1.
Germany
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Germany, officially the Federal Republic of Germany, is a federal parliamentary republic in central-western Europe. It includes 16 constituent states, covers an area of 357,021 square kilometres, with about 82 million inhabitants, Germany is the most populous member state of the European Union. After the United States, it is the second most popular destination in the world. Germanys capital and largest metropolis is Berlin, while its largest conurbation is the Ruhr, other major cities include Hamburg, Munich, Cologne, Frankfurt, Stuttgart, Düsseldorf and Leipzig. Various Germanic tribes have inhabited the northern parts of modern Germany since classical antiquity, a region named Germania was documented before 100 AD. During the Migration Period the Germanic tribes expanded southward, beginning in the 10th century, German territories formed a central part of the Holy Roman Empire. During the 16th century, northern German regions became the centre of the Protestant Reformation, in 1871, Germany became a nation state when most of the German states unified into the Prussian-dominated German Empire. After World War I and the German Revolution of 1918–1919, the Empire was replaced by the parliamentary Weimar Republic, the establishment of the national socialist dictatorship in 1933 led to World War II and the Holocaust. After a period of Allied occupation, two German states were founded, the Federal Republic of Germany and the German Democratic Republic, in 1990, the country was reunified. In the 21st century, Germany is a power and has the worlds fourth-largest economy by nominal GDP. As a global leader in industrial and technological sectors, it is both the worlds third-largest exporter and importer of goods. Germany is a country with a very high standard of living sustained by a skilled. It upholds a social security and universal health system, environmental protection. Germany was a member of the European Economic Community in 1957. It is part of the Schengen Area, and became a co-founder of the Eurozone in 1999, Germany is a member of the United Nations, NATO, the G8, the G20, and the OECD. The national military expenditure is the 9th highest in the world, the English word Germany derives from the Latin Germania, which came into use after Julius Caesar adopted it for the peoples east of the Rhine. This in turn descends from Proto-Germanic *þiudiskaz popular, derived from *þeudō, descended from Proto-Indo-European *tewtéh₂- people, the discovery of the Mauer 1 mandible shows that ancient humans were present in Germany at least 600,000 years ago. The oldest complete hunting weapons found anywhere in the world were discovered in a mine in Schöningen where three 380, 000-year-old wooden javelins were unearthed
2.
Ambulance
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The word is often associated with road going emergency ambulances which form part of an emergency medical service, administering emergency care to those with acute medical problems. The term ambulance does, however, extend to a range of vehicles other than those with flashing warning lights. The term ambulance comes from the Latin word ambulare as meaning to walk or move about which is a reference to medical care where patients were moved by lifting or wheeling. The word originally meant a hospital, which follows an army in its movements. Ambulances were first used for transport in 1487 by the Spanish forces during the siege of Málaga by the Catholic Monarchs against the Emirate of Granada. During the American Civil War vehicles for conveying the wounded off the field of battle were called ambulance wagons, there are other types of ambulance, with the most common being the patient transport ambulance. These vehicles are not usually equipped with equipment, and are usually crewed by staff with fewer qualifications than the crew of emergency ambulances. Their purpose is simply to transport patients to, from or between places of treatment, in most countries, these are not equipped with flashing lights or sirens. In some jurisdictions there is a form of the ambulance used, that only carries one member of ambulance crew to the scene to provide care. In these cases a patient who requires transportation to hospital will require an ambulance to attend in addition to the first responder. The history of the ambulance begins in ancient times, with the use of carts to transport incurable patients by force, Ambulances were first used for emergency transport in 1487 by the Spanish, and civilian variants were put into operation during the 1830s. Advances in technology throughout the 19th and 20th centuries led to the modern self-powered ambulances, Ambulances can be grouped into types depending on whether or not they transport patients, and under what conditions. In some cases, ambulances may fulfil more than one function, Emergency ambulance – The most common type of ambulance, which provide care to patients with an acute illness or injury. These can be road-going vans, boats, helicopters, fixed-wing aircraft or even converted vehicles such as golf carts. Patient transport ambulance – A vehicle, which has the job of transporting patients to and these can be vans, buses or other vehicles. Response units may be backed up by an ambulance which can transport the patient, or may deal with the problem on scene. These can be a variety of vehicles, from standard cars, to modified vans, motorcycles, pedal cycles. These units can function as a vehicle for officers or supervisors, Fire & Rescue services in North America often staff EMTs or Paramedics to their apparatuses to provide medical care without the need to wait for an ambulance
3.
Health insurance
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Health insurance is insurance against the risk of incurring medical expenses among individuals. The benefit is administered by an organization such as a government agency, private business. According to the Health Insurance Association of America, health insurance is defined as coverage that provides for the payments of benefits as a result of sickness or injury and it includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment. A health insurance policy is, A contract between a provider and an individual or his/her sponsor. The contract can be renewable or lifelong in the case of private insurance, provided by an employer-sponsored self-funded ERISA plan. The company generally advertises that they have one of the big insurance companies, however, in an ERISA case, that insurance company doesnt engage in the act of insurance, they just administer it. Therefore, ERISA plans are not subject to state laws, ERISA plans are governed by federal law under the jurisdiction of the US Department of Labor. The specific benefits or coverage details are found in the Summary Plan Description, an appeal must go through the insurance company, then to the Employers Plan Fiduciary. If still required, the Fiduciarys decision can be brought to the USDOL to review for ERISA compliance, the individual insured persons obligations may take several forms, Premium, The amount the policy-holder or their sponsor pays to the health plan to purchase health coverage. Deductible, The amount that the insured must pay out-of-pocket before the health insurer pays its share, for example, policy-holders might have to pay a $500 deductible per year, before any of their health care is covered by the health insurer. It may take several doctors visits or prescription refills before the person reaches the deductible. Furthermore, most policies do not apply co-pays for doctors visits or prescriptions against your deductible, co-payment, The amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service. For example, a person might pay a $45 co-payment for a doctors visit. A co-payment must be paid each time a service is obtained. Coinsurance, Instead of, or in addition to, paying an amount up front. For example, the member might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%. If there is a limit on coinsurance, the policy-holder could end up owing very little, or a great deal. Exclusions, Not all services are covered, the insured are generally expected to pay the full cost of non-covered services out of their own pockets
4.
World War II
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World War II, also known as the Second World War, was a global war that lasted from 1939 to 1945, although related conflicts began earlier. It involved the vast majority of the worlds countries—including all of the great powers—eventually forming two opposing alliances, the Allies and the Axis. It was the most widespread war in history, and directly involved more than 100 million people from over 30 countries. Marked by mass deaths of civilians, including the Holocaust and the bombing of industrial and population centres. These made World War II the deadliest conflict in human history, from late 1939 to early 1941, in a series of campaigns and treaties, Germany conquered or controlled much of continental Europe, and formed the Axis alliance with Italy and Japan. Under the Molotov–Ribbentrop Pact of August 1939, Germany and the Soviet Union partitioned and annexed territories of their European neighbours, Poland, Finland, Romania and the Baltic states. In December 1941, Japan attacked the United States and European colonies in the Pacific Ocean, and quickly conquered much of the Western Pacific. The Axis advance halted in 1942 when Japan lost the critical Battle of Midway, near Hawaii, in 1944, the Western Allies invaded German-occupied France, while the Soviet Union regained all of its territorial losses and invaded Germany and its allies. During 1944 and 1945 the Japanese suffered major reverses in mainland Asia in South Central China and Burma, while the Allies crippled the Japanese Navy, thus ended the war in Asia, cementing the total victory of the Allies. World War II altered the political alignment and social structure of the world, the United Nations was established to foster international co-operation and prevent future conflicts. The victorious great powers—the United States, the Soviet Union, China, the United Kingdom, the Soviet Union and the United States emerged as rival superpowers, setting the stage for the Cold War, which lasted for the next 46 years. Meanwhile, the influence of European great powers waned, while the decolonisation of Asia, most countries whose industries had been damaged moved towards economic recovery. Political integration, especially in Europe, emerged as an effort to end pre-war enmities, the start of the war in Europe is generally held to be 1 September 1939, beginning with the German invasion of Poland, Britain and France declared war on Germany two days later. The dates for the beginning of war in the Pacific include the start of the Second Sino-Japanese War on 7 July 1937, or even the Japanese invasion of Manchuria on 19 September 1931. Others follow the British historian A. J. P. Taylor, who held that the Sino-Japanese War and war in Europe and its colonies occurred simultaneously and this article uses the conventional dating. Other starting dates sometimes used for World War II include the Italian invasion of Abyssinia on 3 October 1935. The British historian Antony Beevor views the beginning of World War II as the Battles of Khalkhin Gol fought between Japan and the forces of Mongolia and the Soviet Union from May to September 1939, the exact date of the wars end is also not universally agreed upon. It was generally accepted at the time that the war ended with the armistice of 14 August 1945, rather than the formal surrender of Japan
5.
German Red Cross
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The German Red Cross, or the DRK, is the national Red Cross Society in Germany. With over 3.5 million members, it is the third largest Red Cross society in the world, the German Red Cross offers a wide range of services within and outside Germany. GRC provides 52 hospitals, care for the elderly (over 500 nursing homes, GRC provides also 75% of the blood supply in Germany as well as 60% of the emergency medical services in Germany and first aid training. GRC headquarters provides international aid in over 50 countries in the world. The majority of active voluntary Red Cross members are part of the five voluntary societies of the German Red Cross, General Kurt W. von Pfuel was the Chairman of the Central Committee of the German National Red Cross during the Great War. One of the terms of the Treaty of Versailles prevented the DRK from having any involvement in military matters, as a result, during the Weimar Republic under the leadership of Joachim von Winterfeldt-Mencken, the DRK became a national organization focusing on social welfare. Shortly after this the DRK was informed that the head of the SA Medical Corps, on 11 June 1933 Frick was invited to speak at the Red Cross Day. He declared, The Red Cross is something like the conscience of the nation, together with the nation, the Red Cross is ready to commit all its strength for the high goals of our leader, Adolf Hitler. The DRK was quick to respond to the circumstances, indeed Winterfeldt-Mencken had always been opposed to the system of parliamentary democracy. The Workers Samaritan League, a humanitarian organization, had always been an unwelcome competitor to the DRK. Hocheisen very quickly arranged that it should be taken over by the DRK, the attitude of the ICRC towards the DRK’s exclusion of the Jews was later expressed in a letter written by Max Huber in 1939. According to him, the obligation of neutral treatment as foreseen in the Geneva Convention was to the victims of war. Despite Winterfeldt-Mencken’s professions of loyalty to the regime, they were not reciprocated, President Hindenburg was able to influence the decision, and selected Charles Edward, Duke of Saxe-Coburg and Gotha who was Queen Victoria’s grandson, rather than Hocheisen. He was already president of the National Socialist Motor Corps. Charles Edward became President of the DRK in December 1933, while Hocheisen became his deputy, not unsurprisingly, they did not work well together. By this stage there was no doubt about who was in charge, grawitz took a radical approach to his task. His ideal concept for the DRK was that of a structure which would fit itself organically into the laws of life in the National Socialist Third Reich. In the years after the Nazi takeover, as well as adopting Nazi salutes and symbols, rescue teams were trained in military conduct, basic concepts of National Socialism, genetics, racial hygiene and demographic policy
6.
