How do you define emergency? It’s an interesting question, right? You read in the news often, “(Insert City/State) has declared as state of emergency.” Driving along highways we read signs telling us how long Emergency Room wait times are. Sometimes, we even use the phrase, “it’s an emergency,” out of context. The word emergency and its meaning is often used in a spectrum of scenarios. Many a times, we also understand an emergency as the sudden onset of the unexpected that requires immediate need and aid. Hurricane Harvey was an emergency. Irma is an Emergency. Charlottesville was an emergency. Barcelona was an Emergency. The National Emergency Number Association reports that in the U.S. alone, there are more than 240 million 911 calls placed a year; thats over 650,000 calls per day in the U.S. So, we have emergencies such as Harvey, Irma, Charlottesville, and Barcelona, and then, on average, we have over 650,000 emergencies a day for individuals. On one hand you have emergencies that exist on the community, city, state, or national level. These are significant and must be addressed rapidly. On the other hand, you have emergencies that exist on the indivual, and perhaps familial level. These are significant and must be address rapidly.
Miriam Webster defines emergency as, “an unforeseen combination of circumstances or the resulting state that calls for immediate action; an urgent need for assistance or relief.” In a medical context, they define emergency as, “a: a sudden bodily alteration (as a ruptured appendix or surgical shock) such as is likely to require immediate medical attention [or] b: a usually distressing event or condition that can often be anticipated or prepared for but seldom exactly foreseen.” I would say these definitions sum up our general understanding for an emergency; however, what we are not told in these definitions is who gets to define, or determine, what classifies as an emergency.
A gunshot wound is an emergency. A hurricane causing unprecedented flooding is an emergency. A terroist attack is an emergency. A house fire is an emergency. A heart attack is an emergency. These are given, and generally fairly well understood to be what they are: emergencies; however, there are also grey areas. Subjectivity and context get involved. What may be an emergency for one person may not be considered too big of a deal for another. So how do we define emergency? We don’t; well, at least not entirley. Why? We can of course take into context the textbook definition as described above, but our answer ultimately depends on the personal involvements with the matter. Ultimately, this allows us to define emergency for ourselves. Often times we can agree with each other on what is, or what is not, an emergency. Other times things are a little more blurry.
Through this first leg along my Watson Year, this topic has come up a lot in conversation. Many medics I have spoken to in Denmark do not bother with defining emergency too strictly. Rather, they just respond. In my conversations with them, and now through some experience in the field here, I am learning that the majority of calls they respond to deals with a chronic issue, and elderly patient, or minor condition. Accordingly, the range 90-95% is thrown out to define how common these types of calls really are. The other 5 – 10%? Well, these are the calls we see in the media and in Hollywood; they are what we so easily think of when emergency response comes to mind. At least, these are what I used to so easily think about. During my time as an EMT in Sewanee, I began to see this, but I think I served for too short. a time to gain a true understanding of what a typical call volume looks like. With Emergency Medical Response, I am learning that a paradox often exists between medic and patient. For many calls, it can be easy to internally shrug the case off as, “just another one,” one that occurs numerous times out of the year, one that is easy to manage, one that you know by heart how to treat and care for. It is true, many times this is the case, but when you think about it from the patient’s perspective, the situation is completely different. This IS their emergency and it is everything for them: the moment they are in right now, lying on the floor, sitting in the stretcher, on the phone with the dispatcher. This is their emergency. Whatever has caused them to call and request an ambulance is severe enough to them that they need emergency assistance. Perhaps it is true that some cases may have been better handled by a personal trip to the doctors office, rather than expending resources, but one thing is clear: for the patient, it is their emergency; it is their world, and it has captivated them to the point in which they see no other option than to call 911, or 112 here in Denmark. The same goes for the bystander, the mother, father, son, daughter, partner, friend. At times in our lives, whether for ourselves or someone we care about, emergencies come to us, and we call.
These are some thoughts that have recently been on my mind as I have engaged in deeper conversations with both individuals in the medical field, with friends, family, and members who live within the community.
Before I get to far into the details of my project, how about some daily updates and photos? Skip on for just the photos or even further for more project oriented reflections!
- Wednesday, August 23: On the 23rd, I finished up my blogging and shared the past two weeks with you all!
