Contemplating life.



…or  Overload, Procrastination, Quiet Reflection, Structure, Time to shine!

I’ve got a lot going on at the moment, keeping myself busy in and outside of work. Too busy, it felt at times, and too uncoordinated. Overload, and with it, Procrastination (of the bad kind)

Time to simplify. Out with the unnecessary, focus on the big picture. Not always easy in the age of information overload and the ever luring presence of social media to get your procrastination fix, but it can be done.

Reflective cap on, time for some introspection, reflection, rearranging, reprioritising. What do I want to do, what can I do, where do I want to go, how do I get there, who do I want to be?

But first, get the basics sorted, daily life. Bringing in some structure:


IMG_1034Soon, blogging should be back on the list.

Interested in the outcome? Watch this space.



Thirty people, spread over four countries and two continents, and with a variety of backgrounds, meet in a wooden hut in the alps for 48 hours. The only thing they have in common, apart from the german language, is an interest – a passion – for paramedicine. Why do people travel hundreds of kilometres on their days off, organise shift swaps, and take annual leave ‘just’ to be with colleagues and to talk shop? Why would mostly underpaid paramedics spend their hard earned money to be in company of others in the same profession?

Dedication and Desire. Dedication to the Profession, and the Desire to improve. Make things better. Improve systems. Improve working conditions. Optimise procedures. Exchange ideas and experiences. Discuss thoughts. Improve outcomes. Save lives. Working and focussing on our raison d’être, our motivation and purpose of existence: the patient, and the community.

It is easy to get stuck in the negative spiral with burnt out, cynical and overly sarcastic colleagues. But nobody ever said it would be easy sailing in this job; that is true from a clinical perspective, but also from an operational point of view. Think back to the time when you were but a newby in the job.. Think of what motivated you to get in to this great and noble profession. What gave you your drive? What were the deciding factors? What grabbed you, and made you go “YES! I want to be a Paramedic!” ?

Make sure to hold your head high, and be a proud professional. We all have our ups and downs, and if you ever find yourself doubting – get out of the rut and surround yourself with some like minded individuals to lift your spirits. Add some clean alpine air to the mix and you’re sorted.

It was a great time meeting with the group, and I, for one, will return home just that little bit more refreshed with just that little bit more motivation to do what I love doing: being a paramedic.

I am refuelled. The flame is still burning strong.




OxyBear is saturated.


_MG_1209StethoLion hears you breathing.




_MG_1183 …whilst it’s cousin naps, solemnly waiting for an emergency of it’s own…


IMG_8204…wishing it had a bed of it’s own, an actual ambulance bed…


Thanks to Martin Greca for the photos. They are Creative Commons licence, but please get in touch with me via the Contact! page if you want to use them.

Bern Baby Bern



Up next on the second day of the meet up was a guided tour of the Paramedic Service in the Swiss City of Bern, curiously named the “Sanitätspolizei”, literally “medical police”. I guess that gives a whole new meaning to the term “Cardiac Arrest”…

In reality though, the terminology can be explained historically – over a century ago, it was realised that a dedicated corps was needed to help people with medical problems in the community (well, get them to hospital). This group was recruited from the police force, and the police moniker stuck, although they have nothing to do with the police at all.

044When the service was being set up early last century, a specialised water rescue group was also needed. So the Sanitätspolizei got lumped with that too, and has proudly kept it to this day and age. Every ambulance is fitted to tow one of the many boats that can be found at their HQ.


The 6 day rota that staff work seemed interesting; day shifts on day 1 & 2, moving on to a night shift from the evening of day 3, finishing on the morning of day 4, and having day 5 & 6 off.

Far more interesting (read: different, strange) was the way vehicles are staffed. To understand this, I will list the “clinical points” that are given to staff of varying clinical grades:

  1. Student Paramedic, year 2
  2. Student Paramedic, year 3
  3. Qualified Paramedic
  4. Experienced Qualified Paramedic
  5. Experienced Qualified Paramedic with ICU/Anaesthesiology nursing qualifications, OR Junior Emergency Doctor
  6. Experienced Emergency Doctor

There are a pool of staff floating around the station (the only station in Bern) at any given time. Staff are not assigned to a specific vehicle during shift, or have a certain partner. When an emergency call comes in, the calltaker/dispatcher (same person) triages the call. Depending on the nature of the call, a varying amount of “clinical points” are needed to appropriately staff the vehicle. A patient transfer job (all done by these guys and girls) can be handled by a single qualified person, only three points are needed (there will always be a fully qualified Paramedic on every vehicle). If a call is deemed low to medium priority and needs (minimum of) six clinical points, it could be two qualified paramedics, or an experienced qualified paramedic with a year three student. Cardiac arrest calls have the highest point count at 9, and one of the staff have to have at least 4 points to their name. For calls like this, they try to put three staff on a vehicle.

