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Every five years, Germany holds Interschutz, which is considered to be the largest fire, rescue and EMS "fair" in the world. This year's expo was in Leipzig, and was, as always, impressive to say the least. Spread throughout five large exhibit halls and featuring a massive outdoor display of vehicles and equipment, it's impossible to see everything in the conference's six days.

Manufacturers of fire, rescue and EMS vehicles and equipment spend a lot of money, time and effort to showcase their wares at the expo. Many new products and innovations are introduced at Interschutz. There are no educational sessions to compete with, so everyone in attendance can focus on the exhibits. There are live product demonstrations, such as the German tank that's been converted into a tracked firefighting vehicle. And, you have to stop and watch the 112-meter high (approximately 367 feet) Bronto aerial platform—a new world record—as it seems to keep climbing into the air forever. So, this month's column is a little out of the ordinary as I tell you about some of the more interesting mass casualty incident (MCI) products at Interschutz.

German MCI Response
The potential for MCIs is great in Germany. Although slightly smaller in square mileage than the state of Montana, the country has some of the largest and busiest airports in Europe. EMS providers constantly face the threat of a wide-body jet (a plane that carries hundreds of passengers) crash. With an extensive passenger rail system between and within cities, railway accidents are always possible. Interestingly, one large rescue truck on display from Stuttgart Fire Department featured wheels similar to railroad cars type so the vehicle can travel the rails to an incident. And, the high speed of Germany's famous autobahn, coupled with a heavy traffic density, creates the constant potential for multi-car pileups yielding numerous casualties.

German EMS is different from that of the U.S. EMS system in numerous ways, and this affects how MCIs are managed. Every state has its own way of providing EMS. In Southern Germany, much of the ambulance service is mainly provided by the German Red Cross, Die Johanniter, the Malteser Hilfsdienst, or the Arbeiter-Samariter-Bund. In the larger Northern cities (e.g.,Hamburg, Cologne and Berlin), the fire department operates the ambulance service. Throughout Germany, many of the ambulances are staffed at the BLS level. ALS is provided not only by paramedics but also by emergency physicians who respond in their own vehicles. So, at an MCI, it's common to have doctors on the scene quickly to assist with managing the incident and treating patients.

Another thing that's common throughout Germany is the wide variety and high volume of emergency response vehicles. Along with all the engines, rescues, aerial apparatus and ambulances on display at the expo, there were also a few different MCI trucks. One of the larger vehicles, built by Lentner, is for the ambulance service Die Johanniter. It's built on a new, rescue-style truck that resembles most German heavy rescues. The second is a converted cargo truck that's operated by MHW (Medizinisches Katastrophen-Deutschland), a group that provides medical assistance in disasters with specialized equipment and teams. Although MCI trucks are more common than trailers in Germany, some trailers also are built by the same companies that make the trucks.

The German fire service has long been a user of "pod" systems, or specialized equipment that's mounted on a platform or in a container body that can easily be placed on a truck using a hook system or winch. Special pods may carry technical rescue equipment, foam tanks and monitors, hazmat equipment and medical equipment. One truck manufacturer has built some specialty pods to serve as mass casualty supply units. The container is simply placed on a truck (referred to as the prime mover) and dropped off at the scene, leaving the prime mover free to return to the station to pick up and drop off whatever additional equipment pods are needed at the incident.

MCI trucks, trailers and pods are a little different than what we typically see in the U.S. The first thing you'll notice is that few, if any, backboards are carried. The medical protocols for spinal immobilization are different in Germany, and most patients aren't placed on backboards, so large quantities aren't needed. Another thing that's different is the use of metal containers to store the supplies and equipment. This is because medical units still prefer metal over plastic. The good news is, these aluminum containers are lightweight, and many feature waterproof lids. The bad news is, even on some of the newer vehicles on display, dents were visible in some of the containers despite the fact that they've never seen the heat of battle.

Another big difference between the German MCI response units and those in the U.S. is that they usually carry a number of large tents that can be erected at the scene. The German philosophy is that it's better to take the time to set up tents to hold and treat patients because it may take some time to transport all the patients from the scene. The drawback to this plan is that the number of personnel needed to support the operation of the MCI vehicle can be quite high. One paramedic I spoke with mentioned that his truck required approximately eight to 12 people to operate in the optimal manner. This doesn't include the providers needed for triage and treatment of the patients.

Another interesting vehicle was a large bus that was converted into a mobile medical treatment area. It was formerly a tour bus that was converted by Stadler ambulance service of Freyung, Germany. The bus features five ambulance cots and additional seating for ambulatory patients. However, the bus isn't intended for actually transporting patients. Instead, it's available to stand by at large public events, where it can be used as a mobile medical aid station or response on an MCI scene. This can be quite useful because it's common to have a number of "doctor cars" respond to the MCI.

Many command and control vehicles were also on display. One in particular was from the U.K. and was built specifically to support MCI operations. The command vehicle was purchased as part of a major domestic preparedness initiative that was implemented shortly after the London train and bus bombings in 2005. The key feature of the vehicle is the highly technical command area in the back. Such activities as tracking of patients, monitoring hospital capabilities and tracking ambulances can be easily managed from this high-tech mobile command room.

If you would like to attend the next Interschutz, it will be in 2015 in Hannover. Hopefully, next time we'll see you at the fair.


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