Hello blog readers! The plan I had set out for myself of “post a blog every two weeks,” as you can see, has been clompletely thrown out of whack, but now I am back at it! The hiatus is a result of three incredible weeks. I have managed to spend significant time in 10 different cities within two countries over the past 21 days. All through the help of one bus ride, four train rides, two flights, generous rides given by friends met along the way, and countless uses of public transportation. I have spent time scaling the sides of near-cliffs on remote islands, stayed up late making new freindships on a boat, and worked on four different ambulance crews in three different places. In the interest of space and your own time, I am going to break up all that has occurred: my post today will cover my time since arriving in Aarhus, where I left off last post, up to my departure to the Faroe Islands. Next week, as I am saying my last goodbyes to this wonderful place, I’ll have another post covering my trip to the Faroes, my last week here and one final excursion before I head off to Chile! How exciting! As of tomorrow, I will be arriving in Santiago de Chile in one week! That is unreal.
In my last post, I first discussed a topic that has become important to me. It is the question of perception and the ways individuals choose to define emergency. I hope while reading, you were able to reflect for yourself the ways you choose to use the word, when it may be justified, and when you may over-exaggerate a situation. There is no right or wrong answer to this, nor is there a judge deeming one person’s emergency more “real” than the next, but I think it is an interesting question for us all to consider.
Here is a recap of the my trip around Jylland and the adventured I had while away.
- Friday, September 8: Friday felt like a failed mission turned awesome. I started my day walking around Aarhus in hopes of getting in touch with someone within Falck. An unsuccessful first attempt left me with a few phone numbers that went unanswered and a new address. I looked onward and ultimately met some administrators of the Falck Midtjylland service. Unfortunately though, they were in the midst of a major overhaul internally, (this is partially due to a new major hospital being built in Aarhus) and they did not quite have the time to sit down and speak further. These things happen. With a rainy walk back to my hostel, I stopped to eat in the Latin Quarter. In the afternoon I found some trails to run on and lastly made plans with a guy my age named Frederik, who I met on Couchsurfing. We cooked dinner together and worked on the boat he and his dad owned. He was planning to move in! Frederick and I spent hours talking about everything from Health Care and politics to our families, our spiritual life, and where we are in the world. It was a special night.
- Saturday, September 9: Frederik, an Aarhus native, took me on a tour through the city and took me to the ARoS Museum, an Art Museum in the heart of the city. It was wonderful. Afterwards I ate at the Aarhus Street Market (I am finding that every major Danish city has one). Lastly, I ventured to Den Gamble By, The Old Town of Aarhus, which is basically an outdoor park/museum representing different buildings and customs of times past. Some houses were replications, while others were preservations of the real thing. There were even characters walking the streets dressed in traditional 17/18th century clothing. An afternoon run, and an incredible burger led into a night at the Atlas Venue where I watched Julie Byrne, an American Singer/Songwriter who was performing.
- Sunday, September 10: I started my Sunday by waking up in my hostel, packing and eating breakfast only to find that Julie Byrne, the woman I had just seen perform the night before, was eating at the table across from me. Small World! With a train ride to Aalborg, I was picked up by Jonas, a guy a few years younger than me that I had previously met at the wedding I attended in August. Jonas’s family graciously opened up their home to me for three nights. Jonas and I toured Aalborg by bike, went on a run together, and ate dinner with the family. Helle, Brian, Sofie, Jonas and Lukas were all so welcoming and accommodating. You couldn’t ask for better!
- Monday, September 11: On Monday I was picked up in Aalborg by a Paramedic named Kasper. The medics in Greve had helped set up a day to Ride-Along with him in Hobro, a small town south of Aalborg. I spent the day with Kasper in his Paramedic Fast Response Vehicle (More on this later) and got the chance to learn about the way the prehospital system works in the Northern Region. Thankfully, Kasper had also worked in the Middle Region, Midtjylland, which was where I had not had as much success gathering information. We covered that as well. The day flew by, but we remained stationary at the station. Although it was a rainy, foggy day, no call was received. I would later learn that the 12 hour night shift that Kasper was also on did not receive any calls either. I would be an oddly quiet 24 hour period, but in the larger scheme, thats something to be thankful for.
