EMS in Spain

[jlc]

Greetings from Spain!

About Spain:
Spain is a member of the European Union located in southwestern Europe. In 2008 the population of Spain officially reached 46 million people. Its total area is 504,782 km2 (194,897 sq mi). According to the World Bank, Spain’s economy is the ninth largest worldwide and the fifth largest in Europe. (wikipedia )

EMS:
There are 17 autonomous communities (autonomous regions) in Spain (like states in USA). Each region has their own Public Health Service (with hospitals, health centers and regional EMS). So there are 17 regional public EMS (they depend of the Regional Government). Furthermore, some cities has a local EMS (it depends of the city council), and some Fire Department has ambulance service too.
In addition, there are non profit organizations like Red Cross or DYA who provide BLS ambulances (rarely ALS ambulances) with volunteers for special situations (music or sport events, support to public EMS,…). There are more private companies too.
Regional EMSs are public services (they depends on Regional Health Services). Each region manages the service differently. Some have their own vehicles and staff. Others outsource (subcontract) the vehicles and some staff to private companies (usually the vehicles and the BLS staff are contracted out and the ALS staff are civil servants –public EMS employees).

Emergency dial: 112
The emergency dial is 112 in all regions, but in many regions, each agency have their own dial too (national police: 091, local police: 092, firefighters: 080, EMS: 061…). So in some regions, the 112 dispatchers send the ambulance (or the firefighter engine, or the police car…), but in others the 112 dispatcher call the 061 dispatcher (or the 080 dispatcher, or the 092 dispatcher,…), and then this sends the ambulance (firefighter engine, police car,…).

There are diferent kinds of ambulance:
- Non assistant ambulance (ambulancia no asistencial) For dialysis, rehabilitation, non emergency patients transport.
*Staff: A driver and sometimes an assistant (first aid course or similar).
*Skills: Only transport/first aids. Usually, this kind of ambulance doesn't attend emergencies.
- BLS ambulance (ambulancia de SVB ).
*Staff: 2 EMT-B (one of them a driver)
*Skills: BLS+AED (non-invasive techniques: splints, cervical collars, spinal board, Kendrick extrication device, first aids, oxygen,…)
- ILS ambulance (ambulancia de SVI or SVE or Sanitarizada).
*Staff: 1 or 2 EMT-B (one of them a driver) and 1 ambulance nurse.
*Skills: addition to above, nurses can apply invasive techniques (IV, NG tube, vesical catheterization, laryngeal mask…). They can use ALS skills based on protocols (like US paramedics) or phone/radio orders) like drugs or intubation. This type of ambulance is newly created (end of 90s) and not all region do.
- ALS ambulance (ambulancia de SVA or UVI móvil).
*Staff: 1 or 2 EMT-B (one of them a driver), 1 ambulance nurse and 1 doctor.
*Skills: ALS techniques.
- HEMS. Staff: 1 or 2 pilots (or 1 pilot and 1 mechanic), 1 flight nurse and 1 doctor
- Rapid response unit (VIR). Staff: 1 driver-EMT-B, 1 doctor (and/or 1 nurse)

Training:
- EMT-B (TES). Before 2007 there was not a national standard, so each region had their own rules (courses from 60 to 600 hours, sometimes only a first aid course). Since 2007 there is a 2 years training occupational course (vocational-Community College).
- Nurse (Enfermero): University degree (3 years until 2009, now 4 years). In some regions nurses need a Master in Emergency Nursing (or experience in ER, ICU,…) for EMS jobs.
- Doctor (médico or doctor): University degree (6 years). If they want to work for the public health service they need to be a Specialist (4-5 years more: Intensive Care Medicine, Family Medicine, Anesthesiology, Cardiology…)
- Volunteers (voluntarios): Red Cross, DYA, Civil Defense… Courses from 40 to 300 hours (first aids, patient transport assistant, life guard,…)

Non-assistant/non-emergency ambulance/patients transports (private company):

Red Cross- BLS Ambulances (Volunteers):

BLS ambulance (061 Aragón: EMS - Autonomous Community of Aragon):

ILS Ambulance (SUC: EMS - Autonomous Community of Canary Islands):

