to tears. I tried to put the long hours in, but my brain would just not cope with the input and could not make any sense to it. By that stage, applications had opened up for the position of Student Paramedic. So instead of studying for my current (failing) degree, I skipped some lectures and instead attended some free “how to ace an interview” courses. I slowly progressed through the application process, preparing meticulously for every stage (I researched nearly every possible interview question there has been in the universe, and laboured over the best answer, wrote them down, and practiced speaking my answers by recording myself on my webcam).

There was only one way of not having to take that stupid maths unit again next semester, and that was to be accepted as a Student Paramedic.


A Decade – part three

Seventeen years was enough. I wanted to experience living in Australia as an adult, not just visiting it. So I packed my bags and moved.

A massive leaving party, and a short holiday later, I arrived in Sydney with two suitcases, two guitars, and a bike. May as well do it properly and start from scratch!

Ambulance Service? A thing of the past. As much as I enjoyed it, being a paramedic is not a job for life, working in IT gives you more career opportunities, pays better, and is far more mobile. To be filed under “past experiences and enjoyments”.

I enjoyed the change in scenery. But I also remember spotting my first ambulance even on the taxi ride from the airport to the friends house I was staying at for the first few weeks. I just like the design, I thought. Just to look.

Work was good. I was getting paid, was getting experience, I had some pretty good colleagues (including the woman that used to sit opposite me who now sleeps next to me). It was on a holiday over to the west side of the country to visit my mum that I was able to organise an observer shift with the ambulance service – I was curious how the Australian system worked, and wanted to compare it to the German system I had experienced over the past three years.

I got dropped off at the ambulance station. The day crew weren’t back yet, and the night crew (I was going to follow them through half the night) hadn’t come in yet, so I waited for a few minutes until my aunt’s colleague’s flatmate (yes, you red correctly) turned up, who I had organised a shift with. In his final year as a paramedic student, he was happy to take me out and who me the Aussie way.

A brief tour or the van, checking the drugs and equipment, I didn’t have much time to sit down until the first job came in. I can’t remember what it was, but what I do remember is that feeling of sitting in an ambulance again. This one was considerably smaller, made woo woo noise instead of neenaw, and had the addition of red and white flashing lights over the european blue I was used to – but each ambulance I have sat in makes a similar noise; the rattle of equipment in the draws, the crackling of the radio, the strain of the engine when the accelerator is mashed to the floor. In addition, all the other feedback was right too, the vehicle been thrown around corners at high speeds, the clinical white interior, the lights bouncing of the surroundings at night time. It all fit perfectly, a feeling and experience that I hadn’t had in a while. Quite nice, and good to know that it doesn’t differ much from Germany. Still hope that the university get back to me to tell me if I’ve been accepted for my bachelor in computer science, I’d like to progress my career in IT.

We drop our patient off at the hospital, and that is where I notice the biggest difference: it is all one service in the city. You see, in Frankfurt, the Fire Brigade had central oversight and control over EMS, and manned some ambulances. Additionally, the Samaritans, the Red Cross, St Johns and the Maltese Cross all ran ambulances in the city, under governance of the Fire Brigade. Five organisations, five employers – and people from different organisations didn’t mingle, it seems. But here, here in Australia, everybody knew their colleagues, they all wore the same uniform! I was introduced as the guy from Germany who wanted an insight in to the Aussie system, I was made very welcome by everyone else. The shift progressed, and I was able to have a good chat with the crew. Once again, we cleared from hospital, and were told that there were reports of a car crash coming in – one ambulance had already been dispatched, but in case backup was needed, we should head in that general direction. And sure enough, a few minutes later we were called to proceed under priority conditions to the scene.