- Tuesday, September 12: Tuesday was spent with Sofie, the oldest daughter, who is my age. We drove to Skagen, the northern-most city in Denmark. First we walked out to Grenen, which is the absolute furtherst north you can be in Denmark. It is also the point where two seas collide (A picture below will show you!). While waves normally collide with the coast, at this point waves batter either side of the coast and then run into each other as the two sides of the beach meet at the very tip. We took our shoes off and put a foot in both sides. Afterwards we visited the Skagen Painters Museum, which holds some famous paintings from artists like Peder Severin Krøyer and Michael & Anna Archer. They had traveled to Skagen to paint in the late 1800’s because of the beautiful natural lighting the area produced. Before heading home we stoped and walked up Råbjerg Mile, a giant Sand Dune that is actually slowly shifting due to wind. It was a massive amount of sand in such an unexpected place! A stop for ice cream and a drive home, I spent my last night with the family again discussing life in Aalborg and life at home in the States.
- Wednesday, September 13: Wednesday was another travel day, I took the train to Esbjerg, which connected in Aarhus, and my AirBnB host was kind enough to pick me up. Turns out he is an American from Arkansas who has been living here in Denmark for the past 5 or 6 years. Michael is his name; he took me around the city center and we grabbed a beer at place called Dronning Louise (Translates to Queen Louise) and settled back at his place for the evening.
- Thursday, Septmeber 14: The paramedic, Kasper, who I had worked with in Nordjylland, helped me get in touch with some individuals who work for the Southern Region of Denmark’s prehospital system. In the morning I made arrangements to meet their service and talk to some medics on Friday, so I took the day to explore Esbjerg and the surrounding area. A run in the later morning past the giant Men at Sea Statues and a ferry ride to the Island of Fanø, the island just west of the city. Fanø is an extremely pleasant old town that is connected to the Wadden Sea, a world heritage sight because of its extremely long, wide, and flat beaches. I checked out the Fanø Bryghus and walked out to the Sea. It Was beautiful and so flat!
- Friday, September 15: On Friday, I traveled went to the ambulance station to meet some of the medics there. I got a tour of their facilities and spent some time talking with the medics both to learn about the work done in the Southern Region and hear about their perspectives on care. With a few hours left, I spent some needed down time in a coffee shop to translate some thoughts to paper on all I had seen in the week. Taking the train back, I met up with Bre Ayala, a Sewanee friend of mine who is abroad for the year teaching in Spain. She and a few friends had taken a trip to Copenhagen and we got to see each other! It was awesome.
- Saturday, September 16: On Saturday, I took a trip with the family to Møns Klint (It was so good to see them after being gone for 9 days!), which are these giant white chalk cliffs south of Copenhagen. Paige, a DIS student who gets the opportunity to spend time with the family I live with, also joined; the six of us explored the cliffs, picnicked outside, looked for fossils, and ate good ice cream before heading back to Copenhagen.
- Sunday, Septmeber 17: I woke up on Sunday, and it was a feeling I knew quite well: Race Day! The 17th was the day of the Copenhagen Half Marathon. I was excited and anxious to get out there and race. Morten had also signed up, so we ate a hearty breakfast and biked out to the race course. Separating, I met up with some of the Sparta Running group members. We warmed up and set out to race. The race was incredible: people lined the streets playing music and cheering. I ran with Frederik and Benjamin, who I frequently paced with in training. We kept a steady pace, but they pulled ahead of me as the raced waned on. I was uplifted by different people saying to me along the course, “Kom så, Mark!” It translates like it sounds, “Come on, Mark!” I finished in 1:14:12, good for 143rd place. I was extremely pleased and it was a huge PR (personal record) compared to my last half-marathon time. I was a little worried about what my running would look like this year, but I am so happy I have found a way to fit in training. It is a great way for me to center myself. I caught up with Frederik just before a giant storm developed over the finish area. Just in time, we made it under some tents as lightning, hail, and heavy rain fell down all around us. Sadly, the race hosts were forced to cancel the latter part of the race due to dangerous conditions. Lightning had stuck the electrical system and even a few people received injuries from second-hand contact with a lightning strike. Morten, my host dad, managed to finish just before they called the race off (he also beat his goal!). We packed up and went home to get warm. The rest of the day was spent relaxing after a hard effort in the morning: coffee, good conversation, and good food with the family. If it isn’t apparent already, I am so thankful for Karen and Morten, and I am so happy I get to spend time with their children, Rune and Iben.