Sorce:http://sanitarizada.blogspot.com

ILS Ambulance (Emergencias Osakidetza: EMS - Autonomous Community of Vasque Country):

Source: http://www.e-mergencia.com

ALS Ambulance and HEMS (SUMMA 112: EMS- Autonomous Community of Madrid):

ALS Team (GUETS SESCAM 112: EMS -Autonomous Community of Castilla-La Mancha):

Source: http://ucienf.blogspot.com

ALS Team (SAMUR - EMS City Council of Madrid):

ALS Ambulance (SAMU Asturias: EMS - Autonomous Community of Asturias):

ALS Ambulance (Bomberos Navarra: EMS - Fire Department, Autonomous Community of Navarre):

Rapid Response Unit -VIR- (SUMMA 112 Madrid):

HEMS (Emergencias SACYL 112: EMS - Autonomous Community of Castilla-León):

 

[jlc]

My second photo-link (BLS Ambulance - Aragon) doesn't work, so I upload it again:

 

[Don Gwinn]

Very cool photos, I'm glad you shared them. I was going to comment on the iron of the ambulances in the first few photos with one yellow light bar, while the one I drive has lights of every color on every part of the truck with a control panel that looks like it takes a college degree to control them (hey, this is the USA, and overdoing it is what we do.) But in scrolling down I see that some of your autonomous regions do the same thing.
But, hey, more is better, right?

 

[jlc]

Very cool photos, I'm glad you shared them. I was going to comment on the iron of the ambulances in the first few photos with one yellow light bar, while the one I drive has lights of every color on every part of the truck with a control panel that looks like it takes a college degree to control them (hey, this is the USA, and overdoing it is what we do.) But in scrolling down I see that some of your autonomous regions do the same thing.
But, hey, more is better, right?

In most countries of Europe, the lights are blue for all emergency vehicles (police, firefighters, ambulances,...) and yellow/amber for slow vehicles (large trucks, crane trucks, tractors...). However, in Spain, traffic code prescribes that only police cars can use blue lights. The rest of emergency vehicles must use yellow (amber) ligthts (like tractors :wacko. This code is very old, so we are trying to change it.
Many EMS have ambulances with blue lights or with red lights (or red-blue, red-yellow, blue-yellow) but it's lawless. We hope change it soon... so some have already change the colour, anticipating the new code.

In addition, there are differences between the types of ambulances. Non emergency ambulances usually carry two lonely yellow lights (beacon lights). However, emergency ambulances (BLS, ILS and ALS) usually carry, at least, a yellow bar (code 360, federal signal, excalibur,...), and they usually carry various white and yelow perimeter lights (lateral) and an arrowstick in the back. Often they carry oscilaser, led reflectors,... in the front, too.

Typical amber lights in Spanish ambulances:

Source: http://www.e-mergencia.com

Other colours (lawless at present):
Red and White (SAMUR Madrid):

Blue and Amber:

Blue and Amber, blue and red,...


Sorry for my English

 

[Don Gwinn]

Su ingles esta muy bueno. Mi espanol no esta muy bueno. Espanol de escuela.

Your English puts my Spanish to shame . . . and I never did learn to understand a native speaker; it's just too fast.

 

[firetender]

In Hawaii, we say "Mahalo!" ("upsidedownexclamationpoint gracias!), though I'm not Hawaiian. Happy to see how you're helping to expand our community and looking forward to hearing more of your experience!

 

[jlc]

Su ingles esta muy bueno.

In Hawaii, we say "Mahalo!"

Thanks to you both.

 

[jlc]

video

This is a link to a video of a TV show (in Spanish) which shows the response of several Spanish emergency teams.