West Germany
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West Germany is the common English name for the Federal Republic of Germany or FRG in the period between its creation on 23 May 1949 to German reunification on 3 October 1990. During this Cold War era, NATO-aligned West Germany and Warsaw Pact-aligned East Germany were divided by the Inner German border, after 1961 West Berlin was physically separated from East Berlin as well as from East Germany by the Berlin Wall. This situation ended when East Germany was dissolved and its five states joined the ten states of the Federal Republic of Germany along with the reunified city-state of Berlin. With the reunification of West and East Germany, the Federal Republic of Germany, enlarged now to sixteen states and this period is referred to as the Bonn Republic by historians, alluding to the interwar Weimar Republic and the post-reunification Berlin Republic. The Federal Republic of Germany was established from eleven states formed in the three Allied Zones of occupation held by the United States, the United Kingdom and France, US and British forces remained in the country throughout the Cold War. Its population grew from roughly 51 million in 1950 to more than 63 million in 1990, the city of Bonn was its de facto capital city. The fourth Allied occupation zone was held by the Soviet Union, as a result, West Germany had a territory about half the size of the interbellum democratic Weimar Republic. At the onset of the Cold War, Europe was divided among the Western and Eastern blocs, Germany was de facto divided into two countries and two special territories, the Saarland and divided Berlin. The Federal Republic of Germany claimed a mandate for all of Germany. It took the line that the GDR was an illegally constituted puppet state, though the GDR did hold regular elections, these were not free and fair. For all practical purposes the GDR was a Soviet puppet state, from the West German perspective the GDR was therefore illegitimate. Three southwestern states of West Germany merged to form Baden-Württemberg in 1952, in addition to the resulting ten states, West Berlin was considered an unofficial de facto 11th state. It recognised the GDR as a de facto government within a single German nation that in turn was represented de jure by the West German state alone. From 1973 onward, East Germany recognised the existence of two German countries de jure, and the West as both de facto and de jure foreign country, the Federal Republic and the GDR agreed that neither of them could speak in the name of the other. The first chancellor Konrad Adenauer, who remained in office until 1963, had worked for an alignment with NATO rather than neutrality. He not only secured a membership in NATO but was also a proponent of agreements that developed into the present-day European Union, when the G6 was established in 1975, there was no question whether the Federal Republic of Germany would be a member as well. With the collapse of communism in Central and Eastern Europe in 1989, symbolised by the opening of the Berlin Wall, East Germany voted to dissolve itself and accede to the Federal Republic in 1990. Its five post-war states were reconstituted along with the reunited Berlin and they formally joined the Federal Republic on 3 October 1990, raising the number of states from 10 to 16, ending the division of Germany
7.
Fire department
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Other life safety services, such as technical rescue, hazardous materials, and emergency medical services may also be provided by the agency. In the United States a fire brigade is the private firefighting organization of a company or enterprise, a fire department usually contains one or more fire stations within its boundaries, and may be staffed by career firefighters, volunteer firefighters, or a combination thereof. A fire department may provide fire protection or fire prevention services, whereby firefighters visit homes and give fire safety advice. In many countries fire protection or prevention is seen as an important role for the service, as preventing a fire from occurring in the first place can save lives. Fire departments are organized in a system of administration, services, training, and operations, for example, Administration is responsible for supervision, budgets, policy, Service offers protection, safety, and education to the public. Training prepares skilled people with the knowledge to perform their duties, operations performs the tasks to successfully save the public from harm. Larger departments have branches within themselves to increase efficiency, composed of volunteers, support, volunteers give advantages to the department in a state of emergency. Support organizing the resources within and outside of the department, research is to give advantages in new technologies for the department. A fire departments jurisdiction is organized by the body that controls the department. This comes from a municipality, county, prefecture, state, province, the most common type of government control is at the municipality level. The jurisdiction size and organisation would be set up by a department or the government in charge of these duties and this deals with the placement of fire stations, equipment, and personnel within the area of control. Fire departments periodically survey their areas and use the data for redeploying proper coverage. This data comes from time, range from station, and/or a population survey. This brings equal service to the community and gives the department efficient places to launch operations. The earliest known firefighting service was formed in Ancient Rome by Egnatius Rufus who used his slaves to provide a fire service. These men fought fires using bucket chains and also patrolled the streets with the authority to impose corporal punishment upon those who violated fire-prevention codes, the Emperor Augustus established a public fire department in 24 BCE, composed of 600 slaves distributed amongst seven fire stations in Rome. Fire departments were formed by property insurance companies beginning in the 17th century after the Great Fire of London in 1666. The first insurance brigades were established the following year, each company had its own fire mark, a durable plaque that would be affixed to the building exterior
8.
Order of Saint John (Bailiwick of Brandenburg)
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The Order is led by its thirty-seventh Herrenmeister, Prince Oskar of Prussia. Each of its knights, about four thousand men worldwide, is either a Knight of Justice or a Knight of Honor, although membership no longer is limited to the nobility, as it was until 1948, the majority of knights still are drawn from this class. The Order comprises seventeen commanderies in Germany, one each in Austria, Finland, France, Hungary, and Switzerland, with the Roman Catholic Sovereign Military Order of Malta, these four Alliance orders represent the legitimate heirs of the Knights Hospitaller. The Order and its orders in the Netherlands and Sweden. The SMOM, headquartered in Rome, admits only men and women of the Roman Catholic faith, in time, these landholdings were gathered into regional administrative divisions known as commanderies, each headed by a senior knight, or knight commander of the Order. The first commandery in the Germanies was founded in the mid-twelfth century, though separated from the Roman Catholic main stem of the Order of Saint John, the Bailiwick of Brandenburg continued to flourish. Admitting only noblemen, principally from the Germanies, the Bailiwick maintained hospitals and other institutions to care for the poor, the sick, and the injured. The horrific Thirty Years War devastated the Bailiwick, resulting in the deaths of many knights and he established a similarly named order of merit, the Royal Prussian Order of Saint John, in its stead. He announced his election to the head of the Order of Malta, during the course of the nineteenth and twentieth centuries, the Order created and supported more and more charitable activities. It now owns and operates numerous hospitals, ambulance services, old-age homes, after World War II, with the Neumark given by the victorious Allies to Poland, the Order moved its headquarters to Bonn, West Germany. After the reunification of West and East Germany, the headquarters were moved again, more than location of the seat of the Order changed in the aftermath of the Second World War. The Finnish commandery, however, remains a purely noble society, as do the now independent Swedish, there are three active classes in the Order, Commander, Knight of Justice, and Knight of Honor. These services are similar to the St. John Ambulance in many Commonwealth nations, all are carried out under the auspices of the Christian faith. Additionally, spiritual retreats and other activities of the Order concentrate on the spiritual formation, the cloak of the Order is plain black with a large, white, linen eight-pointed cross on the left breast. For most knights, the cloak is black woollen with a plain lining, the cloaks of most knights are closed only at the neck, but the Herrenmeister, Commanders, Honorary Commanders, and Knights of Justice also wear a long black cord called a cingulum. The insignia, also known as crosses of honor, are no longer bestowed by the Order automatically, Knights of Honor now must have rendered five years of service to the Order before a cross of honor is granted. Promotion to Knight of Justice requires at least seven years of distinguished service, the basic insignia of the Order is a white-enamelled Maltese cross. Each cross is worn from a black-moire,4. 5-centimeter-wide ribbon worn about the neck, all members of the Order may also wear a plain, Maltese cross as a star or breast badge
9.
Districts of Germany
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A German district is an administrative subdivision known as Landkreis, except in the states of North Rhine-Westphalia and Schleswig-Holstein where it is known simply as Kreis. Most major cities in Germany are not part of a rural district, in this context, those cities are referred to as Kreisfreie Stadt or Stadtkreis. Rural districts are at a level of administration between the German states and the municipal governments. They correspond to level 3 administrative units of the Nomenclature of Territorial Units for Statistics, previously, the similar title Reichskreis was given to groups of states in the Holy Roman Empire. The related term Landeskommissariat was used for administrative divisions in some German territories until the 19th century. The majority of German districts are rural districts of which there are 295, cities with more than 100,000 inhabitants do not usually belong to a district, but take over district responsibilities themselves, similar to the concept of independent cities. These are known as urban districts —cities which constitute a district in their own there are currently 107 of them. As of 2011, approximately 25 million people live in these 107 urban districts, in North Rhine-Westphalia, there are some cities with more than 100,000 inhabitants which are not urban districts, for example Recklinghausen, Siegen, Paderborn, Bergisch Gladbach, Neuss and Moers. Nevertheless, these cities take over many district responsibilities themselves, although they are part of a larger rural district. Midsize towns can perform particular administrative functions of the district as well, the classification as midsize town is usually based on a towns registered population, but varies from state to state. Aachen, Hanover and Göttingen retain certain rights of an urban district, urban districts have these responsibilities and also those of the municipalities. The district council is the highest institution of a district and is responsible for all fundamental guidelines of regional self-administration. This council is elected every five years, except in Bavaria where it is elected every six years. Usually the administrative seat of a district is located in one of its largest towns. However, district council and administrative seat of rural districts are not situated within the district proper. Most of those districts are named after this central city as well. Moers is the biggest city in Germany that is neither an urban district, in parts of northern Germany, Landrat is also the name of the entire district administration, which in southern Germany is known as Kreisverwaltung or Landratsamt. In urban districts similar administrative functions are performed by a mayor, rural districts in some German states have an additional administrative commission called Kreisausschuss
10.