And what a scene it was: The police had blocked the road, the fire brigade were cutting the roof off one car, whilst the ambulance crew on scene had split and were dealing with what was to become our patient, and another one who was in (what I now know as) traumatic cardiac arrest. Both young, having fun, but one of them had a bit too much of a lead foot for their guardian angel to keep up – even the paramedics weren’t going to change that. I was told to stay close to the ambulance, and was happy to do so – I was happy to take a back step on this chaotic scene, try and make sense of it all, get a general overview. A manager turned up, one that I had met earlier at hospital, who reminded me that if I didn’t want to see what was happening, I could sit in the back of the ambulance and shut the door; he made sure I was OK with the whole situation. I was.

After transporting the patient to hospital (I assisted, upon their request, by keeping the attendant up to date on the patients vital signs…OK I may have gone slightly overboard with the constantly changing heart rate until I was gently told to shut up 🙂 Iwas dropped off at a taxi rank. The crew took off for the rest of their shift, and I returned back to my mums place, deep in contemplation of my newly gained experiences of the life of a Paramedic in Australia…


A Decade – Teil Zwei

The next two weeks consisted of a lot of waiting around, reading the newspaper, reading magazines, looking through the ambulance bits, with the occasional call in between. I think we must have done approximately six or seven emergency calls in ten days.

I had become considerably calmer once I realised that I could handle the situations I was taken in to – I was only an observer, and not responsible for much except keeping my mouth shut when appropriate. Jobs I remember was taking an old lady a quarter of a mile down the road for a doctors appointment, a kid with anaphylaxis, an MI and a drunk teen at a foam party at the local disco.

I had tasted my first blood, and relished the flavour. But the waiting drove me crazy.

Later that year, one day after work, I had planned to meet a friend. I had finished earlier than he had, and so had some additional time up my sleeve – and instead of catching the train to out meeting point I did what I still do today when I’m in no rush: walk. Frees your mind, gives you opportunity to think, feel, appreciate, absorb…and walk past organisations that are involved in the cities ambulance service. With time to spare, I thought I’d pop my head in and ask what I would have to do to get on one of their trucks. The answer was simple: sign up, there’s a basic 40 hour course over four weekends starting in two weeks, after that you will be able to third man an ambulance and assist during event first aid work.

The course was interesting. To be honest, I can’t remember much, but there were a lot of concepts discussed. Confusing at the time, but somehow I managed to pass, and proudly received my first certificate relating to medical care. To stay in the organisations good books, it would be good to do a few event first aid services. I did more than a few, was good experience and I met some interesting people…

The tender beginnings in Frankfurt, Germany
…but my real aim was the big white truck with bright red stripes and flashing blue lights…

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For three years I volunteered for first aid and ambulance shifts, slowly getting to know a thing or three about the work, and meeting some interesting people – both colleagues and patients. I really enjoyed my time there, and managed to never be called to a cardiac arrest. In retrospect, I may have even placed a little bit too much emphasis on my volunteering in comparison to my IT training, finishing vocational school for the day, riding my bike to the ambulance station, doing a night shift (rarely doing more than one call after 1am), having a shower on station and riding back to school the next morning. One day, I was five minutes late for school because of a late job – a drunk driver had ploughed in to another car, killing one person and seriously injuring three others (the driver remained unhurt). I can still vividly remember parts of the call – the Mercedes in the middle of the field, the other car absolutely smashed on the Autobahn, one dead body covered by a sheet in the middle lane, the fire brigade on scene, the early morning response prior to rush hour, our patient being on blood thinners, the handover at hospital, knowing that the patient is seriously injured, but not having much idea about the science and the medicine behind it, but knowing that if she survived, she would have two other family members who were also fighting for their lives, and another one who had already lost the battle. All because of one drunk driver in a Mercedes station wagon, with a scratched door and muddy tires in the middle of a field.

The only reason I got away with being five minutes late that day was because the teacher was nearly an hour late. She came in to the room, apologised and briefly explained that there was a horrific accident on the Autobahn that had delayed her.

I didn’t feel like saying anything.