Full TV show (35.2 minutes). External Link:
http://play.cuatro.com/on-line/#/callejeros/ver/socorro

The full video shows different emergency services:
- SAMUR-Madrid (ALS teams/ALS ambulances and Rapid Response Units), Firefighters and Local Police responding to a severe burn patient.
- SAMU-Gijón (ALS team/ALS ambulance) responding to a man with hypoglycemia.
- Firefighters-Granada responding to a broken water pipe.
- SAMUR (ALS and RRU) and Local Police responding to a child with traumatic brain injury (hit by a car).
- SUMMA-Madrid (ALS team/ALS ambulance) responding to a man with syncope (probably due a gastrointestinal bleeding).
- SAMU-Alicante (ALS team/ALS ambulance) responding to a bicycle accident.
- DYA-Elche (BLS ambulance volunteers) and Local Police responding to a woman with minor injuries and alcohol poisoning.
- SAMUR-Madrid (ALS and RRU), Local Police and National Police responding to a traffic accident (with alcohol poisoning).
- DYA-Bilbao/Vasque Country (BLS ambulance volunteers), Local Police (Udaltzaingoa in Vasque Languaje) and Regional Police (ertzaintza in Vasque Languaje) responding to woman with drugs poisoning.
- DYA-Bilbao (BLS-volunteers) and Local Police responding to a girl with alcohol poisoning.
- SUMMA 112-Madrid (ALS) and Firefighters responding to a young man (traffic accident)
- SUMMA 112-Madrid (ALS and RRU) responding to a woman who had an attempted sexual assault.
- Madrid 112 Dispatch Center.
- SAMUR-Madrid (ALS and RRU) and National Police responding to a cardiac arrest.
- Rescue ski patrol (Sierra Nevada, Granada).
- SUMMA 112- Madrid respondig to a man with minor injuries (traffic accident).
- SUMMA 112- Madrid responding to a woman with a syncope.
- SAMUR-Madrid (ALS and RRU) and Local Police responding to a man hit by a motorcycle.
- SAMUR-Madrid (ALS and RRU) and Local Police responding to a driver who had a cardiac arrest and after he had a car crash.
- SUMMA 112- Madrid (ALS) and Local Police responding to an old man with minor injuries (for a fight).

TV show summary (30 seconds)
[YOUTUBE]nJuoAzilAv8[/YOUTUBE]

I hope you enjoy it.

 

[diprinz2]

muchos gracias para la informacion no pude encontrar informacion sobre vuestro systema de ambulencias hasta encontre este post. pero tengo algunos preguntas para usted. Trabajo para una compania ambulencia privada, En mi ciudad todos de los bomberos son EMT Intermidiates (es una nivel entre un paramedico y EMT-B, pueden intubate (no se como se dice en espanol) emprezan IV y dar algunos drugas por IV) .Y ellos responden a casi todos de las llamas de emergencinas. En espana los bomberos responden a las llamas tambien o solo una ambulencia? Y piensa k es necesario para un doctor y un enfermero estar en una ambulencia, o los doctors y los enfermeros serian un mejor uso en los hospitals. In Reno the hospitals are always short nurses and are constantly hiring new nurses, i do not think that if the city requiered a nurse to staff the ALS units they would have enough to do so. Sorry about the spanish but i do not get to speak it much and like to try and practice when ever i get a chance. This is all very interesting to me to see the differences between how different countries do EMS aswell as the similarites (we have the exact same monitors as the crews in your video do). Thanks for all the great information

 

[jlc]

Hi! Hola!

pueden intubate (no se como se dice en espanol)

"intubar" or "entubar". Se usa más "intubar" que "entubar".

En espana los bomberos responden a las llamas tambien o solo una ambulencia?

EMS don't rely on Fire Departments. EMS usually dependent on Health Department. However, some F.D. have their own ambulances (BLS, ILS with f.d. nurse or ALS with F.D. doctor and nurse), for fires, accidents,... Then, the firefighters on ambulances have an EMT-B course.

F.D. Catalonia. Ambulances:

Y piensa k es necesario para un doctor y un enfermero estar en una ambulencia

Is it necessary? No, it's different. Each system has its advantages and disadvantages.

Each country has developed its system in different contexts.
U.S. had a shortage of doctors/nurses and created the profession of EMT-paramedic. This profession has grown in many countries. In many of them, there are different levels of EMTs. The higher level of EMT are moving to university degrees/bachelors in paramedic (Australia, some countries in South America, NZ ,...) because people demand more and better professionals. In the future, many of the countries that use the Anglo-american system have a bachelor in paramedic sciences or emergency sciences for their paramedics.

