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Day 3: Where in the World (of EMS) Is A.J.?

Entry into RETTmobil.

“The hills are alive with the sound of …”

As I crested the top of a hill on my way to RETTmobil, which is outside the small German town of Fulda, it was reminiscent of the scenes in “The Sound of Music” where you hear Julie Andrews’ beautiful voice singing that famous sound and see the beautiful German countryside. Small, neatly built and aligned houses and cottages, winding roads, peaceful open fields and ambulances. Ambulances and EMS vehicles as far as the eyes could see!

Wait, where did the music go and why am I hear the sounds of dual-tone, high-low sirens in the distance?

For a guy like me who has lived his life in EMS, it was like I died and went to heaven only this was way better. It was like someone had dropped me off at the world largest Toy Store – filled with EMS “toys”. Instead of entering the Pearly Gates, I paid my $10 Euros--$12.86 U.S. dollars (a pittance) and entered along with 20,000 other “children.” (See photo gallery)

I front of me were massive tent structures on both sides, packed with almost anything you could imagine in EMS and rescue vehicle and equipment; and plenty of NEW things for a guy who comes from American EMS to see and experience.

Let’s get something on the table right away so the photos attached to this article tell the story and I don’t ramble on and on: EMS in the USA, in many areas, and in many aspects, is stuck in the dinosaur age when it comes to vehicles, ambulance interiors, safety and uniforms.

We moved (reluctantly) from smooth riding limousine ambulance - to trucks and "boxes” that were designed after military box-style ambulances.

Of course, we “souped” them up--adding more cabinets, padding, lighting and electronics than an Army ambulance. But, for a long time we struggled with suspension and electrical issues. We also discovered we had a lot of equipment, but – after loading it all in – we also had a lot of extra space in our cabinets.

So we did the only thing we could think of at the time--and that is, we stuffed lots of “stuff” in the one foot deep by one foot square cabinets we had. We put in a dozen sheets, pillow cases, oxygen masks, ice packs, triangular bandages to fill them and then, when ALS arrived, we added dozens of IV start kits, 50 catheters and 2,000 alcohol preps.

The funny thing is though, as bad as I could be on a call as a paramedic, I never missed 50 IVs on one patient or had to use 36 triangular bandages and 25 ice packs. And I rarely had to use more than one oxygen mask or sheet on 99.9% of my calls.

So you see where this is leading. The Europeans have always been more regimented, space conscious and economical when it comes to ambulances. And, for the most part, they moved from “cars” (limousine ambulances), to compact ambulances that deployed just the essential equipment that they needed. And they never tried to hang people from hooks on the ceiling or place them on a squad bench that ran parallel to the sidewalk.

When you come to Germany and other parts of Europe, you can feel the difference in culture of not just the people, but also EMS. The streets are narrower than the in the U.S., the people sweep their sidewalks every day, they are extremely conscious of the shortage of energy and deploy motion-sensing timers on their lights, limit their use of AC, have solar energy everywhere and use electric taxis and personal vehicles.

They also are neat and very organized in the way they build and store things, because the towns, streets and buildings have historically been somewhat compact. So they maximize their use of space almost everywhere--including in their ambulances.

When you look at the vehicles in the attached photo galleries and in future articles I write about RETTmobil, you’ll see aerodynamic shaped vehicles that are designed for function, safety, high visibility, optimal access by the seated attendants and less “crap” carried and space wasted than we do in our ambulance.

It’s not the North American ambulance manufacturers fault, it’s our fault (and, of course, some of the blame has to rest with the pin-heads in the 1970s who said we all had to comply with federal KKK specifications that were probably thought up by some U.S. Army ambulance manufacturers or ice cream truck aficionados). We bought in to the “bigger is better” mentality and the “all emergency response ambulances have to be shaped like an Army ‘box’" ambulance paradigm.

Fact is, we’re finally “getting it” in the U.S. and wearing high-visibility safety vests on the highways and byways, moving to brighter colored ambulances with safety striping and rear chevrons and smaller, Sprinter-style ambulances with forward facing seating.

My God, what will Johnny and Roy think if we move away from the “Modulance” and no longer run around the back of the patient compartment to retrieve Bicarb caps! Please bring back the holster and hemostats we all carried for years and finally realized were passé.

I threw is a few massive German Army tank ambulances (see photo gallery) in this article just for fun so you not only see the biggest toys here at the Exposition, but also scare you that this might be the next size “ambulance” somebody who never rides in an ambulance suggests at a federal EMS meeting in Washington, D.C. Although massive, these German tank ambulances are safe, efficient and carry only what they need when in battle conditions.

I also threw in my special product “Pick of the Day” at RETTmobil. (See photo gallery.) It’s one of the most practical, functional and inexpensive disaster/MCI response vehicles I’ve ever seen. Made by Ewers, it’s an MCI body (that can be mounted on a various chassis) that featured three massive fold up/down doors (the size of garage doors) that could be opened in a minute to allow you easy access to any case or piece of equipment. No waiting for it to be off-loaded. If you need the case of tourniquets, you simply remove it while others are getting the heavy-duty carts on which it’s stored, off the vehicle via the fold-down rear ramp.

But the real nuts and bolts of RETTmobil are the ambulances designed for European EMS. And I have to point out that the EMS personnel and managers I watched looking carefully though the ambulances that I am featuring in this article were not looking for bigger vehicles and more space. They were looking for ways to optimize the space they had to work with and add equipment such as mechanical ventilators and stair chairs (See the photo gallery).

Enjoy your first look at the innovations and designs at Rettmobil and read the additional articles I will write to show you additional equipment and vehicle I saw here in Germany.  There are just a few interior and exterior shots included here to wet your appetite. I’ll go into detail in future reports, Just take a look at the way these folks maximize their space and position equipment in the best ergonomic and access locations.

The EMS Safety Foundation will also be presenting articles and webinars on RETTmobil that will educate you on the future of EMS.

JEMS, as a part of the Ferno EMS 2020 Vision of the future project, will also bring you video-taped interviews with international EMS personnel and managers, as well as EMS and safety advocates that I interviewed here in Germany.

Stay tuned!

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