Emergency medical services in Germany
Typically volunteer aid organizations, some private companies in larger cities and so called rescue corps provided ambulance services mostly with very little training or medical background.
After World War II, prehospital care in Germany was in its infancy; in most predominately rural areas the German Red Cross provided an ambulance service.
Still, the EMS role was primarily done on a voluntary basis by individuals with only minimal training in emergency health care, using simple transport vehicles with almost no medical equipment.
The need to professionalize emergency health care was picked up by several university medical centers in the late 1950s and 60s (Cologne, Frankfurt, Heidelberg and Munich).
[1] In the late 1960s and early 1970s, advanced demands lead to the establishment of helicopter ambulance services, dispatch centers, radio communication and general better organization of EMS as well as scientific approaches to provide better emergency care.
The system was largely improved in the 1980s and 1990s, leading not only to the then-new profession of Rettungsassistent (1989) but also to the availability of modern medical equipment in outdoor quality.
German law mandates the provision of fire and rescue services, including EMS, staffing and equipping according to levels which correspond to local population.
In independent cities, this is usually provided directly by the Fire Prevention Bureau ("Amt für Brand- und Katastrophenschutz").
[2] [3] [4] Unlike fire protection, the task of providing EMS, while legally mandated, is not necessarily performed directly by the district.
EMS may, however, be contracted out by the district to a number of other potential service providers, including both community non-profit organizations and privately owned companies.
Compliance with those regulations is usually evaluated with respect to effectiveness and meeting public need by the local cities/communities, assisted by specialised physicians.
The medical director is responsible for the creation and issue of regulations, protocols, and standards of care on behalf of the community.
Regulations and protocols may be developed and issued at the discretion of the medical director, who is required to govern their actions according to the general guidelines and financial guidance provided by his county or municipality.
They are brought into action whenever a patient with a serious and complex medical condition, requiring advanced levels of support during transit, needs to be transferred between hospitals.
The availability of this service provides a better treatment option to those patients who, in other EMS systems, might generate low-acuity ambulance calls or emergency department visits.
Occasionally, the visiting GP will contact the EMS dispatcher and order a Krankentransport, should it be determined following medical assessment, that the patient could be cared for in a safer and better manner in a hospital.
Thus the paramedic scope of skills include a set of advanced life support (ALS) treatments, they have to work until an emergency doctor is on scene.
Once on scene, the Notarzt is responsible for all tasks associated with physicians in the field, acts as the crew chief and provides medical direction to all subordinate EMS staff.
Depending on the state in which they work, those in the Rettungshelfer role are usually the drivers of non-emergency patient transports, with a Rettungssanitäter acting as crew chief for the vehicle.
Some larger cities (i.e. Hamburg, Berlin) still operate Notarztwägen (NAW), a RTW supplemented by an ermergency physician and additional material, although this system has become rather outdated, due to its lack of flexibility.
Some multi-purpose police helicopters may perform additional emergency response and transport when required, those crews often are trained as Rettungssanitäter, medical staff will be provided by ground units in case.
In addition, ADAC and DRF operate a fleet of fixed wing air ambulances, including jets, primarily to provide foreign repatriation service to their club members.
Other companies (often health insurances) provide foreign repatriation services for their customers as well, mostly with rented aircraft and medical staff.
German Bundeswehr provides additional air medical evacuation (MEDEVAC) planes and helicopters, primarily for military use but used for support in civil crisis situations as well.
This computer system, while operating in German, is extremely similar to the AMPDS algorithm used by Emergency Medical Dispatchers in the United States.
After sending the alarm, the dispatcher may remain on the line with the caller, providing telephone advice or assistance until the EMS resources arrive on the scene.
All public emergency services in Germany (i.e. EMS, fire, police, disaster response) use the same radio system for communication.
Main advances over the old analog radio system are availability of far more channels and communication groups, encryption possibilities, noise filtering and enhanced signal reliability.
The advantage of this system is the fact that the physician is available for other emergencies, while the ambulance crew can handle minor cases on their own.
The advantage with this approach lies in the ability to perform more difficult tasks without delay, however, on most calls the presence of the physician is not actually required.