- Monday, September 18: After a hard rest from the run before, I woke up on Monday ready for my trip to the Faroe Islands! An 11:00 am flight left me with a little time to sleep in, a good breakfast, and a trip to the airport. I’m going to hold off here and not write more on the Faroes, but check back next week for another update! There will be much more to share!
Now, as always, how about some photos of my trip around Jylland, the cliffs, and the race?
Can’t have a blog post without some project updates! The rest of this post will to detail what I have learned about the 4 other regions in Denmark. Most of what I have spoken about previously on this blog, except recently with my time in Greve, has been about Copenhagen and the greater Capital Region, but there are four others, which are just as significant as the Capital Region. I learned in my week traveling, that although similar, and sometimes even with the same organizations running the ambulances, each region differs a bit. It’s good to keep in mind that what I have written previously about the Capital Region. Here you will find additional thoughts and notes on what is different.
For many things, the regions do things the same. Nurses or other health care professionals receive calls at call centers and then triage the incoming calls using the Danish Index, a triage system that categorizing severity. Upon arrival to the hospital, the management of care is also the same. I detailed the color system after my time in the Bispebjerg Hospital. Though it may not be exactly the same in every place, the structure is similar and the triage is used in the same manner: to get the highest priority patient seen first. Every Region, regulated by the health officials manage contracts for prehospital care. Various organizations make bids or offers that the region chooses for support. Even here with the Welfare System, it is clear that money is a key component, and the organization bidding the lowest contract with an adequate level of care will win. In the Capital Region, contracts are split between the Copenhagen Fire Brigade which mostly operates in the city, and Falck, which works in the more exterior regions of the city and the areas outsides of Copenhagen.
First, here is an online map showing the five different regions of Denmark:
The majority of the Region Sjælland is situated on the main island, but also contains numerous surrounding smaller islands, not all of which are accessible through roads. In the region, at any given time, there are 66 ambulances in service; 24 of which are staffed with at least one Paramdeic on board, which is what we, in the U.S. would equivalate to an ALS (Advanced Life Support) Ambulance. The other 42 ambulances are manned by at least one Level 2 Technician (Behandler), and either a second Level 2 or an Assistant. Additionally, there are 4 one-manned staffed Paramedic Response Vehicles, and 1 Physician Response Unit, like there are in the Capital Region, which consists of one physician and one paramedic. There are 6 First-Responder Units who are typically on shift with local fire departments. There is one Intensive Care Unit transfer vehicle, which consists of a Paramedic and Physician. They are staffed on call at the large hospital in Koge. The car has additional supplies necessary for ICU patients; during transport, the physician rides in the ambulance with the patient. Lastly, there is one of the three medical helicopters in Denmark that is stationed in the region. They are often used in transport and response to areas inaccessible by car, such as some of the outlying islands in the region; however, the helicopter is not limited to response within Region Sjælland, but will respond to any call necessary in the country that it is close to. The helicopter is staffed by physicians. Not in service at all times, a “Special-Lance” is stationed on stand-by for transport of oversized patients, full hospital beds if necessary, or incubation units for neonatal patients. There are not Social or Psyche-lance vehicles in the Region, but medics maintain a strong relationship with the Psychiatric centers for questions and communication when necessary.
The same principle between 112 and 1813 applies in the region, it is just that the 1813 number is different. Not that this is a major issue, but in the effort of having an even platform for regions, perhaps it would be nice to have a standardized second number in the same way that 112 is standardized in the country for emergencies.
