Ambulancecare in the Netherlands (aka Holland)
In Holland we use the term ambulancecare, this is because of the fact that ambulanceservices are health care facilities.
An ambulance is staffed by two people an ambulancedriver and an ambulancenurse.
The ambulancedriver has a BLS level of education and assist the ambulance nurse, they have special driving skills and extended knowledge of trafficlaws.
The ambulancenurse is a ICU-nurse or a nurse-anesthetist and has an ALS level education, the nurses are allowed to perform medical skills without contacting a physician. These skills are all nursing skills and the following medical skills: endotracheal intubation, cricothyrotomie, needle decompression of a tension pneumothorax, cardioversion, defibrillation, intra oss.infusion, placing IV-lines and give IV-fluids and medications.
The nurses are authorized by the medical manager to perform these medical skills.
Because the Netherlands is a small country we have national operation procedures based on the ACLS, PALS and PHTLS standards, these guidelines are revised on a regular base by a special board of all medical specialties and ambulancenurses.
In Holland there are no physicians on the ambulance sas in most European countries.
However in case of a severe accident with long entrapment we can ask for a mobile medical team, those teams are staffed by a trauma physician and a nurse and they come by helicopter or special van.
People can call for an ambulance by dialing the European emergency number 112, here the call is being forwarded to police , fire or ems.
In case of an medical emergency the call is handled by a medical dispatcher these are mainly nurses, these nurses can decide if they sent an ambulance or advise the patient to call his own family doctor when it is not necessary to send an ambulance.
In case of an ambulance call they can decide if the ambulance goes on route with priority A1, A2 or B.
A1 and A2 are emergencies but only A1 calls are life-threathening so the ambulance goes on route with lights and sirens.
Priority B are mostly regular patient transportation calls, however all ambulances in Holland are ALS equiped they are also used for non-emergency patient transportation but in the near future this possibly is going to change.
The health insurance pays for the ambulance ride.