A Decade – Teil Eins

Ten years. Looking back it is still pretty fresh in my mind, yet so long ago at the same time. Ten years ago I got a first proper insight in to the world of being a paramedic.

It began rather…well, decide for yourself. I had completed my mandatory 10 months of Zivildienst (civilian service instead of going to the Bundeswehr, the German Army – at the time Germany still had conscription) as a patient transport driver, and had six weeks or so to kill before starting my Ausbildung (vocational training) in IT. I had been pretty much a wheelchair and stretcher taxi driver, driving disabled kids to and from school, disabled adults to and from work, taking the less mobile to outpatient appointments and hospital discharges. The driveway where we parked our vans to access the hospital was a shared one with the driveway to the local Emergency Department…and with Emergency Departments come ambulances. I’d long had an (some would say unhealthy) interest in vehicles with flashing blue lights, but this was the first time I could actually look inside one for a decent amount of time. Interesting stuff! I’d see the staff milling about, mainly smiling, chatting. One image I will never forget is of a female paramedic sitting on the rear bumper of her ambulance, head in hands, with that powerful yet empty expression on her face – sad, uncomfortable, numb. I wanted to sit down beside her, ask her how she was feeling, what had happened…but one doesn’t do that as a shy 21 year old. I wanted to know what she had just been through, what had caused her so much grief, I wanted to offer any help – but most of all I wanted to do what she did, wear what she did (a paramedic uniform, not women’s clothing).

This desire was not a subtle one (come to think of it, that is one part of my life I’ve never held back. I once used up an entire 36 shot film within fifteen minutes trying to take pictures of emergency vehicles from a helicopter over NYC at the tender age of 7).  The head of the station I worked out of, which was also an ambulance station, offered me a two week work experience, shadowing paramedics on an ambulance after I had finished my Zivildienst. Hell Yeah!

First day. Poor sleep. Excited as a pig in mud, I get my whites (uniform consisting of white polo shirt, white tactical pants, white boots, hi-vis red jacket), and get shown briefly around the station. Every now and again the radio would crackle to life, and the crew would speak some codewords who they were, where they were going to, with the sirens blaring in the background – it all seemed really exciting! (Even today, hearing someone talk through the radio with the sirens going in the background adds a certain drama to the whole transmission). The crew was lounging around, reading, doing stuff on the computer, eating, whatever. I sat down, waiting for the first call.

And waited.

And waited.

And waited.

After five hours, I got excited, a call! No, it was for the other crew. So I kept waiting.

And waited.

And waited.

And whinged that nothing was happening. One of the crew told me that they will definitely be called out in the afternoon, rush hour means work. But I was sick of waiting! But had no choice, so waited a bit longer.


Finally! A job! I am hyperaware and hyperawake, yet have no idea whats going on. I rush downstairs following the other two, and hop in the back of the van:

Photo Source:

The engine roars in to life, I’m strapped in the back of the box, and have no idea whats going on, where we’re heading, what will happen, what to do. I hear the crew talking on the radio. The attendant turns around, and informs me (shouting over the sirens) that there has been a motorcycle crash.

I still remember vividly that fear of panic and fear rising up through my body, up through my neck, in to my head. What the hell have I let myself in to? What in my right mind was I thinking when I signed up? What will I encounter at the crash sight? What do I do? Where do I look?

There was no way around it – I was scared. Really scared. If it was possible, I would have run away back to my car and driven myself home.

The response took ages. Windy roads, lots of accelerating hard, wild corners, sirens blaring, cars not giving way. I was completely lost. Finally, we arrive; all I can see is a small crowd of bystanders whilst I peered through the cubbyhole from the back of the ambulance. My colleague opens the door, I step out. Bright light shines upon me, in a kind of sun-dazed fashion I nervously hop out of the vehicle, and look around: a few people, a motorbike on its side with a few scratches. No mangled metal. No blood. No bones. No screams. The crew are tied up trying to find out what is happening. A bystander grabs me and points me towards something, asking me questions I have no idea what to answer to. I am an untrained observer, but am wearing the same clothes as that of the crew. They realise, and come to my rescue, one deals with the bystander, the other one tells me that the motorcyclist couldn’t bother waiting for us, so he hopped in another bystanders car who drove him to hospital.