There were two striking differences when I came to Region Nordjylland. They have to do with the level of care staffed, and the way in which contracts are assigned. It is different here than elsewhere in the country. First, to speak on cars and response vehicles, there are no requirements to have Paramedics on ambulances, and thus there are none because it saves money. Rather, the region pays for Fast Response Vehicles (FRVs) which I mentioned above and in my description of Region Sjælland. A Fast Response Vehicle is a one-manned vehicle that acts in a sense like a first responder. The car is equipped with all of the supplies you would find on a regular ambulance, as well as a additional medication and supplies because the vehicle is operated by a Paramedic. In the entire Region there are 5 of these vehicles and 2 Physician Cars, which staff a physician and paramedic. Certain calls require a FRV vehicle of Physician Car on scene. These are cases such as: Respiratpory Distress, Circulatory Complications, Heart Related Issues (suspected MI, chest pain, cardiac arrest), Severe Bleeding, Stab & Gunshot Wounds, Unconsciousness, Suspected Trauma, Overdose, Seizure, Falls greater than 4 meters, and Traffic Accidents involving more than one person. Now, this may sound like a very broad spectrum of calls, but there are plenty of other criteria in which these paramedics are not dispatched (as witnessed by my silent observation day in the Region). The FRV responds in addition to a regular ambulance. Sometimes arriving on scene first, it is important that the vehicle has the necessary supplies. Upon arrival and placement of the patient in the ambulance, the paramedic can decide whether or not it is necessary to respond in the ambulance with the patient. This is important. Because there are so few paramedics in the entire region, choosing to ride with the patient takes one of these paramedics out of the mix. Of course, when necessary, this is understandable; however, if an initial call is received for chest pain, and it is determined that the pain is not a cardiac issue, but perhaps a muscle tissue problem, then not transporting would be of benefit to the greater population. If there is a suspected MI, myocardial infarction, more commonly known as a heart attack, then the paramedic must ride without question. Electrocardiograms, which are found on the ambulance, are able to help analyze heart rhythms and determine whether an MI has likely occurred or not. To me, this seems like a unique take on the use of paramedics. Kasper said that in general, if he uses his own medicine, which is only paramedics carry, then he will follow the patient.
Some additional pieces to the support system here. There are a few first responder units stationed as volunteers in areas with limited access. Region Nordjylland also has a helicopter stationed, and is manned by a physician. The ambulances in this Region have video cameras for live feed communication with the physician within the hospital. There is also speakers to play music, but as I learned, even though it is present, it is not often used.
Here are some photos of the FRV and my time in Hobro with Kasper.
The second large difference I noticed in this region is the way in which the contracts are divided. As I mentioned in in my description of Region Sjælland, the Region has a set number of ambulances at any given time. The Capital Region is also this way. I learned in Ballerup, an area on the edge of Copenhagen, that if an ambulance goes out of service, there is a penalty for every 30 minutes another ambulance is not put into service. There is a difference in the Northern Region. Region Nordjylland is regulated by average response time for the whole region, which is around 9 minutes and 30 seconds. Data is kept and compiled for every call received and every ambulance that responds. Penalties are applied when the service does not meet the average time over a given period. It was stressed at the station, as well as when I shared this information with the family I was stying with in Aalborg that this is a dangerous and a risky play with people’s health. It focuses more on saving money than on patients. The practice stands out against what I have been learning about the status of the Welfare State and the way the Danish Health Care focuses on equal access to all. This system of response time is deceiving. A response in Aalborg, the largest city in the Region may be rather quick, perhaps 2-3 minutes in some places, but a response in Hobro, where I was, may take between 15 and 20 minutes since the station has to cover a larger area. The quick response in the larger metropolitan areas drive down the average times and maintain the 9:30 average even though more rural areas are left waiting. A heart attack in a rural area is no less important than a heart attack in the city, and using the response time method takes more trucks off the road in order to save money. The caveat to this is that the region is able to upgrade and downgrade based off of statistical data on how busy the Region is. In the summer, the Northern Region sees an influx in tourism due to the beaches there. Based on this contract system the Region can upgrade the number of vehicles in service at a given time and then remove them during slower times of the year. This is a practice I will be interested in following up on to see if there are any changes in the years to come.
This section will be shorter than others, mostly because I only caught a glimpse of the system here. Similar to Sjaelland and the Capital Region, Region Midtjylland has bought contracts based off of number of units and not response times. I do not know the exact number, but there is something around 50 units in service, and only three have paramedics. Instead of Paramedic FRVs, the Region staffs 10 Physicians to serve as prehospital responders. In addition, the final prehospital helicopter is found in this region as well as a military helicopter which can be used when necessary. Kasper, who I worked with, stressed the challenges he saw during his time in Region Midtjylland. He expressed how expensive it is to staff 10 physicians instead of using paramedics. In the field, there are only so many resources that can be used, and though a physician may have a larger spectrum of knowledge, Kasper noted that a paramedics hands often are just as qualified in providing rapid, immediate medical interventions. Kasper and I discussed the pros and cons of this system versus the Northern Region and we talked about how if there were less physicians, the Region may be able to supply a larger amount of units for the same price, which would increase overall coverage of care.