Here, in Spain, there have not been a shortage of doctors or nurses (now beginning to be a shortage of doctors), so our system has developed differently than the American system. We have well-trained nurses, and here they are accustomed to seeing the prehospital work as part of their scope of practice. So, here, it is not necessary to create a university degree of paramedic sciences. It's easier (and cheaper) to train postgraduate nurses in PH.

For example, in Netherlands, all paramedics are RN trained in prehospital; in Sweden, all emergency ambulances have, at least, a RN; in Finland, when someone is studying for a paramedic degree, get a double degree in paramedic and RN (It's valid throughout European Union as a RN).

In many countries of Europe, the role of the paramedic has been assumed by the prehospital nurse. They are not “hospital nurses” who are coming out. There are nurses inside and outside the hospital.

e.g. If someone wants to work in an ambulance and starts a IV line…
…In US (Canada, Australia, NZ…), he will become a paramedic.
…In Spain (Netherlands, France, Belgium,…) he will become a prehospital nurse.

Every country has their professions with their scope of practice (not only in prehospital; in hospital too).
E.g. here there is no phlebotomist or respiratory therapist or physician assistant. But there’s x-ray technician and laboratory technician and occupational therapist… The nurses do not usually move wheelchairs/beds/strechers in hospitals. Here, there are orderlies who are responsible for it (and carry the samples/tubes/documents to laboratory/departments,…). There are nursing assistants who are responsible for basic tasks (hygiene, nutrition, mobilization,...), allowing nurses (R.N.) to deal with more advanced tasks.

And doctors?
Here, people prefer that doctors attend the most serious cases. In our system, many cases are resolved in the patient's home. Not all cases are transferred to hospital. For example, a doctor may decide to treat supraventricular tachycardia in that place and if resolved, may decide not to send him to hospital (depending on the clinical history). In addition, doctors are free to choose drugs, dosages and treatment, without being limited by a protocol (We have the same drugs in an ALS ambulance than in ER… but we haven’t X-ray in the ambulance yet ).

Due to the shortage of doctors, some predict that in the near future this type of response will be sent only for extremely serious cases, while the intermediate level with nurses will continue to develop, developing a mixed model medicalized (with doctors and nurses) and non-medicalized (with nurses), and, of course, a basic step (BLS) with EMT-B.

Sorry about the spanish but i do not get to speak it much and like to try and practice when ever i get a chance.

You have a good level of spanish. ^_^. However my english level... :blush: is worse :sad:

 

[NJmedic3250]

jlc- what would an American trained Emergency Room Nurse need to do in order to work in Spain as an EMS Nurse?

 

[jlc]

jlc- what would an American trained Emergency Room Nurse need to do in order to work in Spain as an EMS Nurse?

First, you must obtain equivalence on your American nursing credentials. Query, the Spanish Consulate or visit the website of the Ministry of Education:
http://www.educacion.es/educacion/universidades/educacion-superior-universitaria/titulos/homologacion-titulos.html (in Spanish)

To do this, you must speak Spanish.

In some regions you have to do a master degree in emergency nursing. However, if you have experience and training you can pass this requirement . In Madrid, the Lain Entralgo Agency verifies this (Register of EMS staff: EMTb, nurses, doctors, lifeguards):

http://www.madrid.org/cs/Satellite?c=CM_Tramite_FA&cid=1109168965990&definicion=Inscripcion+Registro&language=es&pagename=ComunidadMadrid%2FEstructura&pid=1109265444835&tipoServicio=CM_Tramite_FA (website of the Agency)

http://www.madrid.org/cs/Satellite?blobtable=MungoBlobs&blobcol=urldata&blobkey=id&blobheadervalue1=filename%3DTransporteHomologacion.pdf&blobwhere=1119161098040&blobheadername1=Content-Disposition&ssbinary=true&blobheader=application%2Fpdf (Form-pdf)

In many communities you don't need special requirements.
In others you will have to consult the requirements with the local EMS office.

There are different types of EMS management:

- In most communities, the service is run by Public Health Department. In this case, nurses are employees of the public sector. There are two types of public employment contracts:

• Permanent Employment (which has no time limit): jobs are awarded by competitive examination (exam + merits).
  