- Thursday, August 24: A day at Den Lille Gule Kaffebar, reading Being Mortal, and reflecting on Gawande’s ideas about perceptions versus reality. In the recent chapter I read, Gawande focused on assisted living and how there is a perception shift as we age, but he showed that this shift is not as much correlated with age, as it your current condition. The perception he discussed is how we view our lives, what we want to do with them, how we want to spend our time, and with who? It made me think a lot about what is discussed above, and how our emergencies affect our perceptions.
- Friday, August 25: Plans for this day went out the door as I got more excited to see James in Prague. Dinner with Morten, a delayed flight, and a very happy reunion late on the 25th!
- Saturday, August 26: The 26th was an Adventure Day; James and I set out early to see Prague. We saw great sights, ate good food, drank good beer, and met some new friends while out in town. Throughout the day and evening, we walked through the Old Town, walked across the Charles Bridge, gazed at the St. Vitus Cathedral, ate Beef Goulash, and ended our evening in an underground bar called U Sudu.
- Sunday, August 27: James and I spent some time in a paddle boat on the river that runs through the city center and we walked around a large park called Letenské Sady, which was above the city and provided a beautiful overlook. We ended our evening watching the light fade from the city skyline sitting by the Prague Metronome.
- Monday, August 28: I said goodbye to James at the Train Station and had a final few hours in Prague to myself. I toured the Old Jewish Quarter, ate at Cafe Louvre, and hiked through (up) Petrín Park.
- Tuesday, August 29: I traveled back to the Ballerup Falck Station, interviewed with a paramedic, and spent the afternoon confirming a trip to the Faroe Islands!
- Wednesday, August 30: Following up from the 29th, I solidified my Faroe Islands trip and made plans for the final weeks in Denmark (They move by so quickly!) Wednesday kinda hit me that I have really spent a considerable amount of time here, and also that the my time left is fading. I took some extra time this day to reflect on where I had been and what I have been learning for myself so far.
- Thursday, August 31: This past Thursday I spent 24 hours at the Greve Falck Station in Region Sjælland. Initially thinking I was going to get maybe 8 or 12 hours to observe, I was offered the opportunity to stay on board for a full 24 hours, which is what the medics I observed were also doing. It was amazing. Some of my project updates today will focus on this day and September 6th.
- Friday, September 1: Having been up on the earlier side for a few calls with the medics in Greve, I spent Friday catching up and resting. A nice run, and a long nap got me back in sync. In the evening, I went to the Denmark vs. Poland World Cup Quilifier. Denmark won 4 – 0!
- Saturday, September 2: On Saturday I had the desire to get out somewhere, but I had not quite planned far enough in advance. After a morning run I settled on Malmö, a 30 minute train ride into Sweden. I spent the afternoon and evening in the city, saw a beautiful sunset and met two students from the States. (We returned to Copenhagen and convinced their two other friends I was Swedish for about 2 hours – Don’t ask me for my accent, but my name was Sven).
- Sunday, September 3: Living into the “day of rest” my early Sunday was spent just this way. In the afternoon, however, I embarked on a 30km long run through the park I enjoy! I had my phone with me this time and was able to face time everyone in my family (check out the awesome photo below)! It was a fun way to catch up while showing them where I was!
- Monday, September 4: Monday looked similar to two weeks ago. I spent most of the day taking notes, transcribing recordings and preparing some thoughts to share with you guys!
- Tuesday, September 5: Today is a blog day! It may bleed a little into tomorrow but I plan to take the day to update you all! I’ll pause for a break and a run with the Sparta Group and will try to finish up this evening. Tomorrow I head back to Greve, another 24 hour shift is scheduled for me!
- Wednesday. September 6: Back to Greve I went for a 24 Hour shift with Falck. We had another great day, interchanging between calls, downtown, and some continuing education training.
- Thursday: September 7: Finishing up in Greve, I came come for a run, putting in some final thoughts for this blog post and a bus ride to Aarhus!
Before we get more into some project details, how about some pictures from the past two weeks?
It’s almost hard to know where to start! The two main things I want to share with you are about my time on two 24-hour shifts with a Falck Ambulance team, and the ‘Patient Journal’ System used around Denmark.
The Patient Journal:
The Patient Journal is an essential component to any medical system, whether that be a large hospital system, a general practicioners office, or within the ambulance. The Journal is the place to document patient history, to keep track of all of the past visits, treatments, medications, etc. It is what some may call, “your medical file.” In recent years, many, if not most systems around the U.S have shifted to a more electronic based system. This is really beneficial because it securely stores all the information in one place, and often povides a route for you to access it on your own outside of the doctors office, such as, a copy of your immunization record.