Region Syddanmark also has a few unique aspects to their system, especially the history behind how they have formed. Just like in other regions, Syddanmark chooses their service based off contracts. A few years ago, the Region was run by Falck, like much of the other parts of Denmark, but a company called BIOS won the most recent contract. They are a Dutch company that entered the region once the contract was obtained. This posed some challenges. The medics who worked for Falck remained loyal to the company and choose to work elsewhere, and BIOS struggled to find employees. Bringing in Dutch employees was a challenge because of the clear language barrier. Eventually, BIOS went bankrupt in the area, and the Region was left in crisis without a functioning service. For this reason, the Region itself took over the pre-hospital sector and now runs the ambulances. They are the first of the five regions to do so and has currently been operating for one year. There are a few Falck stations that do remain in a small portion of the northeast part that borders Midtjylland, but otherwise the service is operated strictly by the region.
In Esbjerg, I had the opportunity to speak with a few medics at the main Esbjerg Station. They noted that they really enjoyed the change that has happened and they think that if you wait a few years and follow the changes in the system around the country, that more regions may follow suit and run their own service. This Region regulates their coverage based off of total numbers of ambulances in the Region, which is roughly 52-55 trucks on call at any given day. Their station had a map of all of the locations where ambulances are positioned.
Many of the medics on board Only hold the Level 2 (Behandler) qualifications, but the Region is beginning to implement paramedics in their trucks. Within the Region, there are 5 Physician Response Cars which consist of a doctor and paramedic team. Because the Region’s location, the southern border is extremely close to Germany. At times and when necessary, the Region uses the German Helicopter stationed across the border, and they have access to German Hospitals if, based off of the patient’s condition, it is better to transport them there due to time. Currently, the medics in Esbjerg have to drive severe patients to Odense, where the major hospital for the region is. As you can see on the map, it is quite a distance (roughly 130 KM). The new creation of larger Super Hospitals in the Region and elsewhere is supposed to help with this issue and long transport times that are a result.
As mentioned above, my time in Esbjerg allowed me to get some personal opinions of the control Region Syddanmark now has on the pre-hospital sector. It is good to note that these are opinions and not facts, and should be understood as such moving forwards. The medics in Esbjerg like the new system; they mentioned to me how it felt like a fresh start. At times they felt as if working with Falck was getting too “old school” in the way the administration worked with the employees, and that there was often too many restrictions on what medics could do. Currently, the medics working for the Region feel like the administration is more dynamic and that the access to treatment is more loose, which allows them to use the full breadth of their training in comparison to a limited approach. As the medics noted, I too will be interested in following along with this Region and whether they set an example towards style of pre-hospital care that other Regions may follow in suit.
. . .
That just about covers the four other regions and my time in Jylland. It was filled with many adventures and a lot of learning! The negative aspect that I heard echoed around the regions is the trouble with cross-regional communications. Each region, as I mentioned with the Patient Journal, uses the same technology, but each are set up on different servers. Thus information can not be as fluidly transfered or accessed when necessary. Perhaps a change in software would be an easy fix to this, but I could see how others would use this draw back as a reason for there to not be Regional lines around Denmark. Currently only time will tell.
Lastly, some question feedback (Sis!):
To follow up on a question from last post. Mary Kate asked about how much access medics have to your medical history through the Patient Journal. To my knowledge, there is not specific consent given, at least it is not done during transport, but perhaps it is something as a citizen you agree to? Medics scan patient’s ID or enter their number, and the journal entry is created. The information that medics can access is extremely limited, so its not like one medic can go in and see every documentation you have on your medical file. They’re limited to viewing the journal notes from past ambulance rides. Hospitals have their own patient journal technology in which the notes taken in transport are imported. Although they have access to it, they’re not necessarily going into the files and reading. On scene and in transport, there normally is not enough time to do so, but it can be helpful if the patient is a frequent caller, because it helps give a better understanding on the patient’s overall or long-term condition. Secondly, all this travel has left me without watching the video link you sent, but I will now :).
As always, thanks for checking in. Check back shortly for a new post detailing my trip and work in the Faroe Islands, as well as my last week in Denmark!