• Temporary Employment: It is awarded by merit list -waiting list, reserve list, holding pool… I don’t know how to say that in English- (experience, training, conferences, research papers...) Used for replacements of workers (pregnancy, illness, holidays, leave of absence...) or until that job is awarded by competition.

- In other communities, the EMS is managed by a public foundation or a public company, which provides requirements for jobs (usually by competitive examination).

- Only in some places part of the EMS is managed by private companies. In this case the nurses are employed by curriculum, personal interview, etc.

There are private companies that perform patient transport for insurance companies (interfacility transport), repatriation, preventive services, etc.
But the most EMS are public services, so most of nurses are public employees (for Public Health Department, or Public Foundation, or Public Company).

Each region manages the service differently. Some have their own vehicles and staff. Others outsource (subcontract) the vehicles and some staff to private companies (usually the vehicles and the BLS staff are contracted out and the ALS staff are civil servants –public EMS employees).

So it is very difficult to get a job as an EMS nurse. When there are multiple vacancies, Health Department announces a competition (exam + merits). This can happen every 2 or 3 years. Sometimes the EMS jobs are announced along with the hospital jobs (ER, ICU...), and employment candidates choose the job in order of score. Only nurses who have studied for the examination who have high experience and training can get a permanent job.

Meanwhile, most nurses begin in temporary jobs to accumulate points (for experience). For that, they sign on waiting list of EMS (reserve list, holding pool…). If you have many points you can work continuously covering vacancies. You can get a long term temporary work (for several years) in newly created jobs until the announcing of the exam competition, or covering a leave of absence, etc. But to get a permanent job (forever) you have to pass an official competitive exam.

 

[NJmedic3250]

Well first off, thank you so much for getting back to me. This is some great information. I do have to say after reading what you have written, and doing some research on my own, the system you have out in Spain is very interesting. I was just interested in seeing what it would take to become employed out there. Thanks again.

 

[Dreadnought]

I spent a month in Alicante studying Espanol at the Universidad de Alicante and I absolutely loved almost everything about the experience, city and country included.

Your posts have been extremely thorough and insightful. Thank you for all of this great information, it is very interesting.

As a quick afterthought, what is your opinion on, for instance, a citizen of the USA relocating to Spain in order to pursue EMS work? Obviously the person would have to be well versed in the language, but how do you suppose they will be treated within the EMS system? Would there be a preference for Spanish citizens (as it would be understandable; more understanding of culture, law, and country)?

Thank you!

 

[Mex EMT-I]

Alo.

Gracias por la información, siempre es sumamente interesante conocer los servicios de emergencia de otros paises.
Yo soy de Mexico y aqui nuestro sistema va años luz detras del de cualquier país desarrollado.

Una pregunta, la cruz roja de españa tambien brinda servicio de ambulancias?

Muy buenas fotos.

Saludos desde la tierra del nopal.

 

[jlc]

As a quick afterthought, what is your opinion on, for instance, a citizen of the USA relocating to Spain in order to pursue EMS work? Obviously the person would have to be well versed in the language, but how do you suppose they will be treated within the EMS system? Would there be a preference for Spanish citizens (as it would be understandable; more understanding of culture, law, and country)?

I'm sorry I did not reply soon. :blush:

Public Jobs:

There are no privileges for Spanish Citizens. The scoring matrix is public and objective. Nobody gets more points for being Spanish.

The scoring matrix doesn't score the nationality, it only score experience and training.

e.g. Scoring Matrix (temporary nurses jobs recruitment for the public EMS of the Autonomous Community of Aragon):
Experience:
- ICU or EMS in Public Services (Spain or EU): 0.25 points per month
- ER or Urgent Care in hospitals or in Primary Care Centers (Spain or EU): 0.20 points per month
...
Training:
- Certificates or training courses accredited by the National Training Committee of the Ministry of Health (or by Universities or by Public Health Offices): 0.20 points per credit (1 credit = 10 hours)
- CEN (by Spanish Society of Emergency Medicine): 4 points.
...
etc.