I have spoken previously about the integrated health system in place here, and the Patient Journal used on all ambulances is just another example of the the benefits of this integrated system. Before, when observing in the Emergency Room, I noted that physicians could access a a patient’s transport notes to see updates on the patient’s condition, vitals, etc. What I am describing here is the device and technology used to make the documentations. Here is a photo of the Journal used on Ambulances in Denmark.
I was really fascinated by this device. I had seen some electronic systems in the states before, even for ambulances, but nothing like this. It is important to note, however, that many places in the states may very well be using this same device or something like it! There are lot of great things that can be done with it: a bar scanner on the side can scan a patients ID and open their file, which contains information on past ambulance transports as well. Their ID number can also be entered manually and their file then accessed. Once ‘logged in’ for the patient on a specific call, you are prompted through a series of checklists that helps categorize and describe the nature of the call. There are places to enter medication administered, to register the patient’s current medications, and to write a follow-up narrative. Data collected periodically from the electrocardiograma (EKG) can be transfered using bluetooth technology. The back of the tablet has a camera which can take photos and be sent onward to the hospital prior to arrival if necessary. Once complete the information is stored and kept within the patient’s file. Medics cannot access a patient’s full medical history, which can be found at the hospital, but all the data entered while on a call can be transfered and entered into the patient’s larger hospital file. As said before, data entered during a call can be accessed in real-time by the hospital when necessary.
A perfect example I witnessed of the benefits of this system was during a call on my first Ride-Along in Greve. We responded to a suspected stroke patient, but due to the time it would take the patient to the neurological hospital, the medics I was working with would have worked well over a 24-shift. A second ambulance responded to transfer care and to transport the patient. As we waited for the 2nd vehicle, the medics I was with went ahead and started collectiong information: vitals, an EKG, a list of current medications, inserting an IV, hearing about the events leading up to the incident, etc. Meanwhile, all of this information was being entered into the Patient Journal. Upon the arrival of the 2nd ambulance, we transfered the patient and went on our way to finish the shift. There was no more transfer than the patient themself. The 2nd ambulance only had to access the patients file through their ID and the information was there and ready to be continued. This was really something that fascinated me, and spoke heavily about how the integration within the larger system here helps cut back on the risk of losing information or patients in transition of care.
48 Hours on the other side: perspectives from my first ride in a Danish Ambulance:
What a 48 hours it was! I first want to express my gratitude to Jan, the paramedic who worked on getting this set up for me, and his partner, Just, a Level 2-Technician who stayed on with me for 24 hours after Jan finsihed his 8 hour shift. Both have been extremely helpful and I owe a lot to them for their patience, acceptance and hospitality. They always took a moment to follow up with me on calls (as they are clearly all in Danish while on scene and in transport!). Both times, yesterday, and on the 31st of August, I worked with Jan and Just. Thirty minutes into my first shift in Greve, we received a call. There I was, sitting in the back of in ambulance…in Denmark. Lights and sirens were flashing and sounding off around us; we were responding to an undetermined stroke or seizure – the dispatcher was unable to understand fully the nature of the call and decided to send us – Triage 1 – a different level system than in the Capital Region, but essentially the same as an “A” call, where lights and signs are required. I could hardly believe where I was. Memories of my time in Sewanee as an EMT quickly resurfaced throughout the day, and excited anticipations of what this year may hold came to the forefront of my mind.
I added such a long introduction at the beginning of this post because the concepts I was discussing were reflected so often in our work and the observations I made. I wanted to pose the question to you all, “how do you define emergencies,” because this question was on my mind both of my days at the station and while on calls. I asked this both for myself and with curiosity for the patient. Jan, Just, and I discussed these conditions often after. We discussed how the patient responded, and how the family that we often encountered acted. I won’t get into great details of each cal; they’re what you may see anywhere and not specific to Denmark or Greve. You are just as likely to find a case of stroke, seizure, hip dislocations, depression, atrial fibrillation, elderly pneumonia, etc. in Greve, as you will in Charlotte, NC or Sewanee, TN. These types of events happen everywhere.