Johanniter-Unfall-Hilfe
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The organisation was founded in 1952 in Hanover under the leadership of Rudolf Christoph Freiherr von Gersdorff. One of the reasons for its creation was the rise in injuries. As of 2008 the organisation had 28,300 active volunteers and youth members, among recent developments of JUH in Germany is the establishment of local and regional groups that provide first responder services on horseback. Johanniter-Unfall-Hilfe in Germany is organised in nine state chapters which comprise more than 200 associations on district and it has about 12,000 full-time and part-time employees and is supported by roughly 1.5 million financial donors. The Brandenburg Bailiwick of the Order of St John has been certified as a recipient of donations by Deutsches Zentralinstitut für soziale Fragen, Civil servants are another factor that contributes to JUHs economic success. More than 10,000 children and youths are engaged in the youth chapter Johanniter-Jugend. This youth chapter is a member of the Evangelical youth consortium in Germany, from 2002 to 2013 retired General Hans-Peter von Kirchbach was president of Johanniter-Unfall-Hilfe. Professor Horst Wilms is the chief physician. Johanniter-Unfall-Hilfe in Austria was founded on 21 June 1974 in Vienna, today JUH in Austria is member of the Vier for Wien ambulance association. Viennas four largest ambulance services (Red Cross, Arbeiter-Samariter-Bund Austria, JUH, JUH serves areas in Vienna, Orth an der Donau, Tyrol and Carinthia. These regions have different focuses though, while JUH in Vienna is primarily tasked with emergency medical service, the Johanniters in Tyrol are mainly employed with home nursing and patient transport. There is a nursing service A. I. D that is specific to Vienna. The Brandenburg Bailiwick of the Order of St John has been active for more than 20 years in neighbouring Poland where it has established 21 social care points. In the course of the expansion of the European Union in 2004, the relief organisation Joannici Dzieło Pomocy was founded. Together with the Polish Johanniter foundation it engages primarily in ambulance services, nursing, since its foundation, Joannici Dzieło Pomocy has recorded a constant growth which is thought to continue due to high requests in first aid courses. Johanniter-Unfall-Hilfe has bound itself to Christian charity, as a work of the Order of St John it sees its challenge in the needs and dangers of the people. The central motivation is humanitarian aid, emergency medical service, JUH operates 210 ambulance stations in Germany which are equipped with patient transport ambulances, emergency ambulances and emergency physician vehicles. Civil defence and disaster relief, this involves the response to major disasters
11.
St John Ambulance
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The active uniformed first-aiders known as the St John Ambulance Brigade or Community Services were introduced in 1887. There are now more than 500,000 such volunteers worldwide, the brand name and logo are owned by the Most Venerable Order of the Hospital of St John of Jerusalem with the international office located in London, England. Logos may vary in each country but always contain the eight-pointed Maltese Cross as the essential identifier, the membership aspect of St John Ambulance is largely ranked, and members fall into a hierarchical structure of reporting. Most members of St John Ambulance are not themselves members of the Order, Most notably, the Order of St John and St John Ambulance are non-denominational, so as to serve all. St John Ambulance works on a geographical nature than the Order. The legal status of each varies by country, province, state, county, territory. John Ambulance St John Ambulance in India St John Ambulance Ireland St John Ambulance of Malaysia St John New Zealand St John Singapore St. John Ambulance South Africa St, in cooperation with the Johanniter Orden, the Johanniter-Unfall-Hilfe was founded in 1952. In recent years, more national Saint John societies, not directly linked to the British St, as a result, Johanniter International today links sixteen national Saint John organisations all over Europe. In the phrase Order of St John, St is an abbreviation for Saint, the unusual name of the organisation has been known to cause confusion to members of the public, and many people often assume that the St John prefix indicates a church related organisation. In fact, in its form, the prefix refers to the Order of St John. The Orders mottoes are Pro fide and Pro utilitate hominum, the Priory of England and The Islands has recently replaced the Latin mottoes with a single English sentence, For the faith and in the service of humanity, which some see as a controversial move. However, in December 2006 it was agreed by Priory Council that this move should be partially reversed, the Order is not to be confused with the Sovereign Military Order of Malta or other members of The Alliance of the Orders of St. John of Jerusalem. There are also copycat organisations using the St John name which are not generally recognised by members of the Alliance of Orders of St John, Most of these are small Commonwealth islands, or countries in which there is only a minor presence. In countries such as Australia and Canada the Priory is a corporation whose purpose is to administer the Order of St John on behalf of its Prior. St John Ambulance training and volunteer / professional services are governed by Council Boards of DIrectors, as a voluntary organisation St John Ambulance is a community-based and community-owned charitable entity ultimately accountable to the community in which it operates. That said, the relationship between the Order of St. John and St. John Ambulance is not directly paralleled and this explains somewhat why a breakdown into Priories may not be tantamount to a breakdown of St John Ambulance. 10 July 1877, St John Ambulance Association formed to teach first-aid in large railway centres, june 1887, St John Ambulance Brigade is formed as a uniformed organisation to provide a First Aid and Ambulance services at public events. 14 May 1888, British Order of St John is granted royal charter by Queen Victoria,1908, By mutual agreement with St Andrews Ambulance Association, St John Ambulance Association ceased operating in Scotland but the Order continued to operate
12.
Order of Malta Ambulance Corps
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The Order of Malta Ireland - Ambulance Corps is a voluntary ambulance and first aid organisation operating in Ireland in affilitation with the Sovereign Military Order of Malta, founded in 1938. Its purposes include teaching first aid, providing ambulance cover at events, patient transport, community. The Sovereign Military Order of Malta has 5, 000+ volunteers throughout the island of Ireland and its headquarters are located in Saint John House,32 Clyde Road, Ballsbridge, Dublin 4, Ireland. The National Director of the Order of Malta Ambulance Corps is Comdr, in common with all members of the Ambulance Corps, John is a volunteer. He is assisted by two Deputy Directors, David Birchall KM & Brian Coote KM, a Chief Medical Officer Dr. Diarmuid Murray, and a staff with responsibility for different areas of ambulance corps work. The President of the Irish Association of the Sovereign Military Order of Malta is Richard Duc de Stacpoole, KM, who succeeded Sir Adrian FitzGerald, Bt. the Knight of Kerry, KM. Thirteen men were recruited by Professor OMalley, six sixth year students from St. Josephs College the Bish, Secondary School, Galway, two Scout Masters, and one lay member. These thirteen members were the members of the ambulance corps in Galway. The new recruits were enrolled on a series of First Aid lectures, the bandaging was taught by Theatre Sister Mary Shaughnessy. Examinations in First Aid were held in January 1938 and all were successful, in February 1938 First Aid services were requested for a National League match in Castlebar. The duties were allocated in alphabetical order meaning Burke and Coogan were first on duty, the first Officer in Charge of the Galway Unit was Sgt. A second unit was set up in 1939 in Kilkenny and since then the Ambulance Corps has grown in strength providing First Aid cover for many major sporting, the Ambulance Corps is a national organisation with 5,346 members involved in 86 units across the Island of Ireland. For administration purposes, the country is divided into regions which are managed by regional directors, each region consists of a number of units which deliver services at local level. The organisation operates over 165 ambulances, mobile accident and emergency suites, support vehicles, medical bikes, the organisations headquarters are located in St Johns House Clyde Road, Ballsbridge, Dublin 4. Within the building there are lecture halls for training and a command and control centre to coordinate vehicles. Through their youth section, Order of Malta Cadets accommodates for children aged 10–16 years, Cadets are trained in basic life saving skills, first aid, CPR and assisting with activities of daily living. The organisation provides a program of youth development and sporting activities for young people. Additionally, cadets are involved in the community helping the elderly, young senior members aged 17 and 18 have designated youth leaders to ensure they receive individual and appropriate support and guidance as they develop individually and within the Ambulance Corps
13.
Municipality
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It is to be distinguished from the county, which may encompass rural territory and/or numerous small communities such as towns, villages and hamlets. The term municipality may also mean the governing or ruling body of a given municipality, a municipality is a general-purpose administrative subdivision, as opposed to a special-purpose district. The term is derived from French municipalité and Latin municipalis, a municipality can be any political jurisdiction from a sovereign state, such as the Principality of Monaco, or a small village, such as West Hampton Dunes, New York. The power of municipalities range from virtual autonomy to complete subordination to the state, municipalities may have the right to tax individuals and corporations with income tax, property tax, and corporate income tax, but may also receive substantial funding from the state. Similar terms include Spanish ayuntamiento, also called municipalidad, Polish gmina, Dutch/Flemish Gemeente, in Australia, the term local government area is used in place of the generic municipality. Here, the LGA Structure covers only incorporated areas of Australia, incorporated areas are legally designated parts of states and territories over which incorporated local governing bodies have responsibility. In Canada, municipalities are local governments established through provincial and territorial legislation, the Province of Ontario has different tiers of municipalities, including lower, upper, and single tiers. Types of upper tier municipalities in Ontario include counties and regional municipalities, nova Scotia also has regional municipalities, which include cities, counties, districts, or towns as municipal units. In India, a Nagar Palika or Municipality is a local body that administers a city of population 100,000 or more. Under the Panchayati Raj system, it directly with the state government. Generally, smaller cities and bigger towns have a Nagar Palika. Nagar Palikas are also a form of local self-government entrusted with duties and responsibilities. Such a corporation in Great Britain consists of a head as a mayor or provost, since local government reorganisation, the unit in England, Northern Ireland and Wales is known as a district, and in Scotland as a council area. A district may be awarded borough or city status, or can retain its district title, in Jersey, a municipality refers to the honorary officials elected to run each of the 12 parishes into which it is subdivided. This is the highest level of government in this jurisdiction. In the United States, municipality is usually understood as a city, town, village, or other local government unit, in the Peoples Republic of China, a direct-controlled municipality is a city with equal status to a province, Beijing, Tianjin, Shanghai, and Chongqing. In Taiwan, a municipality is a city with equal status to a province, Kaohsiung, New Taipei, Taichung, Tainan, Taipei. In Portuguese language usage, there are two words to distinguish the territory and the administrative organ, when referring to the territory, the word concelho is used, when referring to the organ of State, the word município is used
14.