Apparently he waved at us as he passed us going the other way.

to be continued…

LondOne, Two, Three!

Omne trium perfectum – everything that comes in threes in perfect

After gaining some interesting insights how paramedics operate in London by riding out with Lysa Walder in 2009 and InsomniacMedic in 2011, the year has come where I put myself in the hot seat and actually work in London.

After two shifts in the capital of the United Kingdom, the largest city in Europe and one of the most vibrant and exciting cities in the world, what does Yours Truly think?

In brief: Yours Truly is happy. It’s busy, there’s traffic everywhere, there are people everywhere, and its not hot.

Some of my initial impressions in a bit more depth include:

– it’s much busier. Generally you will get a job the minute you begin your shift, and then when you clear or “green up” at hospital or whoever you left your last patient. This is good, this keeps me awake.

– in these two twelve hour shifts I’ve possibly encountered as much heavy traffic as I have in two years in Perth. Again, this is good (yes, I know you think I’m mad)

– Roll In, Roll Out stretchers are nowhere to be seen. The majority of ambulances have tail lifts, some have ramps. Much more back and shoulder friendly. This is good, obviously.

– whilst we’re talking equipment, the vehicles are bigger here too. Funny – when you think of it, in Western Australia (WA) we had wider roads and less traffic, but smaller vehicles…go figure. In the UK, at led thou can stand up straight in the back of the vehicle even if you are taller than 160cm. I like this. A lot. The only thing I miss are the red lights lunching off the walls at night – UK law states no forward facing red lights allowed on any vehicle.

– being a bigger city, there are obviously more ambulance on the road, and many more paramedics on shift. They’re everywhere, impossible to know all of them, which makes it all a little less personal…but on the upside you get to see and meet new people every time. And not only London Ambulance Service paramedics, there are various private frontline service staff (like myself), people from neighbouring services and patient transfer staff milling around too – an interesting mix. In Australia every state or territory has one single statutory ambulance service. UK ambulance services seem to like to contract private services to cover peak periods. A new concept to me.

– FRU, RRU, PRU: Fast, Rapid, or Paramedic Response Unit. Different names, same thing: single responders in a car that are sent out to get to patients quicker. Again, this doesn’t really exist in WA. A new experience for me arriving at a patient that is already receiving paramedical care.

– not only are there different response vehicle types, but also more levels of responders. Every frontline emergency ambulance in metropolitan Perth is either a double paramedic or a paramedic/student paramedic crew. Here, very rarely do two paramedics (as in UK HCPC registered paramedics) work together. Frontline crews are usually made up of either a Paramedic or an (Emergency Medical) Technician as the clinical leader, teamed up with a Technician or a driver with advanced first aid skills (ECA, Emergency Care Assistant). In WA, I was one of many paramedics. Here, I am one of many paramedics too, but also with many technicians and ECAs, who have a lower clinical rank. I was at a job where we were backed up by a double technician crew – I was the only paramedic on scene. New experience working in the city and being the only ALS trained person on scene.

– i=Information. We all know that the information sent to us by Comms/Control/Dispatch is hazy at the best of times…and that is not their fault (well, not always, but we all make mistakes occasionally!). Easy fix? Don’t give out much information. Typical call out info for me, apart from the address, was: “49M, sick” or “23F, OD”. No names, no background info, if there was any hint of danger on scene they would radio that information through. I was used to much more information being sent through (that was generally inaccurate)…after an initial light shock at the lack of information I started thinking this may not be such a bad idea- at least it gets you thinking in many more directions; especially as a student I noticed I (and many other colleagues) would easily be lend and fooled by on screen information that had nothing to do the the main condition the patient was presenting with.

