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My trip with Falck Denmark

Friday, 29 September 2017

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As a current third year paramedical science student at Edith Cowan University I have gained a wealth of practical experience predominantly through the hospitals of Perth, Western Australia. Being lucky enough to have been given the opportunity to spend 5 weeks completing ambulance work with Falck in Denmark, I experienced a variety of patients, both critical and non-critical, in a setting very different from what I was used to. As I found out over the length of my stay both equipment, education, and procedures differed slightly, making for an interesting and eye-opening experience. Not to mention the fact that English is the second language in Denmark, which gave patient communication a new level of complexity (which I thoroughly enjoyed).

Having arrived in Denmark after a near 30-hour trip, I spent a total of 4 days in the city of Copenhagen, which was full of history, culture, amazing architecture, and incredible food. Cycling is the predominant mode of transport in Copenhagen and the city encourages you to do so with an abundance of dedicated cycle paths.

After my time in Copenhagen I travelled to the city of Aalborg in the North of Jutland. Aalborg is Denmark’s third biggest city with an approximate population of 200,000. I was welcomed and introduced to the team at the Aalborg city ambulance station (Fig 2) which is operated by Falck. I quickly became acquainted with the ambulances, station, and facilities.

Interestingly the education differs drastically and places a large emphasis on practical experience before you may even complete the paramedic qualification. The basic education itself takes 2 years and 8 months, then you become a qualified assistant (level 1). Then you must have 1 and a half years of ambulance experience. After this point, you may take the Pre-Hospital Trauma Life Support (PHTLS) course after which you can start the Behandler program (level 2). This part of the course takes place at school, hospital through driving practice in an ambulance. It takes 3 and a half months. Behandler roughly translates to ‘treater’ and at this level you may administer most medications and perform most procedures. Then you must have 3 years of practical experience at a level 2 in order to be able to qualify for the paramedic qualification (Level 3). As a paramedic you become qualified in advanced medications and, intraosseous access, CPAP (continuous positive airway pressure), and intubation.

The ambulance service in Denmark utilises doctor cars. This is comparable to the fast response cars manned by single paramedics here in Australia. However, the doctor cars are stationed at the hospital and whenever a priority 1 call is received a paramedic and doctor attend the event in combination with the ambulance. The doctor cars carry Lucas machines and the more advanced medications including heparin (not carried routinely on ambulances in Denmark).

On the 30th of June, I was placed on the Falck doctor car. We attended several STEMI (ST elevation myocardial infarction) patients and also my first cardiac arrest patient. We were dispatched to a 60+ year old male in cardiac arrest at a local bar in town. The narrow roads, old buildings, and different equipment made this a nerve-wracking experience. The ambulance arrived 2 minutes prior and commenced initial resuscitation efforts, upon arrival I took over compressions. There were 5 team members on scene, and as I was performing compressions everyone was communicating. My team were speaking in Danish, and due to my very limited understanding I could not understand a word of it! However, I did not feel out of place nor as if I did not know what was going on. This was an interesting moment as it showed that the advanced life support algorithms are universally applicable and you can adequately take part even if you don’t understand the local lingo. It was an organised, effective, and timely resuscitation and it showed that the paramedics and other staff in Falck Aalborg are extremely efficient.

I took part in a total of 3 cardiac arrests in my time in Denmark. The second of which arrived via rescue helicopter, which was fantastic to be a part of. After transporting the patient to hospital, I was able to witness the cardiac catheterization and ongoing efforts made in hospital. This gave me an all-inclusive view of resuscitation from the pre-hospital environment to theatre.

Other memorable scenarios involved part of a patient’s nose being bitten off, seizure patients, and car crashes. The patient with their nose semi- detached was the most aggressive patient I have experienced to date. Lack of variety was not an issue on my trip. One of the trips I took part in which remains one of the most stressful was a call to a teenager with abdominal pain at 3am. The patient themselves was not what made this trip so memorable, it was the family. They spoke English and were from Somalia. On scene, the family were banging on the glass of an apartment building and screaming, trying to defuse the situation was difficult. The patient was confused, gave vague answers, and simply stared at the ceiling. The family were running around, grabbing our arms, shoving us, shouting, and slamming doors.

After stabilisation and transportation, we suspected acute appendicitis as a potential diagnosis for the patient. Whilst it was a confusing patient presentation, the hectic environment personally made me realise sometimes how difficult it is to conduct an assessment and control a scene concurrently.

In terms of the Danish people I met, they were lovely. Everyone took me in with open arms. I was also given tours of the police and fire stations and met many workers from these areas, who I often ran into during certain trips. In addition, I visited the local military base, met training medics (who were eager to strap me into military extrication equipment), and was shown their versions of ambulances for use in Afghanistan and alike. This was all organised unknown to me by the Falck Ambulance Manager Karina Jensen, a fantastic woman whose dedication to paramedicine is inspiring.

I’ve made many friends in Denmark, and within Falck, and I hope I get the opportunity to work there again. I was given a memorable introduction into ambulance work. Everyone I met was passionate about the job, eager to teach and share stories, and this is definitely a workplace community I wish to be a part of.

- Luke Price, ECU 3rd Year Paramedical Science Student

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