rope[change | edit source]
In many parts of Europe a different paradigm is used for prehospital care, in which doctors, nurses and occasionally medical students function as pre-hospital providers, either in conjunction with or instead of paramedics. The following are two fairly representative examples illustrating the differing approach to the idea of paramedics in Europe.
France[change | edit source]
Paramedics, as we understand the role, do not exist in France. Within France, EMS is provided by means of an organization called a SAMU for each French Departement (county). Emergency response may be through the use of a fire department-based ambulance, such as the Paris Fire Department (www.pompiersparis.fr), or by an ambulance (labeled SAMU)staffed by a physician-led team (SMUR). The French philosophy is to provide more definitive care at the scene during life-threatening emergencies, and a SMUR team, consisting of a physician, a nurse, and an ambulance driver, may elect to conduct the majority of care, even resusctitation attempts, at the scene, prior to transport. SMUR teams are typically hospital-based. Since 1986, fire department-based ambulances have had the option of providing resuscitation service (reanimation) using specially-trained nurses, operating on protocols, in the role that we would normally expect to be performed by the paramedic. In actual practise, however, such units, and nurses, are extremely rare outside of the City of Paris. In France non-emergency and low-priority ambulance services are normally provided by private companies, with no formal requirements for the training of their staff.
Germany[change | edit source]
In Germany, the closest role to that of paramedic is called Rettungassistent. Although there are others working in EMS in Germany, this is considered to be the only professional role, and the training of subordinate staff can vary greatly. The Rettungassistent is required to complete two years of training, the first consisting of theory classes at the post-secondary level, and hospital-based clinical experience. The second year consists of a 1,600 hour EMS-based preceptorship. At the conclusion of this training the Rettungassistent will have a skill set which is roughly similar to that of paramedics in many other countries, and will function as the crew chief on an emergency ambulance. One important difference, however, involves the manner in which EMS operates in Germany. In the German system it is much more common for emergency doctors (called Notarzt) to respond directly to high priority emergency calls. A Notarzt is a physician with additional training; although no specific medical specialty is required, the majority are anesthetists. The role of the Rettungassistent is to assist the Notarzt in the treatment of the patient; they may perform all of their advanced life support skills only under the direct supervision of the Notarzt. In exceptional circumstances, when there is an immediate threat to life, and when the Notarzt is not present, the Rettungassistent must be able to unilaterally perform all of their ALS skills. Not doing so places them in violation of federal German legislation (Handeln durch Unterlassen), however, federal law in German will normally provide the Rettungassistent with legal protection, under these extraordinary circumstances. (32,35 StGB)
Hong Kong[change | edit source]
- St. John Ambulance in Hong Kong A charitable organization with
a long history stretching back over a century and has been serving the community since 1884. In Hong Kong, the St. John Ambulance Association was established in 1884.It provides ambulance service,first aid and caring training course.
- Auxiliary Medical Service An independent government department
that trained, committed voluntary medical and health services provider in Hong Kong. Its mission is to supply effectively and efficiently regular services.
South Africa[change | edit source]
All health practitioners in The Republic of South Africa are regulated by a standards generating body (SGB), the Health Professions Council of Sout