To get the resource running, the dispatcher broadcasts the names of the staff that they want to respond, they go down to the garage, get a “job fax” (a printout stating the nature of the call). Staff then grab a vehicle, tell control what vehicle they are on, the call details are sent to that vehicle (including sat nav), and away they go. After a call is finished, the vehicle is returned to base, the crew restock and clean it, as it unlikely that they will use it themselves in that configuration again.

Confused much? So were we.

IMG_8208Emergency! Jackets and boots are not allowed past the garage, so staff leaver them here, ready for their next call

A few numbers before I leave you with a selection of vehicle pictures:

The Sanitätspolizei Bern

  • have 150 staff
    • 15 of those are office based. They are all qualified paramedics, and can respond to calls if need be (non-clinical work such as accountancy and HR are dealt with by the city of Bern, and are located elsewhere, separate from the service).
  • receive 186 000 calls for help annually (510 calls a day)
  • dispatch 39 000 calls annually
  • do both primary (75%) and secondary (25%) calls.
    • On average, once a week the water rescue team are dispatched. Approximately half of the staff are water rescue trained, both above the water (boats) and below (rescue divers).
    • 2% of secondary calls are made up of transporting corpses to the mortuary. These transports are done with neutral coloured vans with undercover lights and sirens if needed – an example given where expedited removal is needed is to clear the high speed rail lines after people have been hit by a train.
  • have a company policy that staff must use the sliding pole to reach the garage when called out. It is seen as too dangerous to use the stairs. This caused amusement amongst some of us, as in Germany many services have banned the use of sliding poles as it is seen as safer to use the stairs.

And now, finally, the moment you’ve been waiting for. Colorful cars!


The group around a Mercedes Sprinter 315, coachwork by the German company Ambulanzmobile, type “Delfis”. This is the main type of emergency ambulance in use in Bern.


036Mainly used for nonemergency calls is the smaller VW T5, coachwork again from Ambulanzmobile, type “Hornis”. Can be used for emergencies as well, has all the same kit, just less room.


049The so called “Hochlang” (literally: talllong, because it is tall and long) built on a Mercedes E Class chassis is a dying breed – as they age, they will not be replaced by newer versions. They are primarily used for long distance transfers – colleagues who have used them love the smooth ride, but this comes at the expense of far less room compared to other types of vehicles.



An officers/supervisor car, Mercedes ML.



And they even have a Lambo in the garage!



Thanks for additional pictures by © Nils Düster and (cc) Martin Greca. To get in touch with them, please contact me via the Contact! page

Mountains and Madness

A few months back I was made aware of – a high quality German speaking forum for paramedics and those interested in topics about and around paramedicine. Their user meeting was coming up in May, and I might be interested in coming down to Switzerland for a few days. Well….why not?

The meet up was spread over three days. The first day was more of a get to know each other day between paramedics and some emergency physicians from all over Germany, Switzerland, one from Papua New Guinea and yours truly from London. The interesting thing when meeting people in real life after knowing them only from a forum, is the need to establish a link between their online user name and their real name (and their face). Having been quite new to the forum I just had to get to know everybody, end of story. Nothing better than a good old fashioned barbecue then!

IMG_8196Yes, those are actually tofu sausages in the bottom right hand corner, sourced from ethically slaughtered tofu animals.

Set in a scout style wooden hut in the swiss alps (you’d have to be about 1.50m (4’11”) to walk around comfortably in the bedrooms), it was back to the basics: five minute drive to the next tiny village, luckily we had running water and electricity. But no comforts of a luxury hotel – wash up yourself, make your own room (i.e. bring your own sleeping bag for the 8 person sleeping room with bunk beds). I didn’t mind it, nothing wrong with making do with the bare necessities…we’re often enough used to it at work after all! Even the (very) near by (restless) cows with their bells around their necks all too soon became a background noise that I could easily zone out from.

The afternoon, the evening and the night progressed. Food was heaped on to the flames, drinks (kept cold in a trough) were distributed generously (but not too generously). Stories, systems, scenarios and studies were exchanged. Ideas and concepts were conceived, discussed, formed, changed and adapted.

After surviving a night bunched together with various snoring colleagues of various snoring intensities and various snoring intervals (with varying snoring rhythms and notes, including but not limited to: staccato, legato, samba, jive, E flat minor and G sharp), the late morning breakfast was just what was needed to wake us up for the afternoon, our visit of the Paramedic Service in the Swiss City of Bern, the Sanitätspolizei Bern…

Follow your dreams…and your patient

“Every hospital should follow every patient it treats long enough to determine whether the treatment has been successful, and then to inquire ‘if not, why not’ with a view to preventing similar failures in the future.”