States of Germany
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Germany is a federal republic consisting of sixteen federal states. Since todays Germany was formed from a collection of several states, it has a federal constitution. The remaining 13 states are called Flächenländer, the creation of the Federal Republic of Germany in 1949 was through the unification of the western states created in the aftermath of World War II. West Berlin, while not part of the Federal Republic, was largely integrated and considered as a de facto state. In 1952, following a referendum, Baden, Württemberg-Baden, in 1957, the Saar Protectorate rejoined the Federal Republic as the Saarland. Federalism is one of the constitutional principles of Germany. After 1945, new states were constituted in all four zones of occupation, in 1949, the states in the three western zones formed the Federal Republic of Germany. This is in contrast to the development in Austria, where the Bund was constituted first. The use of the term Länder dates back to the Weimar Constitution of 1919, before this time, the constituent states of the German Empire were called Staaten. Today, it is common to use the term Bundesland. However, this term is not used officially, neither by the constitution of 1919 nor by the Basic Law of 1949, three Länder call themselves Freistaaten, Bavaria, Saxony, and Thuringia. He summarizes the arguments for boundary reform in Germany. The German system of dual federalism requires strong Länder that have the administrative and fiscal capacity to implement legislation, too many Länder also make coordination among them and with the federation more complicated. But several proposals have failed so far, territorial reform remains a topic in German politics. Federalism has a tradition in German history. The Holy Roman Empire comprised many petty states numbering more than 300 around 1796, the number of territories was greatly reduced during the Napoleonic Wars. After the Congress of Vienna,39 states formed the German Confederation, the new German Empire included 25 states and the imperial territory of Alsace-Lorraine. The empire was dominated by Prussia, which controlled 65% of the territory, after the territorial losses of the Treaty of Versailles, the remaining states continued as republics of a new German federation
15.
MICU
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They are staffed by highly trained doctors and nurses who specialise in caring for critically ill patients. ICUs are also distinguished from normal hospital wards by a higher staff-to-patient ratio and access to advanced medical resources, common conditions that are treated within ICUs include ARDS, trauma, multiple organ failure and sepsis. In 1854, Florence Nightingale left for a Crimean War, where triage, until recently, it was reported that Nightingale reduced mortality from 40% to 2% on the battlefield. In 1950, anesthesiologist Peter Safar established the concept of Advanced Support of Life, Safar is considered to be the first practitioner of intensive care medicine as a speciality. In response to an epidemic, Bjørn Aage Ibsen established the first intensive care unit in Copenhagen in 1953. The first application of this idea in the United States was in 1955 by Dr. William Mosenthal, in the 1960s, the importance of cardiac arrhythmias as a source of morbidity and mortality in myocardial infarctions was recognized. This led to the use of cardiac monitoring in ICUs. Hospitals may have ICUs that cater to a medical speciality or patient, such as those listed below. This specialty unit cares for patients who have not left the hospital after birth. Common conditions cared for include prematurity and associated complications, congenital disorders such as Congenital diaphragmatic hernia, pediatric patients are treated in this intensive care unit for life-threatening medical problems such as asthma, influenza, diabetic ketoacidosis, or traumatic brain injury. Some facilities also have specialized pediatric cardiac intensive care units, where patients with heart disease are cared for. These units also typically handle cardiac transplantation and postop care of cardiac catheterization patients if those services are offered at the hospital, patients who may voluntarily harm themselves are delivered here so they can be monitored more vigorously. Patient rooms are locked, preventing escaping, patients here are treated for aneurysms, brain tumors, stroke, rattlesnake bites and post surgical patients who have undergone various neurological surgeries and require hourly neurological exams. Many nurses who work within these units have neurological intensive care certifications, once the patients are more stable and off the ventilator, they are transferred to a neurological care unit. These are found only in hospitals certified in Trauma and have a dedicated Trauma Emergency Department equipped with a team of surgeons, nurses, respiratory therapists, and radiological staff. Patients are usually held in facilities for a limited amount of time. These units are also called step-down, progressive and intensive recovery units and are utilised until a patients condition stabilizes enough to them for discharge to a general ward. Surgical Intensive Care Unit, A specialized service in hospitals that provides inpatient care for critically ill patients on surgical services
16.
Intensive-care unit
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They are staffed by highly trained doctors and nurses who specialise in caring for critically ill patients. ICUs are also distinguished from normal hospital wards by a higher staff-to-patient ratio and access to advanced medical resources, common conditions that are treated within ICUs include ARDS, trauma, multiple organ failure and sepsis. In 1854, Florence Nightingale left for a Crimean War, where triage, until recently, it was reported that Nightingale reduced mortality from 40% to 2% on the battlefield. In 1950, anesthesiologist Peter Safar established the concept of Advanced Support of Life, Safar is considered to be the first practitioner of intensive care medicine as a speciality. In response to an epidemic, Bjørn Aage Ibsen established the first intensive care unit in Copenhagen in 1953. The first application of this idea in the United States was in 1955 by Dr. William Mosenthal, in the 1960s, the importance of cardiac arrhythmias as a source of morbidity and mortality in myocardial infarctions was recognized. This led to the use of cardiac monitoring in ICUs. Hospitals may have ICUs that cater to a medical speciality or patient, such as those listed below. This specialty unit cares for patients who have not left the hospital after birth. Common conditions cared for include prematurity and associated complications, congenital disorders such as Congenital diaphragmatic hernia, pediatric patients are treated in this intensive care unit for life-threatening medical problems such as asthma, influenza, diabetic ketoacidosis, or traumatic brain injury. Some facilities also have specialized pediatric cardiac intensive care units, where patients with heart disease are cared for. These units also typically handle cardiac transplantation and postop care of cardiac catheterization patients if those services are offered at the hospital, patients who may voluntarily harm themselves are delivered here so they can be monitored more vigorously. Patient rooms are locked, preventing escaping, patients here are treated for aneurysms, brain tumors, stroke, rattlesnake bites and post surgical patients who have undergone various neurological surgeries and require hourly neurological exams. Many nurses who work within these units have neurological intensive care certifications, once the patients are more stable and off the ventilator, they are transferred to a neurological care unit. These are found only in hospitals certified in Trauma and have a dedicated Trauma Emergency Department equipped with a team of surgeons, nurses, respiratory therapists, and radiological staff. Patients are usually held in facilities for a limited amount of time. These units are also called step-down, progressive and intensive recovery units and are utilised until a patients condition stabilizes enough to them for discharge to a general ward. Surgical Intensive Care Unit, A specialized service in hospitals that provides inpatient care for critically ill patients on surgical services
17.
General practitioner
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In the medical profession, a general practitioner is a medical doctor who treats acute and chronic illnesses and provides preventive care and health education to patients. A general practitioner manages types of illness that present in a way at an early stage of development. The holistic approach of general practice aims to take into consideration the biological, psychological and their duties are not confined to specific organs of the body, and they have particular skills in treating people with multiple health issues. They are trained to treat patients of any age and sex to levels of complexity that vary between countries, the role of a GP can vary greatly between countries. In some healthcare systems GPs work in primary care centers where they play a role in the healthcare team. The term general practitioner or GP is common in the Republic of Ireland, in these countries the word physician is largely reserved for certain other types of medical specialists, notably in internal medicine. Historically, the role of a GP was once performed by any doctor qualified in a school working in the community. However, since the 1950s general practice has become a specialty in its own right, the Alma Ata Declaration in 1978 set the intellectual foundation of what primary care and general practice is nowadays. The basic medical degrees in India and Bangladesh are MBBS, BAMS, BHMS and BUMS and these generally consist of a four-and-a-half-year course followed by a year of compulsory rotatory internship in India. In Bangladesh it is five years followed by a year of compulsory rotatory internship. The internship requires the candidate to work in all departments for a period of time. The registration of doctors is usually managed by state medical councils, a permanent registration as a Registered Medical Practitioner is granted only after satisfactory completion of the compulsory internship. The Federation of Family Physicians Associations of India is an organization which has a connection with more than 8000 general practitioners through having affiliated membership, in Pakistan,5 years of MBBS is followed by one year of internship in different specialties. Pakistan Medical and Dental Council then confers permanent registration, after which the candidate may choose to practice as a GP or opt for specialty training, Family Medicine residency training programme of Ziauddin University is approved for Fellowship in Family Medicine. In France, the médecin généraliste is responsible for the term care in a population. This implies prevention, education, care of the diseases and traumas that do not require a specialist and they also follow the severe diseases day-to-day. They have a role in the survey of epidemics, a role. They often go to a home when the patient cannot come to the consulting room
18.
Emergency department
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The emergency department is usually found in a hospital or other primary care center. In some countries, emergency departments have become important entry points for those without means of access to medical care. The emergency departments of most hospitals operate 24 hours a day, griswold also equipped police and fire vehicles with medical supplies and trained officers to give emergency care while en route to the hospital. Today, a hospital has its emergency department in its own section of the ground floor of the grounds. As patients can present at any time and with any complaint, triage is normally the first stage the patient passes through, and consists of a brief assessment, including a set of vital signs, and the assignment of a chief complaint. Most emergency departments have an area for this process to take place. Most patients will be assessed at triage and then passed to another area of the department, or another area of the hospital. Conversely, patients with serious conditions, such as cardiac arrest, will bypass triage altogether. The resuscitation area, commonly referred to as Trauma or Resus, is a key area in most departments, the most seriously ill or injured patients will be dealt with in this area, as it contains the equipment and staff required for dealing with immediately life-threatening illnesses and injuries. Typical resuscitation staffing involves at least one attending physician, and at least one and these personnel may be assigned to the resuscitation area for the entirety of the shift, or may be on call for resuscitation coverage. Examples of majors include chest pain, difficulty breathing, abdominal pain, Advanced diagnostic testing may be conducted at this stage, including laboratory testing of blood and/or urine, ultrasonography, CT or MRI scanning. Medications appropriate to manage the condition will also be given. Depending on underlying causes of the chief complaint, he or she may be discharged home from this area or admitted to the hospital for further treatment. Patients whose condition is not immediately life-threatening will be sent to an area suitable to deal with them, such patients may still have been found to have significant problems, including fractures, dislocations, and lacerations requiring suturing. Children can present particular challenges in treatment, many hospitals have a separate area for evaluation of psychiatric problems. These are often staffed by psychiatrists and mental health nurses and social workers, there is typically at least one room for people who are actively a risk to themselves or others. Fast decisions on life-and-death cases are critical in emergency rooms. As a result, doctors face great pressures to overtest and overtreat, other common variations include emergency ward, emergency centre or emergency unit
19.