About nationality, there are general requeriments for public jobs (for all public departments):

- Be a citizen (Nationality / citizenship) of the European Union.
http://en.wikipedia.org/wiki/Citizenship_of_the_European_Union

Article 45 of the Treaty on the Functioning of the European Union states that
1. Freedom of movement for workers shall be secured within the Union.
2. Such freedom of movement shall entail the abolition of any discrimination based on nationality between workers of the Member States as regards employment, remuneration and other conditions of work and employment.

Or

- To be a citizen of a state that has established a treaty with the European Union and ratified by Spain which is applied the free movement of workers.


Private Companies
The most doctors and nurses are Public EMS employees in Spain. However, many EMT-B are sub-contracted by private companies, so in that case the company has its subjective preferences for employed workers and they could prefer Spanish workers. But I think there isn't discrimination based on nationality because I know some EMT from Romania or Africa, nurses from Portugal and doctors from South America working for private EMS companies in Spain.

Gracias por la información, siempre es sumamente interesante conocer los servicios de emergencia de otros paises.
Yo soy de Mexico y aqui nuestro sistema va años luz detras del de cualquier país desarrollado.

Una pregunta, la cruz roja de españa tambien brinda servicio de ambulancias?

Muy buenas fotos.

Saludos desde la tierra del nopal.

Hola, es un placer encontrar aquí a alguien que habla mi mismo idioma.

In addition, there are non profit organizations like Red Cross or DYA who provide BLS ambulances (rarely ALS ambulances) with volunteers for special situations (music or sport events, support to public EMS,…).

In all regions there is a public EMS with professional staff (not volunteers). However in some regions non-profit organizations as Red Cross provides emergency ambulances permanently as support for the public EMS. These ambulances are usually BLS units, because Red Cross usually hasn't ALS personnel (nurses and physicians) permanently. Red Cross provides ALS ambulances only for special situations.

In most regions, the Red Cross provides ambulance service as a booster to public EMS on holidays and weekends (no permanently, only when volunteers are available), and for preventive services (music concerts, sports, festive events, etc.).

 

[jlc]

Una pregunta, la cruz roja de españa tambien brinda servicio de ambulancias?

Muy buenas fotos.

Fotos/photos de voluntarios de Cruz Roja Española / Spanish Red Cross volunteers:

 

[Mex EMT-I]

Hey.

Hola JLC.

Muchas gracias por tu respuesta, y por tus fotos, estan increibles. Trataré de subir algunas de la cruz roja en México esta semana.

Saludos.

 

[llavero]

Also exists another corporation dedicated to the same thing, that my friend jlc has not mentioned, is the Volunteers' Group of Civil Protection (Civil Defense).

As his name indicates, it is a group of support to the forces of the State, acting when these need them like in floods, catastrophes, accidents, and also for preventive services (music concerts, sports, festive events, etc.). They possess services of ambulances, extinction of fires, lifeboats, helicopters, and more.

Not in all regions exists this corporation, and is managed by the Headquarter of Civil Protection and Emergencies (Department of the Interior, Government of Spain) followed by other minor corporations, and in some cases (not in all) Red Cross.





Sorry about the english but i do not get to speak it much.

 

[MrBrown]

Brown is highly impressed with prehospital medicine in the EU; it's so gosh darn sophisticated and you have really awesome looking uniforms!

Here in New Zealand (as of this year) we have three levels of prehospital emergency medical provider (the generic term is "Ambulance Officer" but I am trying to get away from using it as it is rather outdated).

Emergency Medical Technician
Diploma in Ambulance Practice (6-10 months)

- Oxygen, OPA/NPA, LMA, AED, aspirin, GTN, salbutamol, glucagon/oral glucose, ondansetron, paracetamol, methoxyflurane, IM adrenaline (consult)

Paramedic
Bachelors Degree in Health Science (Paramedic) (3 years)

- IV cannulation, 12 lead ECG interpretation, manual defibrillation, syncronised cardioversion, adrenaline, morphine, naloxone

Intensive Care Paramedic
Post Graduate Diploma in Intensive Care Paramedicine

- Ketamine, midazolam, atropine, amiodarone, pacing, frusemide (probably being withdrawn), rapid sequence intubation

Midazolam IM and IN will probably make it's way down to Paramedic level eventually. Some areas have cortisosteriods and CPAP but not all.