Chilli con carne and compound leg fractures

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A grey car with a young couple has crashed directly into a wall and is now a crumpled wreck. The police are already at the scene when the emergency physician and the ambulance arrive.

The young female passenger has been flung out of the car. She is conscious but has a broken neck and the emergency physician immediately tells the paramedics to stabilise her head and neck.    

In the car, the male driver is still sitting in the driver's seat. He is having difficulty breathing and has open wounds to the leg and face that are bleeding heavily. 

Fire & Rescue personnel have now arrived on site. They are told to cut the roof off the car with an electrical metal-saw before they lift the young man out of the car together with the emergency physician. 

Her name is Sarah Isak Julin and she is a ninth semester medical student, and right now, also the person giving instructions to the paramedics, firefighters and police at the scene of the accident. 

"The driver was critical so we had to get him out quickly. But I assessed that it was necessary to cut him free first in order to protect his back as much as possible," she says.

Together with 24 other medical students from AU, Sarah Isak Julin is taking part in the "prehospital services" course, which is completed with a practical training day at the Kirstinesminde Emergency Management Centre a little outside Aarhus.

Make the police wait

In the role of emergency physician the young medical students must keep a cool head and direct both fellow students and the experienced professional personnel taking part in the training day.

"I actually think it went well with finding out what was happening and staying calm," she says, though there was a moment of doubt when an impatient policeman wanted civil registration numbers and blood samples from the accident victims in the middle of everything. 

But the police had to wait because the medical personnel make the decisions here. The "impatient" policeman from East Jutland Police makes the same point when he evaluates the training with the students.  

"Police and ambulance personnel can sometimes have plenty of questions they want answered, but that’s not your job. You can always say that you don’t have time now. You're the ones who have to decide what is important. Make sure you show that you are the ones who decide out there. That makes it easier for everyone," he says.

Misery loves company

The students are divided into four teams. During the day they will all experience four different accident scenarios at the training site, which is a dystopian urban landscape with collapsed houses, burning buildings and worn-out car wrecks.

The victims are played by healthy teenagers made-up with theatrical blood, artificial wounds and black ink that looks like soot from a fire.    

"Of course this is never going to be completely realistic, but we try to create an artificial reality where the students get some insight into different types of patients," says the course organiser Ingunn Skogstad Riddervold before she is interrupted by a beeping walkie-talkie. A new round of accident scenarios are about to begin. 

"Yes, not exactly the same as holding a normal lecture," she says with a smile, while sirens from emergency vehicles start again around the training site.    

How will you react?     

During the lunch break the medical students have a chance to get their pulses back to normal. Seated at long tables, they sit next to the young accident victims who are happily scoffing chilli con carne, apparently unaffected by puncture wounds, compound fractures and collapsed lungs. 

This is the first time the course in "prehospital services" has been held and according to course manager Ingunn Skogstad Riddervold, it is crucial that the students get out of auditoriums and come to understand the pressure they must work under when faced with a you are in an emergency situation.

"You can read book after book, but when you are in the middle of a critical and difficult situation, it can be hard to know how you will react," she says and continues:

"Imagine you have to choose between a small child that has been injured and an old man. You will typically go to the child. But if you use a professional medical approach then you must examine both patients systematically and assess how critical their condition is and where you can save lives and make a difference."

The students will be tested in different roles – incident commander, emergency physician, doctor's assistant and paramedic – so they end up with practical experience of the collaboration between the various emergency services seen from several angles.  

"The incident commander or the emergency physician are the one’s with the ultimate responsibility, but they are not alone with the task at the scene of the accident. It is important to be able to benefit from the other resources and to get the collaboration to work. That requires good methodology and good communication," says Ingunn Skogstad Riddervold.

Extremely privileged

Speaking after a successful training exercise, medical student Nikolaj Dich says that having so much responsibility does not deter him. In the role of incident commander, he has just decided to send one of the two burn victims to the specialist burns treatment department at Rigshospital in Copenhagen.

"I like situations where you need to be able to keep your cool and see the big picture. Of course, it’s difficult to say whether it would be just as easy in reality. The first few times you’ll probably have to really concentrate to be able to keep calm,” he says.  

In addition to the final training day, the course has also included advanced resuscitation, a visit to the emergency medical dispatch centre, and an actual emergency response with the emergency physician vehicle and ambulance, with the student as an observer. Nikolaj Dich has no regrets about choosing the course. 

“I feel extremely privileged. We have met many competent people from various professional groups, who take our role very seriously. Even though it is role-playing, at the back of your mind you know it’s not really that far from here to what we could face once we’ve graduated.”

First time ever

This is the first time the elective subject in "prehospital services" has been held at Aarhus University. The course is aimed at medical students who want to work with the prehospital area as emergency physicians or incident commanders in the field. These are tasks that are traditionally handled by anaesthetists.

What are prehospital services?

Prehospital services in the Central Denmark Region were established in 2009.

Previously it was not common practice to have a medical doctor present when the ambulance responded. Generally speaking, it was a case of transporting the patient to the hospital.

Mainly because the treatment options for ambulance paramedics are limited. They are not allowed to give intravenous medicine and carry out advanced treatment.

But the medical staff from the pre-hospital can do this and they are able to respond in one the emergency vehicles or nine emergency physician vehicles. The emergency vehicles are staffed by nurses and paramedics, while there is a medical doctor and a doctor's assistant in the emergency physician vehicle.

"With the changes made to the healthcare system over recent years, the hospitals have been cut back and replaced with a mobile emergency response. In this way you send the doctor out to meet the patient faster," says Ingunn Skogstad Riddervold, who is responsible for the "prehospital services" course at Aarhus University. 

As from 2011, all calls to the Danish emergency telephone number 112 relating to acute illness and injury have been forwarded to the Acute Medical Coordination Centre’s emergency control centre. The prehospital healthcare staff are placed here and they are able to quickly assess the degree of urgency and decide which type of help should be dispatched.sonale, som kan hastegradsvurdere patienten og beslutte, hvilken form for hjælp der skal sendes ud.

Translated by Peter Lambourne