9-1-1
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9-1-1 is an emergency telephone number for the North American Numbering Plan, one of eight N11 codes. Like other emergency numbers around the world, this number is intended for use in emergency circumstances only, in approximately 96 percent of the U. S. the Enhanced 9-1-1 system automatically pairs caller numbers with a physical address. In the Philippines, the 9-1-1 emergency hotline has been available to the public since August 1,2016 and it is the first of its kind in Asia-Pacific region. It replaces the previous emergency number 117 used outside Davao City,999 is used in the United Kingdom and many British territories. 112 is the equivalent emergency number used in the European Union, in the US, some carriers, including AT&T, map the number 112 to the emergency number 9-1-1. In the earliest days of telephone technology, prior to the development of the rotary dial telephone, to place a call, the caller was required to pick up the telephone receiver, sometimes turn a magneto crank, and wait for the telephone operator to answer. The caller would then ask to be connected to the number they wished to call, in an emergency, the caller might simply say Get me the police, I want to report a fire, or I need an ambulance or doctor. Until dial service came into use, one could not place calls without operator assistance. The first known experiment with an emergency telephone number occurred in the United Kingdom in 1937. Winnipeg initially used 999 as the number, but switched numbers when 9-1-1 was proposed by the United States. In 1967, the Presidents Commission on Law Enforcement and Administration of Justice recommended the creation of a number that could be used nationwide for reporting emergencies. The Federal Communications Commission then met with AT&T in November 1967 in order to choose the number, in 1968, the number was agreed upon. AT&T chose the number 9-1-1, which was simple, easy to remember, dialed easily, Bevill reportedly answered the phone with Hello. At the City Hall with Fite was Haleyville mayor James Whitt, at the station with Bevill were Gallagher. The phone used to answer the first 9-1-1 call, a red model, is now in a museum in Haleyville, while a duplicate phone is still in use at the police station. In 1968, 9-1-1 became the emergency number for the United States. Calling this single provided a caller access to police, fire. The number itself, however, did not become known until the 1970s
20.
Advanced life support
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Advanced Life Support is a set of life-saving protocols and skills that extend Basic Life Support to further support the circulation and provide an open airway and adequate ventilation. ALS assumes that basic life support are administered, the main algorithm of ALS, which is invoked when actual cardiac arrest has been established, relies on the monitoring of the electrical activity of the heart on a cardiac monitor. Depending on the type of arrhythmia, defibrillation is applied. Oxygen is administered and endotracheal intubation may be attempted to secure the airway, at regular intervals, the effect of the treatment on the heart rhythm, as well as the presence of cardiac output, is assessed. Medication that may be administered may include adrenaline, amiodarone, atropine, bicarbonate, saline or colloids may be administered to increase the circulating volume. A major new worldwide consensus has been based upon the best available scientific evidence. The ratio of compressions to ventilations is now recommended as 30,2 for adults, to produce higher coronary, defibrillation is now administered as a single shock, each followed immediately by two minutes of CPR before rhythm is re-assessed. Many healthcare providers are trained to some form of ALS. In out-of-hospital settings trained emergency medical technicians, paramedics or medics typically provide this level of care, canadian paramedics may be certified in either ALS or in Basic Life Support. Emergency medical technicians are often skilled in ALS, although they may employ slightly modified version of the Medical algorithm, in the United States, Paramedic level services are referred to as Advanced Life Support. Services staffed by basic EMTs are referred to as Basic Life Support, in the Republic of Ireland, Advanced Life Support is provided by an Advanced paramedic. This terminology extends beyond emergency cardiac care to describe all capabilities of the providers, in hospitals, ALS is usually given by a team of physicians and nurses, with some clinical paramedics practicing in certain systems. Cardiac arrest teams, or Code Teams, generally include junior doctors or senior nurses and technicians from various specialties such as medicine, anesthetics. UK Resuscitation Council ALS page About First Aid ALS Definition
21.
Physician
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Both the role of the physician and the meaning of the word itself vary around the world. Degrees and other qualifications vary widely, but there are common elements, such as medical ethics requiring that physicians show consideration, compassion. Around the world the term refers to a specialist in internal medicine or one of its many sub-specialties. This meaning of physician conveys a sense of expertise in treatment by drugs or medications and this term is at least nine hundred years old in English, physicians and surgeons were once members of separate professions, and traditionally were rivals. Henry VIII granted a charter to the London Royal College of Physicians in 1518 and it was not until 1540 that he granted the Company of Barber/Surgeons its separate charter. In the same year, the English monarch established the Regius Professorship of Physic at the University of Cambridge, newer universities would probably describe such an academic as a professor of internal medicine. Hence, in the 16th century, physic meant roughly what internal medicine does now, currently, a specialist physician in the United States may be described as an internist. Another term, hospitalist, was introduced in 1996, to describe US specialists in internal medicine who work largely or exclusively in hospitals, such hospitalists now make up about 19% of all US general internists, who are often called general physicians in Commonwealth countries. In such places, the more general English terms doctor or medical practitioner are prevalent, in Commonwealth countries, specialist pediatricians and geriatricians are also described as specialist physicians who have sub-specialized by age of patient rather than by organ system. Around the world, the term physician and surgeon is used to describe either a general practitioner or any medical practitioner irrespective of specialty. This usage still shows the meaning of physician and preserves the old difference between a physician, as a practitioner of physic, and a surgeon. The term may be used by state medical boards in the United States of America, in modern English, the term physician is used in two main ways, with relatively broad and narrow meanings respectively. This is the result of history and is often confusing and these meanings and variations are explained below. In the United States and Canada, the term physician describes all medical practitioners holding a professional medical degree, the American Medical Association, established in 1847, as well as the American Osteopathic Association, founded in 1897, both currently use the term physician to describe members. However, the American College of Physicians, established in 1915, does not, its title uses physician in its original sense. A physician trained in the United States has either a Doctor of Medicine degree, all boards of certification now require that physicians demonstrate, by examination, continuing mastery of the core knowledge and skills for a chosen specialty. Recertification varies by particular specialty between every seven and every ten years, graduates of osteopathic medical schools in the United States should not be confused with osteopaths, who are trained in the European and Commonwealth nations. Their training is similar to physical therapy and they are not licensed to prescribe medications or perform surgeries, also in the United States, the American Podiatric Medical Association defines podiatrists as physicians and surgeons that fall under the department of surgery in hospitals
22.
Residency (medicine)
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Residency is a stage of graduate medical training. A resident or house officer is a physician who practices medicine usually in a hospital or clinic under the direct or indirect supervision of an attending physician, successful completion of a residency program is a requirement to obtaining an unrestricted license to practice medicine in many jurisdictions. Residency training may be followed by fellowship or sub-specialty training, a resident physician is more commonly referred to as a resident, senior house officer, or alternatively as a senior resident medical officer or house officer. Residents have graduated from a medical school and hold a medical degree. Residents are, collectively, the staff of a hospital. This term comes from the fact that resident physicians traditionally spend the majority of their training in house, duration of residencies can range from three years to seven years, depending upon the program and specialty. A year in residency begins between late June and early July depending on the program, and ends one calendar year later. Depending on the number of years a specialty requires, the term junior resident may refer to residents that have not completed half their residency, Senior residents are residents in their final year of residency. Some residency programs refer to residents in their year as chief residents. Alternatively, a resident may describe a resident who has been selected to extend his or her residency by one year and organize the activities. If a physician finishes a residency and decides to further his or her education in a fellowship, post-residency physicians are referred to as attending physicians, or consultants. However, the above applies only in educational institutes in which the period of training is specified in advance. In privately owned, non-training hospitals, in countries, the above terminology may reflect the level of responsibility held by a physician rather than their level of education. The first formal residency programs were established by Sir William Osler, residencies elsewhere then became formalized and institutionalized for the principal specialties in the early 20th century. But even mid-century, residency was not seen as necessary for general practice, residencies are traditionally hospital-based, and in the middle of the twentieth century, residents would often live in hospital-supplied housing. Call was sometimes as frequent as every second or third night for up to three years, pay was minimal beyond room, board, and laundry services. It was assumed that most young men and women training as physicians had few obligations outside of training at that stage of their careers. The first year of practical patient-care-oriented training after school has long been termed internship
23.