Ernest Codman 1914


Let me adapt that to our profession, one hundred years later:

“Every Paramedic Service should follow every patient it treats long enough to determine whether the treatment has been successful, and then to inquire ‘if not, why not’ with a view to preventing similar failures in the future. This information should be shared openly with staff for education purposes and to allow a greater interprofessional understanding of each role involved in patient care”

Florian Breitenbach 2014 (Thanks @MDuschl)


It’s not what you expect to see when casually checking your social media sites after getting up in the morning: A series of short eulogies on a friends account.

Death has only tangientally touched my personal life. Deaths in the family occurred  at a very young age where I didn’t know them enough and didn’t understand the concept of death, and not knowing them as an adult, unable to build a bond between them and myself.

We, in contrast, had spent four years of our lives together that shaped and changed us: we had become paramedics together. Through university, through paramedic school, in the classroom, on the road, at graduation: we did it together in our group, growing from keen students to grown up paramedics. Whether at one of our first practice scenarios in school, or at a job working together: you were a solid colleague, a mate that I could count on, someone who had my back even on tough calls. You got on with the job that we both loved: helping people, and having a laugh with them, never at them.

Although we weren’t close, we kept in touch as colleagues, even if I was in your country of birth, and you were in my country of birth. I was glad that we were able to catch up over a pint when you came to visit England recently, and it saddens me that we won’t be able to do it again as we had planned, either here or over your way.

Pleasure to have met you, an honour to have worked with you, and a sad day reminiscing about the good times spent during our journey together.


Design, a sometimes forgotten and neglected topic not only in the Paramedic world. Examples include the often poor visibility of exterior ambulance design, unsafe practices on interior ambulance designs, hideously designed uniforms, and not properly thought through industrial design of the equipment we use (heavy, cumbersome, unreliable, expensive. Or all four).

One thing that has always bugged me 
is the utilitarian approach to designing the patient area of the ambulance. Essentially the Paramedic’s office, a bit more thought would go a great deal. I was reminded of this shortcoming today when I visited the London Design Museum. There are some great designs and designers on this earth, but apparently we need to stick to old-thinking style layouts, with the accompanying drab and depressing colours. How about improving our workspace – I’m sure it would have a positive impact on   happiness at work, and even a good effect on (conscious) patients and bystanders. Environmental perceptions shouldn’t be underestimated.



An interesting piece of ‘design’ was the Music Memory Box, designed to help dementia sufferers. The box is filled with objects and tunes that the individual has a strong emotional bond with; these ties are still present even with advanced dementia, and can provoke quite startling emotional outbursts. I can already picture a bunch of poor demented paramedics in a nursing home, with somebody having put the radio tones for a call in the Music Memory Box. The otherwise quite placid retiree would come out with a strong “Oh damn! Not another call, I wanted to eat my lunch!”.


I’ll leave you to ponder with a picture and a quote from a sculpture outside the Design Museum:



Though human genius in its various inventions with various instruments may answer the same end, it will never find an invention more beautiful or more simple or direct than nature, because in her inventions nothing is lacking and nothing is superfluous.

Leonardo da Vinci.



Further reading & Links:

Ambulance Visibility:

Ambulanzmobile: Delfis Ambulance Design:

Design Council: Making Ambualnces that don’t kill people:

London Design Museum:

Transport Design of the Year 2012: Redesign of the Emergency Ambulance:

Music Memory Box:

Keeping it real


In the EMJ Podcast from April 23, 2013 “The Wells scores for VTE” (iTunes link), a notion that is briefly mentioned and discussed is the move away from the “rule in/rule out” strategy for (possible) disease management in emergency medicine, instead employing clinical probability, the burden of disease and considering false negatives and false positives.

And how does this tie in to the world of Paramedicine? Let me demonstrate.

I’m sure most of us have responded to calls where patients have punched their minor ailments in to a computer, and the wonderful world wide web has diagnosed them with cancer, the black death, and being pregnant with triplets.

In a sense, paramedics often do similar things. We are quick to turn up to patient, assess them, expect the worst, then make them expect the worst, and transport them to hospital. Just in case. To be sure, to be sure.

The only thing that is sure is that it is clogging up the hospitals.

Instead of ruling a specific disease in “because we can”, how about emphasising clinical probability and disease severity, and weighing them up against each other? We need more training and education focussing on minor injuries and diseases, allowing us to recognise issues, and deal with them appropriately. More diagnostic kit is becoming increasingly mobile, with blood analysis now not only for glucose levels, but for white blood cell count, and more. A framework of robust clinical decision making guidelines for the well educated paramedic, together with optional online (phone/video) consulting for a second opinion and appropriate referral pathways is the way of the future.

The “You call, we hall, that’s all” paradigm is outdated.

Paramedics are specialists in unscheduled and emergency healthcare. Care right at your doorstep. An you won’t necessarily even have to cross it.

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