– uniforms: yep, they’re dark green too, but that’s where the similarities stop. I’m wearing epaulettes (a word nobody seems to be able to spell correctly) again, but unfortunately UK paramedic uniforms don’t boast reflective strips anywhere except on the jackets.

…and what about the patients? A bit early to tell, but for a general summary: people are people. Same problems, slightly different way of tackling them. What I have noticed in some is the typical British stoic stiff upper lip and politeness, manifesting in a stubborn “I’m perfectly all right, thank you” (no, you’re not), and “it feels like I need to…well…this sounds rather awkward…like I need to fart. Sorry for being so rude!”

To which I reply: “Stop being so British!”

And then there’s the sightseeing. I going to parts of London I haven’t been before. I was telling my crewmate the other day what would be the peak of my paramedic career: driving around Trafalgar Square on Blues’n’Twos, followed afterwards by parking the ambulance up on Westminster bridge and getting a photoshoot of the “man and his van” with Big Ben in the background.

“You’re such a tourist!” she replied with a smile 🙂

Ambulanzia Paramedici

3am. Early morning. Dark of night. Witching hour.

Whatever you call it, many a body clock reaches it absolute low within the 24hour period. A busy nightshift with a rest period between 0300 and 0400 is generally bearable; one without is intolerable.

We had been out all night. We had worked all types of calls, minor to major. My level of enthusiasm was not at its peak, but bobbing around in the sea of sleepiness. I was hoping for a short break; a pause to let my heavy eyelids droop over my dried and tired eyes, to be allowed to escape in to a warm, soft and happy dreamworld. But none of that happened. Instead, we received yet another call after handing our patient over at hospital.

I closed my eyes anyway and leaned my head on my hand, elbow on window sill, whilst my partner navigated the dimly lit streets, devoid of any activity in the dead of the night. I would have drifted off if it were not for the bouncing of our wheels, indicating the ambulance was just about parked in the driveway. A quick drink of water, a quick glance at our patients name from the screen; reluctantly opening the van door I feel a cool breeze engulfing my face, and take a few deep breaths, hoping the flood of oxygen to the system will wake me up a little more. I grab my gear, and groan at the sight of a bunch of wet and narrow stairs – could be a complicated extrication.

We are met inside by the daughter, who states mum had a funny turn, and was worried. We awkwardly gathered some history, as it appeared our patient did not understand a word of english – not making things any easier. Luckily the family were more than happy to help. I commenced taking vital signs, and whilst taking a blood pressure, sitting next to the patient on the bed, I wished that I could just let myself fall back, stretch my back and sprawl my limbs across the big and comfy bed.

But that probably wouldn’t look too professional, so I didn’t.

The decision to transport to hospital was made, and in order to try and establish a little more rapport, I crammed out some (pseudo?) italian, “hospitale” and “ambulanzia” whilst pointing to the door that we must now head outside. A little sigh of relief was breathed internally when she insisted on walking herself (which was fine with her presenting condition). She even insisted on sitting in the ambulance, which meant that we could sit approximately opposite each other on an equal level, and look each other in the eye (as opposed to physically having to look down on somebody who is lying on a stretcher – bit of psychology involved there I reckon!).

We were going along in the back of the ambulance, and all of a sudden our patient opens up and speaks (heavily accented but understandable) english! Huzzah! Communication breakthrough achieved. A few personal details for the paperwork done, and then we got on to the details of her life – where in Bella Italia she comes from, her love of cooking and baking, Pasta, Lasagne, Pizza, Tirami Su – you name it, she had an authentic recipe stashed away in her memory, and regularly made use of it for the family. She then asked me what I do, or rather what I call myself. “Paramedic” wasn’t quite understood. “Medici?” She asks me? No, not a doctor, I am a “Paramedici!” Showing her my Ambulance Paramedic badge, I repeat: “Ambulanzia Paramedici!”