Emergency medical services
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This is most likely an emergency department at a hospital. In such services, the EMS is not summoned by members of the public, in some jurisdictions, EMS units may handle technical rescue operations such as extrication, water rescue, and search and rescue. Training and qualification levels for members and employees of emergency medical services vary widely throughout the world, in some systems, members may be present who are qualified only to drive ambulances, with no medical training. In contrast, most systems have personnel who retain at least basic first aid certifications, additionally many EMS systems are staffed with Advanced Life Support personnel, including paramedics, nurses, or, less commonly, physicians. Emergency care in the field has been rendered in different forms since the beginning of recorded history, the New Testament contains the parable of the Good Samaritan, where a man who was beaten is cared for by a Samaritan. Luke 10,34 - He went to him and bandaged his wounds, pouring on oil, then he put the man on his own donkey, took him to an inn and took care of him. Also during the Middle Ages, the Knights Hospitaller were known for rendering assistance to wounded soldiers in the battlefield, the first use of the ambulance as a specialized vehicle, in battle came about with the ambulances volantes designed by Dominique Jean Larrey, Napoleon Bonapartes chief surgeon. Larreys projects for flying ambulances were first approved by the Committee of Public Safety in 1794, in civilian ambulances, a major advance was made with the introduction of a transport carriage for cholera patients in London during 1832. This tenet of ambulances providing instant care, allowing hospitals to be spaced further apart, the first known hospital-based ambulance service operated out of Commercial Hospital, Cincinnati, Ohio by 1865. In June 1887 the St John Ambulance Brigade was established to provide first aid and it was modelled on a military-style command and discipline structure. Named the Vienna Voluntary Rescue Society, it served as a model for similar societies worldwide and this was followed in 1900 by New York City, who extolled its virtues of greater speed, more safety for the patient, faster stopping and a smoother ride. These first two ambulances were electrically powered with 2 hp motors on the rear axle. Canadian historians dispute this with the city of Toronto claiming The first formal training for ambulance attendants was conducted in 1892, two-way radios became available shortly after World War I, enabling for more efficient radio dispatch of ambulances in some areas. Prior to World War II, there were areas where a modern ambulance carried advanced medical equipment, was staffed by a physician. In many locations, however, ambulances were hearses - the only vehicle that could carry a recumbent patient - and were thus frequently run by funeral homes. These vehicles, which could serve either purpose, were known as combination cars, prior to World War II, hospitals provided ambulance service in many large cities. With the severe manpower shortages imposed by the war effort, it became difficult for many hospitals to maintain their ambulance operations, City governments in many cases turned ambulance services over to the police or fire department. No laws required minimal training for personnel and no training programs existed beyond basic first aid
24.
Paramedics in Germany
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Paramedics in Germany are the main providers of emergency care in emergency medical services in Germany. There exist two professional levels regulated by law, the Rettungsassistent and the Notfallsanitäter. Both are able to provide the first level of emergency care. Additionally, they can get backup by a physician on scene. Thus the German paramedic scope of skills include a set of advanced life support treatments, then the paramedics act under direct medical supervision of the physician. Non life-threatening emergencies are handled solely by the paramedic ambulances without a physician on scene, other regulated qualifications in German EMS are Notarzt and the more basic emergency technician level Rettungssanitäter. The development of services in Germany started in the late 19th century. Typically volunteer aid organizations, some companies in larger cities. This more or less lasted until the 1960s, emergency care was provided by organizations or untrained ambulance men. In the late 1960s and early 1970s, however, it became obvious, the sending of physicians to the scene was introduced, following the concept bringing the doctor to the patient, not the patient to the doctor. The development of the emergency physician started, bearing the need for somewhat qualified assistance on scene. A law to establish the occupation of Rettungssanitäter has been discussed, the government however saw difficulties in financing the training of this new profession. So, eventually in 1977 the original idea was introduced as a 3.5 month training curriculum common to all Länder of Germany and this led to a more professionalized approach, but clearly below the level of the intended original law. By the 1980s it became clear that many situations were occurring in which the level of the Rettungssanitäter was inadequate. The developing of pre-clinical procedures demanded additional qualification for treating patients in the field and it was deemed necessary to find a new profession with even more knowledge and skills. This was when, in 1989, the profession of the Rettungsassistent was created, in contrast to the Rettungssanitäter, the Rettungsassistent was a state-certified profession with a job title protected by law. Since then, EMS in Germany has evolved into a formal, well organized structure, with standards for training, vehicles. Formerly Rettungssanitäter trained providers could get an upgrade to the new profession with proof of 2000 hours experience in EMS, the Rettungssanitäter still exists as a common entry/assistance level for EMS, for volunteer work and industrial emergency medicine
25.
Emergency medical responder
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Emergency medical responders are people who are specially trained to provide out-of-hospital care in medical emergencies. There are many different types of emergency responders, each with different levels of training, ranging from first aid. Emergency medical responders have a limited scope of practice and have the least amount of comprehensive education. The EMR is not meant to replace the roles of emergency medical technicians, emergency medical technologists or paramedics, Emergency medical responders typically assist in rural regions providing basic life support where pre-hospital health professionals are not available due to limited resources or infrastructure. Emergency medical responder is a term, used either to describe a certain EMS certification level. Specifically used, an Emergency Medical Responder is an EMS certification level used to describe a level of EMS provider below that of a medical technician. Broadly used, a first responder is the first medically trained personnel who comes in contact with a patient and this could be a passerby, citizen volunteer, or fire department, police, or emergency medical services personnel. Generally speaking, Emergency Medical Responders require 80 to 120 hours of training, primary Care Paramedic, depending on province, require generally a two-year diploma of paramedicine. Under the new NOCP, most providers that work in ambulances are identified as paramedics, however, in some cases, the most prevalent level of emergency prehospital care is that which is provided by the Emergency Medical Responder. Generally speaking, emergency medical responders require 80 to 120 hours of training, as a group, EMRs staff rural ambulance stations, community volunteer ambulance services, fire departments, police departments, industrial ambulances or mobile treatment centers. For many small communities, without this level of certification, the operation of a small community ambulance system might not be possible. EMRs across Canada contribute an important role in the chain of survival and this level of training is equivalent to an Emergency Medical Technician in the United States. Emergency Medical Responders would not be eligible for these educational advances due to their scope of practice. The U. S. Department of Transportation recognized a gap between the eight hours training required for providing basic first aid and the 180 hours typical of an EMT-Basic program. Also, some rural communities could not afford the comprehensive training, the First Responder training program began in 1979 as an outgrowth of the Crash Injury Management course. In 1995 the DOT issued a manual for a level of training called First Responder. This training can be completed in twenty-four to sixty hours, the first responder training is intended to fill the gap between first aid and Emergency Medical Technician. The American Red Cross conducts a course titled Emergency Medical Response that fits this definition, in the US the term Emergency Medical Responder has largely replaced the term Certified First Responder or Medical First Responder beginning in 2012
26.
Emergency medical technician
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Emergency Medical Technician and ambulance technician are terms used in some countries to denote a health care provider of emergency medical services. EMTs are clinicians, trained to quickly to emergency situations regarding medical issues, traumatic injuries. EMTs operate under a limited scope of practice, EMTs are normally supervised by a medical director, who is a physician. Some EMTs are paid employees, while others are volunteers, there is considerable degree of inter-provincial variation in the Canadian Paramedic practice. For this reason, any discussion of Paramedic Practice in Canada is necessarily broad, regulatory frameworks vary from province to province, and include direct government regulation to professional self-regulating bodies, such as the Alberta College of Paramedics. Only someone registered in Alberta can call themselves an EMT or Paramedic in Alberta, in this manner, the confusing myriad of titles and occupational descriptions can at least be discussed using a common language for comparison sake. Most providers that work in ambulances will be identified as Paramedics by the public, however, in many cases, the most prevalent level of emergency prehospital care is that which is provided by the Emergency Medical Responder. Primary care paramedics are the entry-level of paramedic practice in Canadian provinces, primary Care Paramedics may also receive additional training in order to perform certain skills that are normally in the scope of practice of Advanced Care Paramedics. This is regulated both provincially and locally, and ordinarily entails an aspect of medical oversight by a body or group of physicians. This is often referred to as Medical Control, or a role played by a base hospital, the Advanced Care Paramedic is a level of practitioner that is in high demand by many services across Canada. However, still not all provinces and jurisdictions have ACPs, the ACP typically carries approximately 20 different medications, although the number and type of medications may vary substantially from region to region. As well as bypassing a closer hospitals to get an identified stroke patient to a stroke centre, Critical Care Paramedics are paramedics who generally do not respond to 9-1-1 emergency calls, with the exception of helicopter scene calls. Instead they focus on transferring patients from the hospital they are currently in to other hospitals that can provide a level of care. CCPs often work in collaboration with registered nurses and respiratory therapists during hospital transfers, however, when acuity is manageable by a CCP or a registered nurse or respiratory therapist is not available, CCPs will work alone. Providing this care to the patient allows the hospital to avoid losing highly trained staff on hospital transfers. CCPs are able to all of the care that PCPs and ACPs provide. Where an PCP and ACP may run 40–50 medical codes per year a CCP may run 1–2 in an entire career. IV/IO starts are nearly non-existent in the field and for this reason CCPs are required to attend double the amount of time in classroom situations or in hospital to keep current
27.
