Rupert Boyce-Bown, who is a first aider with St John Ambulance, travelled to the region of Allgäu in Bavaria (Germany). He supported there the ambulance service of Johanniter Germany in a rural and mountainous area, stretching from the prealpine lands up to the Alps.
You will find here below the general impression from this special experience as reported by Rupert himself.
All pictures by Rupert Boyce-Bown
“I am a first aider with St John Ambulance in England and took up the opportunity of an exchange visit with Johanniter Germany and the ambulance service at Kempten in Bavaria. It was the last week of my university elective summer period before starting permanent employment, so a great opportunity.
My flight from Stanstead airport landed at 7.45am in Memmingen, a tiny little airport with room for about three planes of which we were the only one.
My contact had said he would try to arrange a pick up for me, and when I came through the airport there was someone in a Johanniter coat waiting for me. She drove me in a Johanniter car back to Kempten. Being a trained rapid response driver, and with no speed limits on German motorways, this was the first time in my life I have ever travelled more than 200 kmph by road!
She took me to the ambulance station which Johanniter share with the Bavarian Red Cross (they do the same things and even share the same duty as them, but they have their own garages, vehicles and team). My host for the week was Tillmann, a really friendly Johanniter paramedic who spoke great English and was delighted to practice it.
He took me to get me kitted out in the red Johanniter uniform, although I used my SJA boots, as they are a size 14 and not available everywhere!
And then literally five seconds after I had changed, I was whisked out on the first job.
It was a 15 minutes drive away, right on the edge of their ‘patch’. Interestingly, for all their road discipline, the German drivers don’t get out of the way of an ambulance on blue lights the way the English do.
When we arrived, the local GP and a Red Cross nurse were already there. I was surprised to find out that, although 99% of German ambulances are crewed by at least one paramedic, the service is still based on the idea that ambulance men are not clinical. The paramedics are still not allowed to perform any form of intervention without a doctor present, unless it is an emergency.
When we returned to the ambulance station I was shown around. The garage has four response ambulances (although a maximum of two are usually run at a time). But they have a LOT of specialist vehicles and equipment. They had three patient transfer ambulances, a disaster response team, a garage full of mountain rescue vehicles, a garage full of event first aid vehicles, a fleet of nurse-cars, a fleet of doctor-cars, emergency doctor response vehicles and even a boat!
Johanniter also do everything from nurseries to homeless shelters – also based on the site – as well as public training. I felt very at home, because we do all those things at St John Ambulance too, just not all on one site.
On my second day I met the crew at six am. The morning shifts in Kempten run from 6am to 2pm, which over the next few days I really learned to appreciate. By finishing at 2pm there is still a lot of day ahead of you to enjoy, and I did, visiting the local sites and enjoying the amazing alpine woods and meadows.
Because of the early start, I went with the crew to have breakfast at the local hospital canteen - rolls, ham, cheese, coffee, etc – and was amazed to find it only cost a couple of euros. Talk about a good staff discount!
We went to a few patient call-outs, and then I was shown around the emergency services control centre for Kempten. It was very modern and impressive, and they told me they have 18 emergency service helicopters within a half hour away that they can call on. But Tillmann made an interesting point – we may have fewer facilities in England, but they do work to a much higher standard. For example, London may have only two helicopters, but the service is pretty awesome. The 18 around Kempten provide the old “scoop and run” service – no special treatment, simply transporting patients to hospital for treatment.
I was also given a tour of the fire station in Kempten - one of three in the town, excluding the rural volunteer-run stations. They had 28 vehicles there that day. Alongside normal big fire engines, cranes etc they had natural disaster vehicles and vehicles with swappable modules. They just hook up whatever they need, so for example, for floods, they would connect the massive pump and the 3km reel of hose as thick as your thigh, and possibly the insta-inflatable sandbags unit. The fire brigade also had a large training centre, garages and their own workshops. All very impressive.
Back at the ambulance station, we washed the ambulance, inside and out, with soap and water, and then sat out in the sun until our next call came in. On average each ambulance does five, one-hour call-outs on an eight-hours shift.
My third day was German mothering Sunday, and Tillmann said because it was Sunday, and mothering Sunday at that, it was going to be quiet...
Well, there is a tradition that you should never use the Q word, and true to form, we had a very busy day.
We went to elderly people with dementia and falls, two psychiatric cases, a broken arm a head laceration with blood everywhere (from a small cut – she was ok) and even saw a car hit a cyclist on our way to pick up a patient, so stopped to check them out.
Interestingly, Germany runs a level of service that aims to let them get to allcalls within 12 minutes, even during peaks of demand, which means that normally there will be spare ambulances. Our English 999 service runs a service which can respond to all of the average demand level calls within 12 minutes. Not surprisingly, that makes for longer waits at the peak times.
My next day was also busy, this time with several younger people. There were two “frequent fliers” – patients who were well known to the ambulance service and the hospital for their recurring admissions. When we talked to them on the way to hospital, the stories they told about isolation and social pressure felt very much the same as we hear in England.
I was on the only bariatric ambulance in the region, and the next day we were called to do a patient transfer one hour away from Kempten as that region’s ambulance was in the workshops. The only difference between this and a normal ambulance is that it is equipped with a self-lifting trolley so it loads itself into the ambulance.
The usual ambulances still have manual lifting of the patient and stretcher into the ambulance. It meant all the ambulance crews were incredibly fit, but not surprisingly, they wanted tail-lifts like on English vehicles.
We eventually made it back to the ambulance station, but before the garage doors had even shut they were opening again and we were off. It was another busy, busy day, and the hospital was finding that too.
To my surprise, I found the hospital didn’t use a triage system. Walking patients go and sit in a waiting room. Those who can’t work would go into the queue of people on trolleys in the corridor, and they were taken from there first.
But I was also interested to learn that the ambulance people don’t have to wait around for hospital staff to give a handover to. While in the ambulance on the way to the hospital they do a write up on a tablet computer and send that on ahead of their arrival. When they arrive, they can give the name of the patient to the receptionist and the hospital has all the details, meaning the ambulance crew are free to leave much sooner. It means that there are no ambulances out of service because of queues.
The last thing I saw was a traumatic brain injury (the patient was OK), and that patient marked the end of my last shift with Johanniter – a fitting climax to a great week.
All in all I had a really enjoyable time with Tillmann and his Johanniter colleagues. So much was very similar to my experiences in England, and yet some things were so very different. The equipment is more modern and more plentiful than I am used to in either St John or the NHS, but the care and compassion of the crewmen is exactly the same. The patient problems are the same as in England, and the treatments and care given to them very similar too. The biggest differences between my base in Essex and Kempten, were really the geography and population density – alpine meadows and sparse population versus flat Essex landscapes and increasing development!
I would absolutely recommend the experience to any of my colleagues – it was a fascinating insight into what makes our services different and yet the same, and how St John, internationally, is one, big family”.