“Ah, Ambulanzia Paramedici!” Her face lightens up even more, and I am proud to have established a little foreign language communication.

So proud, in fact, that I reply with “Si, senorita!”, only then realising that I am way off the mark with the language again. The last few minutes of the trip continue like this, me trying to get my point across with italian(ised) words and (authentic?) hand gestures, and she guessing the meaning and then teaching me one or two new nuggets of vocabulary. In between all this, I occasionally catch the bleary eyed nothingness expression of my colleague in the rear view mirror, which was turning in to a slightly less bleary eyed look of puzzlement, then finally in to an occasional chuckle and snort of my poor grasp (and interesting try) on the Italian language, together with a little astonishment where all the fatigue had gone to.

A thank you letter.

Mister Green is a regular. Paramedics are dispatched on a regular basis to his domain, for a variety of reasons. I had been told of him, I had read about his management plan at hospital, but I never had the pleasure to actually meet him.

And to be honest, it actually was a little pleasure. He was polite, relatively clean and tidy, quick on his feet – but reckoned he needed our services nonetheless. With the signs and symptoms he presented with, we had no problems taking him to hospital.

Chronic issues? Probably. Hyperchondriac, attention seeking or time-wasting (as many colleagues class him)? Possibly, but the acute setting is not the place to judge that, especially as I had not come across Mister Green before. No reason to treat him any differently.

En route to hospital, he was friendly and chatty. He told us how he held “you ambos” in very high regard, and really liked the ambulance service. Especially since he had recently received a letter from our head office, thanking him for his continued use of the service, and that the ambulance service is looking forward to his custom in the future.

I think he may have misunderstood that letter slightly… 🙂

Cab Stories

The radio crackles, the screen in the ambulance jumps in to life as we are diverted from our lower priority call.

The surroundings light up in a mixture of red, white and blue LEDs, stopping traffic while we U-turn the ambulance towards this trauma call.

More information is sent our way: Patient has been stabbed with a stool.

After a short moment whilst I try to envisage such a scene, I turn to my partner and say: “We’ll need a stool sample”.

To which the reply comes: “Probably won’t be too difficult, they should have some stool hanging out of them”.

Foreign and exotic travels

“Female, post collapse”

Not much information, but we are used to that. I can appreciate the difficulties of getting information out of an emergency caller, but still think there ought to be a better way of extracting such crucial information.

We flick our lights on, the siren parting most of the traffic. A few minutes later we pull up in front of a large, luxurious hotel, and are greeted by a cheery Peter the Porter*.

“Hello!” he smiles and waves, “I’ll show you where you’re off to, you wouldn’t want to get lost amongst the hallways!”

If only more jobs had porters like Peter.

We weave along the passages, under arches, up lifts, and through the door of the room, where we see…our patient laying face down on the bed, limbs sprawled out in a starfish position, with a colleague performing vigorous back massage. If it weren’t for the patient lying prone, the motions and vigour could have easily been mistaken for chest compressions.

Her facial expression shows evidence of discomfort.

We shuffle in to the room, introduce ourselves, and the CPR-esque massage is discontinued.

Her facial expression shows evidence of relief.

Through a significant Kiswahili language barrier it turns out that our patient just needed a lie down after suffering some back pain from lifting a heavy bag. Every time we asked a question to try and ascertain that little bit more of information needed for treatment, her  swahili friends would break out in the most colourful and chaotic of chitter-chatter in order to try and translate between the two languages and get our point across to the patient; the answer would ensue another round of feverish, frivolous and furious group translation attempts, before being relayed to us by six different people. If you closed your eyes, it could have been easy to let ones mind wonder to exotic and foreign lands, with locals bartering at markets, and exchanging the local town news. Instead, we were trying to conduct a medical interview.

It worked out quite well in the end; the patient and their friends were all lovely people with a genuine desire to help us – and with combined efforts we did overcome the language barrier.



* not his name, but it has a certain ring to it, you have got to admit!