Paramedic
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A paramedic is a healthcare professional, predominantly in the pre-hospital and out-of-hospital environment, and working mainly as part of emergency medical services, such as on an ambulance. The scope of practice of a paramedic will vary between countries, but generally includes autonomous decision making around the care of patients. In some countries Paramedic is a title and accountable to a professional regulatory body. The scope of the role varies widely across the world, having developed as a paraprofession in the United States during the 1970s. There are different models of care for EMS providers which significantly influence the scope of practice of paramedics in an area, in the Franco-German model paramedics directly support a doctor in the field, in a role more akin to a hospital nurse, rather than operating with clinical autonomy. The development of the profession has been a move from simply transporting patients to hospital. Throughout the evolution of care, there has been an ongoing association with military conflict. Such individuals, although not physicians, were probably among the worlds earliest surgeons by default, being required to suture wounds, in time, however, these arrangements began to formalize and become permanent. During the American Civil War, Jonathan Letterman devised a system of field hospitals employing the first uses of the principles of triage. In most cases these ambulances were operated by drivers and attendants with little or no medical training, an early example was the members of the Toronto Police Ambulance Service receiving a mandatory five days of training from St. John as early as 1889. Prior to World War I motorized ambulances started to be developed, in terms of advanced skills, once again the military led the way. The Korean War also marked the first widespread use of helicopters to evacuate the wounded from forward positions to medical units and these innovations would not find their way into the civilian sphere for nearly twenty more years. By the early 1960s experiments in improving care had begun in some civilian centres, one early experiment involved the provision of pre-hospital cardiac care by physicians in Belfast, Northern Ireland, in 1966. In 1966, a report called Accidental Death and Disability, The Neglected Disease of Modern Society—commonly known as The White Paper—was published in the United States. As a result of the The White Paper the US government moved to develop standards for ambulance attendant training, ambulance equipment. The White Paper also prompted the inception of a number of medical service pilot units across the US including paramedic programs. The success of these led to a rapid transition to make them fully operational. In 1969, the Haywood County Volunteer Rescue Squad developed a program under the medical direction of Ralph Fleicher
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CEN 1789
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CEN1789,2007 is the European Union standard for ambulances and medical transportation vehicles. This European standard specifies requirements for the design, testing, performance and equipping of road used for the transport. This standard is applicable to road ambulances capable of transporting at least one person on a stretcher, the current version of standard CEN1789 was published by the Comité Européen de Normalisation on June 29,2007. This replaced a version of the standard, published in 2000. European standards are generally annotated by the organization, standard number, because of the likelihood of significant changes between versions, on the most current version of any standard should be used. The Comité Européen de Normalisation is an agency of the government of the European Union, while CEN1789,2007 represents the current European standard for the design of ambulances, it is by no means the only example of such a standard. Standards for ambulance design have existed in the United States since 1976 and this standard has been revised several times, and is currently in version F, known as KKK-1822-F. As with the European system, only the most current version of the standard should be used. One of the first known standards for ambulance design occurred in London, England, as the result of efforts by the Metropolitan Asylums Board, while horse-drawn, this provided the actual standard for many of the earliest civilian ambulances around the world. More contemporary versions of design standards also exist at a local level in Canada, Australia. In each case, the country or jurisdiction develops such standards based upon its own needs, priorities, and realities, in some cases, standards compliance may not be planned, and may occur as an incidental result of normal operations. To illustrate, a country has no domestic ambulance manufacturers. In most cases, the ambulances imported by the country will end up complying with the larger countrys standard. American and Australian standards were reviewed and considered during the development of the European standard, the standard is intended to gradually transform the existing patchwork of ambulance design and equipment across Europe into a single set of standards. An ambulance from one country would possess sufficiently common characteristics to be recognizable by the residents of another country. Above all, such vehicles would be safe for those being transported in them, those working in them, other users of the road, requirements are specified for categories of road ambulances based in increasing order of the level of treatment that can be carried out. Please note that while the Classification is standarized in the European Union, the same vehicle may be used differently in varying countries. There are also emergency physician based systems in some European states, often with vehicles with medical equipment, patient transport ambulances Type A1 is without lights and sirens Type A2 with lights and sirens and can function as emergency ambulances
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Neonatal
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An infant is the more formal or specialised synonym for baby, the very young offspring of a human or other animal. A newborn is, in use, an infant who is only hours, days. In medical contexts, newborn or neonate refers to an infant in the first 28 days after birth, the term applies to premature, full term, and postmature infants, before birth, the term fetus is used. The term infant is typically applied to children under one year of age, however, definitions may vary. When a human child learns to walk, the toddler may be used instead. In British English, infant is a term that can be applied to children aged between four and seven. As a legal term, infancy continues from birth until age 18, a newborns shoulders and hips are wide, the abdomen protrudes slightly, and the arms and legs are relatively long with respect to the rest of their body. In first world nations, the total body length of newborns are 35. 6–50.8 cm. The Apgar score is a measure of a transition from the uterus during the first minutes after birth. In developed countries, the birth weight of a full-term newborn is approximately 3.4 kg. After the first week, healthy term neonates should gain 10–20 grams/day, a newborns head is very large in proportion to the body, and the cranium is enormous relative to his or her face. While the adult human skull is one seventh of the total body length. Normal head circumference for an infant is 33–36 cm at birth. At birth, many regions of the skull have not yet been converted to bone. The two largest are the anterior fontanel, located at the top front portion of the head, and the smaller triangular-shaped posterior fontanel. Later in the life, these bones will fuse together in a natural process. A protein called noggin is responsible for the delay in an infants skull fusion, during labour and birth, the infants skull changes shape to fit through the birth canal, sometimes causing the child to be born with a misshapen or elongated head. It will usually return to normal on its own within a few days or weeks, special exercises sometimes advised by physicians may assist the process
30.
Iserlohn
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Iserlohn is a city in the Märkischer Kreis district, in North Rhine-Westphalia, Germany. It is the largest city by population and area within the district, Iserlohn is located at the north end of the Sauerland near the Ruhr river. The Pancratius church was founded in around 985, but the first written document mentioning lon dates only from 1150, in 1237 the Count of the Mark gave Iserlohn municipal rights. In 1975 the city, which had been an urban district before, incorporated the surrounding ex-municipalities of Letmathe, Hennen, Sümmern and Kesbern, as a larger mid-sized city, Iserlohn, however, still has a special status as compared to most other municipalities in the district. This means that the city takes on tasks more usually performed by the district so that in some ways it is comparable to an urban district, the Dechenhöhle was discovered in 1868 during the construction of the railway line Hagen-Iserlohn. 360m are accessible for visitors, and lots of stalactites make it a spectacular sight, the Danzturm, located atop the southern hill overlooking the old city, is a landmark and featured on the logo of the local brewery. The tower features spectacular views of the valley and surrounding hills and is open to the public with an inn at the base. In the 18th Century, the became known for its Iserlohn boxes. The city is home of the Iserlohn Roosters, a DEL ice hockey team and they came into the DEL in 2000 and developed from a low-budget-team to a solid team, which battles every year for a Playoff-spot. The club plays its homegames at the Eissporthalle Iserlohn, which holds 4967 spectators, the original club EC Deilinghofen was founded in 1959 and went bankrupt in 1987, the second club ECD Sauerland existed from 1988 to 1994. 1994 the Iserlohner EC was founded whereof the Roosters came to the DEL, in Iserlohn are 15 elementary schools and 13 secondary schools. Also two universities of applied sciences are located in the city of Iserlohn, the Business and Information Technology School is a private state approved business school with a campus near the Seilersee. Every year a part of the Iserlohner culture is the Schützenfest at Alexanderhöhe with its Parkhalle, in the middle of the coat of arms is Saint Pancras, patron of the oldest church in Iserlohn. He is depicted between two towers of the city wall. The checked fess below is derived from the arms of the Counts of the Mark, die Oberste Stadtkirche Iserlohn – Zeitbilder und Momentaufnahmen. Westfalenverlag Dortmund Peter Müller und Günter Stalp, Unsere gute alte Straßenbahn, hans-Herbert Mönnig Verlag Iserlohn, Iserlohn – unsere lebendige Stadt. Ein Bildband von Iserlohnern für Iserlohner, Heinz Stoob, Westfälischer Städteatlas, Band, I,9 Teilband. Im Auftrage der Historischen Kommission für Westfalen und mit Unterstützung des Landschaftsverbandes Westfalen-Lippe, edited by Heinz Stoob, Official site Official site Newspaper Iserlohner Kreisanzeiger und Zeitung
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Mercedes-Benz T2
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The Mercedes-Benz T2 was a transporter manufactured by Daimler-Benz. The T2 is also known as the Düsseldorf transporter, since it was built until 1996 in Düsseldorf, the third series, built from 1996 at Ludwigsfelde, was branded the Mercedes-Benz Vario. Some T2s were assembled by Mercedes-Benz España in their Alcobendas assembly plant, for Argentina, the first T2 product are the L608 D in 1969 until 1990. In 1989, the new products are the L710, L914 and 814 with the LO variant, the Venezuelan version of the T2 was manufactured in Barcelona by the Grupo Consorcio 1390 S. A. as the Mercedes-Benz Class L3. The L3 was built from 1969 up to 1978, when the company was bought by the Ford Motor Company, in 1967, the T2 was introduced as a successor to the L319 / L406 series. The vehicle filled the gap between the smaller Mercedes-Benz T1 and the trucks, manufactured in Wörth. The T2 was available as a box van, a light truck. From 1977 the chassis was offered, for the mounting of larger box van and bus bodies, in 1981 the T2 received a facelift, the most visible differences were the new radiator grille, which now was a moulding of black plastic. In the early 1970s, T2 was also offered branded as a Hanomag-Henschel, in Brazil and some other South American countries it was built with a turbo system. Production of flat-bed trucks of the first generation ended after 19 year construction period, after approximately 450,000 vehicles had been produced, the second generation of the T2 was introduced in 1986, and was manufactured until 1996. It was significantly upgraded, the bonnet having become longer and the design altogether more sharp-edged, the chassis sold in large numbers in the United Kingdom and Ireland during the minibus revolution. Variations included the 609D, 614D, 709D, 711D, 811D, the LO812 was sold in Australia from the early 1990s, Westbus purchasing 26 in 1992 and National Bus Company purchased 45 in 1994/95. Various other operators would purchase smaller fleets, the T2 is still manufactured in Argentina as the L710 and the LO915 chassis for minibus applications. Media related to Mercedes-Benz T2 at Wikimedia Commons
32.
ADAC
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The ADAC is an automobile club in Germany, founded on May 24,1903 as German Motorbiker Association, and was renamed to its present name in 1911. With more than 18 million members in May 2012, it is the largest automobile club in Europe and it is also the largest motorcyclist association in the world, with 1.5 million members. Both the ADAC, and its older rival AvD, are members of the FIA, the European Grand Prix, the former ADAC Eifelrennen, the 24 Hours Nürburgring and many other races are hosted by ADAC. The ADAC also operates a fleet of mobile mechanics in yellow cars that assist motorists in trouble - the Yellow Angels. The ADAC runs its own modification center whereby ordinary vans are turned into mobile garages in 55 man-hours, in addition to this, the ADAC provides 44 air ambulance helicopters for urgent medical rescues in Germany, strategically placed so that any location can be reached within 15 minutes. The ADAC also offers its membership to non German residents, having signed contracts with automobile clubs worldwide, in the UK, it is possible to have breakdown recovery through the local AA while having an ADAC membership. The ADAC is publisher of the magazine with the largest distribution in Germany, on June 3,2008, the ADAC suspended its involvement with the FIA over the scandal surrounding Max Mosley and his subsequent retention as FIA president. The ADAC break-down assistance service was launched in Germany in 1927, during the Nazi period, starting in 1934, all motorists organizations and clubs were replaced by Der Deutsche Automobil-Club e. V. which was closely associated with the National Socialist Motor Corps. These original ADAC Gelbe Engel used NSU Konsul motorbikes, at the end of 1962 ADAC announced the retirement of their motor-bike-sidecar combinations which would be replaced by 40 appropriately equipped Volkswagen Beetles. Growth rates during the twenty years were greatly boosted by German reunification. ADAC is a member for the European Road Assessment Program in Germany. ADAC regularly publishes maps showing safety characteristics of German roads and these maps based on EuroRAPs Road Protection Score Protocol is a measure of how well a road protects road users in the event of an accident. Data on road characteristics is gathered by driving through road inspections using a specially equipped RPS inspection vehicle, trained assessors then rate the safety features and hazards on the inspected road and use standardised formula to produce a safety rating—star rating—which is comparable across Europe. ADAC also undertakes road inspections on behalf of other EuroRAP members, ADAC is the campaigns partner in Germany. Breakdown Breakdown Cover European Campaign for Safe Road Design EuroRAP The dictionary definition of ADAC at Wiktionary ADAC official website
33.