It is true that I do not have a large amount of information or experience in which I can start making comparisons (I think this will come as the year progresses and I see more), but it was clear to me that these guys, and their collegues at the station, were there because they wanted to be. Their impact on the patients was felt, even across the language barrier I face. Tone and body language transgress and revealed to me empathy: the key component necessary for proper treatment. Even with all the tech and supplies that the ambulance provides, Just noted that it doesn’t get you very far if you cannot treat the patient on a personal level. A simple touch, a smile, or a distraction through conversation goes a long way when someone is faced with a stressful situation. Jan and Just were doing just that and it was amazing to see.
Emergencies come to all of us at some point, in some capacity or another. Medics like Jan and Just are here in Denmark ready to respond to them. They are ready to care for those who call, no matter the level of seriousness in their mind. When I embarked on this year, I led with the question, “how do various systems of emergency care around the world operate, establish trust, provide security and ensure well-being for the individuals around them?” For one, they’re using the best of their resources, which in this area, as I have spoken, is really well provided for, but more importantly, they are doing the hard work. They are doing the kind of work that makes you leave dinner after only a few bites, or that wakes you up at 3:00 am after just a few hours. They are showing up…and they are doing more than just medical treatment; they’re caring for people in every sense of the word, and for whichever emergency the patient on their stretcher finds themselves.
Before we close, here are a few photos of myself and my time in Greve.
What’s ahead? As I have mentioned, time is moving fast! Tonight I arrive in Aarhus, the second largest city in Denmark, for three nights. I have been told that Aarhus is the cultural capital of Europe (I feel like some may argue that), so I am excited to see what is there! I hope to find some stations around the city to talk to, and also speak to some locals about care in a different Health Region! Following Aarhus, I will travel to Aalborg in the Nordjylland, the northern part of the country. I will also get three nights there and a 12-hour observation shift with a paramedic in a neighboring town! Following Aalborg, I will head southwest to Esbjerg in Region Syddanmark. With only two nights I hope to mix some sightseeing and project learning. I will head back Friday evenin on the 15th of September and will take a day trip to Møns Klint, the white chalk cliffs of Denmark, with my host family. On the 17th, I run the Copenhagen Half Marathon, and on the 18th a fly to the Faroe Islands for a week to learn about the health system there and gain perpesctives on healthcare within an isolated community. By the time I return, I only have 8 days left in Denmark…one of which is already set back in Greve for another day of observation! It is hard to believe all that is ahead, but I am so excited for the next few weeks and all that I will see, learn, and do.
Thanks for checking in, bearing with what at times may feel like rambling, and being interested in all that I am learning! Last time I asked for feedback, questions, or suggestions, and I will do the same now. Send your thoughts my way if they come to you!
Mary Kate, my sister, asked a few in my last post. This current blog doesn’t focus too much on those questions, but in brief here are some thoughts: Are Ambulances standardized in the states? — To an extent, yes. There are certain quality assurance regulations that an ambulance, or the company running the service, must abide by, but there is still some deviation from ambulance to ambulance, or company to company. There are so many ambulance services around the States; I couldn’t even begin to name them all! A benefit for Denmark is their size, there just isn’t a huge need for so many different services. In the U.S. ambulances are regulated by the Deaprtment of Transportation (a little odd if you ask me), and are regulated both federally and on the state level. This feeds into the second question: Is their a hierarchy of care in the U.S? Yes, but again, it isn’t the same everywhere. It does, however, follow a similar path. The National Registry of EMTs, NREMT, provides licensure on a national level. To receive this license, you must pass a test and have an approved practical examination. There are different levels you can receive: First Responder, Basic EMT (EMT-B, or just EMT), Advanced EMT (AEMT), and Paramedic (EMT-P). One example of how there are some differences can be found in Tennessee, which used to have three levels: EMT-B, EMT-IV (where you could administer intravenous therapy), and Paramedic. They recently switched to the national structure and changed EMT-IV to AEMT, which added some new skills to an EMT-IV’s knowledge base. Lastly, Mary Kate, you asked about the Social Ambulance — Something I am still working on. I have had some trouble getting a hold of them and their location within the Copenhagen is proving to be elusive! Following my travels, I will keep searching. I do know, however, that this is a service not provided nationally, or even regionally. It is something provided by the Copenhagen Commune, which is essentially the city government. Thanks for asking, sis!
Until next time,