Federal Police (Germany)
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The Federal Police is a uniformed federal police force in Germany. It is subordinate to the Federal Ministry of the Interior, ordinary police forces, meanwhile, are under the administration of the individual German states and are known as the Landespolizei. The Bundespolizei was formerly known as the Bundesgrenzschutz, which had a restricted role. Prior to 1994 BGS members also had military combatant status due to their historical foundation, in July 2005 the law renaming the BGS as the BPOL was enacted. The BPOL has the following missions Border security, to include passport control, providing transportation security at international airports and on the German railways. Supporting international police missions for the United Nations and EU in Kosovo, Sudan, Liberia, Afghanistan, Gaza Strip, Moldova, providing in-house security for some German embassies. The Bundespolizei can also be used to state police if requested by a state government. The BPOL maintains these reserve forces to deal with major demonstrations, disturbances or emergencies, several highly trained detachments are available for crisis situations requiring armored cars, water cannon or other special equipment. In addition, the Bundespolizei cooperates closely with German state executive authorities, the nominally temporary border controls were initially put in place just on the border with Austria, but by the following day they were being put in place at all borders with fellow EU members. The same day, Austria and other EU members who were part of the Schengen Area began to put in place their own border controls in response to Germanys actions. The new German border controls are to be primarily enforced both by the various Landespolizei of those German states that external borders, and in particular by the Bundespolizei. The Bundespolizei consists of around 40,000 personnel,30,000 are fully trained police officers,21,000 provide border, railway and aviation security. 6,000 serve in the Alert Police,3,000 serve in the following special units, The Central Office for Communications and Information. 10,000 salaried civilian support personnel, including,6,800 civil servants who perform administrative,2,000 Immigration inspectors who perform operational duty handling border protection and immigration matters and airline passenger checks. The BPOL national headquarters in Potsdam performs all central control functions, eight regional headquarters control the BPOL stations conduct rail police and border protection missions. These areas of responsibility conform to the state boundaries which they did not do prior to 1 March 2008. The regional headquarters are as follows, Bad Bramstedt covering Schleswig-Holstein, hanover covering Bremen, Hamburg and Lower Saxony. Koblenz covering Saarland, Rhineland-Palatinate and Hesse, pirna covering Saxony, Saxony-Anhalt and Thuringia
34.
First aid
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First aid is the assistance given to any person suffering a sudden illness or injury, with care provided to preserve life, prevent the condition from worsening, and/or promote recovery. First aid is generally performed by the layperson, with many people trained in providing basic levels of first aid, mental health first aid is an extension of the concept of first aid to cover mental health. There are many situations which may require first aid, and many countries have legislation, regulation and this can include specific training or equipment to be available in the workplace, the provision of specialist first aid cover at public gatherings, or mandatory first aid training within schools. First aid, however, does not necessarily any particular equipment or prior knowledge. First aid can be performed on all mammals, although this article relates to the care of human patients, the ancient Egyptians were the first to use bandages including the high genius doctor Imhotep. They not only used them o to create mummies but also as part of the treatments for surgical patients, most ancient Greek doctors, philosophers, etc studied in ancient Egypt and then returned to Greece. The bandaging of battle wounds is shown on Classical Greek pottery from circa 500 BCE, there are numerous references to first aid performed within the Roman army, with a system of first aid supported by surgeons, field ambulances, and hospitals. Roman legions had the role of capsarii, who were responsible for first aid such as bandaging. Further examples occur through history, still mostly related to battle, with such as the Knights Hospitaller in the 11th century CE, providing care to pilgrims. During the late 18th century, drowning as a cause of death was a concern amongst the population. This led to the formation, in 1774, of the Society for the Recovery of Persons Apparently Drowned, later the Royal Humane Society, who did much to promote resuscitation. Napoleons surgeon, Baron Dominique-Jean Larrey, is credited with creating an ambulance corps, the Red Cross and Red Crescent are still the largest provider of first aid worldwide. The bandage was issued as standard to the Prussian combatants, and this was followed by creating its own wheeled transport litter in 1875, and in 1877 established the St John Ambulance Association to train men and women for the benefit of the sick and wounded. Following this, in 1878, Shepherd and Colonel Francis Duncan took advantage of the newly charitable focus of St John, the first classes were conducted in the hall of the Presbyterian school in Woolwich using a comprehensive first aid curriculum. First aid training began to spread through the British Empire through organisations such as St John, often starting, as in the UK, with high risk activities such as ports, certain skills are considered essential to the provision of first aid and are taught ubiquitously. Particularly the ABCs of first aid, which focus on critical life-saving intervention, ABC stands for Airway, Breathing, and Circulation. The same mnemonic is used by all emergency health professionals, attention must first be brought to the airway to ensure it is clear. Following evaluation of the airway, a first aid attendant would determine adequacy of breathing, some organizations add a fourth step of D for Deadly bleeding or Defibrillation, while others consider this as part of the Circulation step
35.
Defibrillator
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Defibrillation is a treatment for life-threatening cardiac dysrhythmias, specifically ventricular fibrillation and non-perfusing ventricular tachycardia. A defibrillator delivers a dose of electric current to the heart, the electrical shock does not have to be timed with the hearts intrinsic cardiac cycle. This depolarizes a large amount of the muscle, ending the dysrhythmia. Subsequently, the natural pacemaker in the sinoatrial node of the heart is able to re-establish normal sinus rhythm. In contrast to defibrillation, synchronized electrical cardioversion is an electrical shock delivered in synchrony to the cardiac cycle, although the person may still be critically ill, cardioversion normally aims to end poorly perfusing cardiac dysrhythmias, such as supraventricular tachycardia. Defibrillators can be external, transvenous, or implanted, depending on the type of device used or needed, Defibrillation is often an important step in cardiopulmonary resuscitation. CPR is an intervention aimed to restore cardiac and pulmonary function. Defibrillation is indicated only in certain types of cardiac dysrhythmias, specifically ventricular fibrillation, if the heart has completely stopped, as in asystole or pulseless electrical activity, defibrillation is not indicated. Defibrillation is also not indicated if the patient is conscious or has a pulse, improperly given electrical shocks can cause dangerous dysrhythmias, such as ventricular fibrillation. Survival rates for out-of-hospital cardiac arrests are poor, often less than 10%, outcome for in-hospital cardiac arrests are higher at 20%. Within the group of people presenting with cardiac arrest, the cardiac rhythm can significantly impact survival rates. Compared to people presenting with a rhythm, people with a shockable rhythm have improved survival rates. Manual external defibrillators require the expertise of a healthcare professional and they are used in conjunction with an electrocardiogram, which can be separate or built-in. A healthcare provider first diagnose the cardiac rhythm and then determine the voltage. These units are found in hospitals and on some ambulances. For instance, every NHS ambulance in the United Kingdom is equipped with a manual defibrillator for use by the attending paramedics, in the United States, many advanced EMTs and all paramedics are trained to recognize lethal arrhythmias and deliver appropriate electrical therapy with a manual defibrillator when appropriate. Manual internal defibrillators delivers the shock through paddles placed directly on the heart and they are mostly used in the operating room and, in rare circumstances, in the emergency room during an open heart procedure. Automated external defibrillators are designed for use by untrained or briefly trained laypersons, AEDs contain technology for analysis of heart rhythms
36.
Stretcher
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A stretcher, litter, or pram is an apparatus used for moving patients who require medical care. A basic type must be carried by two or more people, a wheeled stretcher is often equipped with variable height frames, wheels, tracks, or skids. In American English, a stretcher is referred to as a gurney. The name comes from a horse-drawn cab patented in the USA by J. Theodore Gurney in 1883 which bore a similarity to early wheeled stretchers, stretchers are primarily used in acute out-of-hospital care situations by emergency medical services, military, and search and rescue personnel. In medical forensics the right arm of a corpse is left hanging off the stretcher to let paramedics know it is not a wounded patient and they are also used to hold prisoners during lethal injections in the United States. An early stretcher, likely made of wicker over a frame, simple stretchers were common with militaries right through the middle of the 20th century. EMS stretchers used in ambulances have wheels that makes transportation over pavement easier, an integral lug on the stretcher locks into a sprung latch within the ambulance in order to prevent movement during transport. Modern stretchers may also have battery-powered hydraulics to raise and collapse the legs automatically and this eases the workload on EMS personnel, who are statistically at high risk of back injury from repetitive raising and lowering of patients. Specialized bariatric stretchers are also available, which feature a wider frame, stretchers are usually covered with a disposable sheet or wrapping, and are cleaned after each use to prevent the spread of infection. Shelves, hooks and poles for medical equipment and intravenous medication are also frequently included, the bed can be raised or lowered to facilitate patient transfer. The feet can be raised to what is called the Trendelenburg position, some manufacturers have begun to offer hybrid devices that combine the functionality of a stretcher, a recliner chair, and a treatment or procedural table into one device. Simple stretchers are the most rudimentary type and they are lightweight and portable, made of canvas or other synthetic material suspended between two poles or tubular aluminum frame. Many are stored as disaster supplies and are former military equipment. Some models may allow the patient to sit upright in a Fowlers or Semi-Fowlers position. The scoop stretcher is used for lifting patients, for instance from the ground onto a stretcher or onto a spinal board. The two ends of the stretcher can be detached from other, splitting the stretcher into two longitudinal halves. To load a patient, one or both ends of the stretcher are detached, the halves placed under the patient from either side and fastened back together. With obese patients, the possibility exists of accidentally pinching the patients back when closing the stretcher, typically it is shaped to accommodate an adult in a face up position and it is used in search and rescue operations
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