Paramedics in Germany
Encyclopedia
Paramedics in Germany are part of the Emergency medical services in Germany
. The position is called Rettungsassistent in German
. The Rettungsassistent is the primary profession in emergency-type prehospital care. It is a rather new profession, being introduced by law in 1989 by the German Bundestag
.
, prehospital care in Germany was in its infancy; the idea to professionalize emergency health care was picked up by several university medical centers in the late 1950s and 60s (Cologne, Frankfurt, Heidelberg and Munich). The idea to bring the doctor to the patient, rather than the patient to the doctor was already born before World War II. The result was the evolution of a type of ambulance physician called a Notarzt who dealt primarily with providing emergency medical care in the out-of-hospital setting. The service delivery model that this approach describes is commonly referred to as the Franco-German model.
After World War II in most predominately rural areas the German Red Cross
provided an ambulance service. In West Germany
the Fire Departments provided 24/7 service as a professional service in some cities and urban centres or towns. With the increase in individual motorized traffic at the beginning of the 1950s, road accidents also increased, leading to greater numbers of both injuries and fatalities. This encouraged the formation of several emergency services, one of the first being the Johanniter-Unfall-Hilfe e.V., a subsidiary of the German Order of St.John
. These services not only transported patients, but had limited means of treating them on-scene, as well as being able to arrive at the scene of accidents more quickly.
In the 1950s and 1960s, the EMS role was primarily done on a voluntary basis by individuals with only minimal training in emergency health care. The first emergency medical technicians were trained jointly by some fire departments and universities. In the 1970s, however, it became clear, that are more professional approach is needed. A law to establish the occupation of Rettungssanitäter has been discussed, with a 3 year training curriculum (Gesetzentwurf der Bundesregierung über die Definition
und das Anforderungsprofil des Berufes ´Rettungssanitäter´ (BT-Drucksache 7/822)). The government however saw difficulties in financing the training of this new profession. Unfortunatelly than in 1977 the original idea was introduced as a 3,5 month training curriculum common to all Länder
(federal states) of Germany. 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 knowledge level of the Rettungsanitater was inadequate, and the developing role of the ambulance physician (Notarzt) needed additional assistance in treating patients in the field. 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 is a state-certified profession. Over the past 25 years EMS in Germany has evolved into a formal, well organized structure, with standards for staff training, vehicles, and service delivery.
and Sachsen
, which cover some or all of the tuition fees, the students have to pay for their own training. Tuition fees range from € 2.500 to € 4.500, depending on the college, state and organisation. Typically, firefighters, policemen and members of the armed forces who undergo training do not pay tuition; their employer covers the fees.
In the first year, the student learns the theoretical basics of this profession, including invasive procedures. Incorporated are several weeks of in-hospital internships, typically in emergency department
s, operating rooms and trauma unit
s.
The theoretical training is divided into several major parts:
Furthermore, the student is taught skills in treating patients. These include:
The first year ends with a board examination which covers all the knowledge a paramedic must have.
In the second year, students have to do a minimum 1600-hour internship in the EMS to further their skills. Usually, they start as a third person on a transport ambulance in order to observe and learn from the trained professionals. Sometimes, paramedic students who also have the qualification of Rettungssanitäter are used as a second on a two-person team. However, at all times the student will be under supervision by a Lehrrettungsassistent.
After completing their year of internship, there is a closing meeting after which, should the student be deemed fit, he or she is awarded the vocational title of Rettungsassistent. The certificate is issued by the Ministry of Health.
The training can be shortened under specific circumstances. Students who hold the title of Rettungssanitäter are allowed in most states to shorten their theoretical training and, if they have already worked in EMS for some time, they only need to do a shortened internship, depending on the state in which they do the training. In Sachsen-Anhalt
, the internship usually consists of only 480 hours.
The least-trained would be the Rettungshelfer(BLS) with only basic skills, followed by the Rettungssanitäter(between ILS and ALS), which used to be the most advanced pre-hospital care role.Short course is being phased out.
Ranking above the Rettungsassistent (ACLS) is the Notarzt, a physician with extra training in emergency medicine
. However, within Germany emergency medicine does not exist as a recognized medical specialty. As a result, the Notarzt is most often an anaesthetist (although occasionally an internist or surgeon) performing this work in addition to their regular practice >
All professions are normally deployed according to their skills
There is some pressure in Germany to eliminate the qualifications of Rettungshelfer or Rettungssanitäter in the non-voluntary areas of the German EMS. This is driven by the assumption that even today these two do not possess the skills for today's modern and complex emergency medicine. Every state has different reqirements to staff an ambulance or emergency physicians vehicle (Notarzt-Einsatz-Fahrzeug, NEF).To phase out short courses
Some German states and/or some organizations (employers) require yearly training (mostly around ~30 hours) for serving in professional EMS.
Other possible professional roles are EMS leader on scene, emergency dispatcher, shift or group leader, supervisor/trainer and EMS chief or positions outside the classic EMS field such as consulter or salesman for EMS equipment.
One of them is the HEMS
crew member training, after which the Rettungsassistent is certified to work on a rescue helicopter. This role includes assisting both the pilot (i.e. navigating, spotting landing sites) during flight, and assisting the emergency physician with medical care. Another qualification is that of Lehrrettungsassistent, a Rettungsassistent qualified to teach and supervise paramedic students during their training. Those seeking this role receive special training in which they learn education theory and the use of teaching strategies. (PPEd & PGCE)
For senior paramedics with a lot of expertise there is the qualification of Organisatorischer Leiter Rettungsdienst (OrgL). This qualification is closely related to mass casualties. A Rettungsassistent assuming this position will be responsible for the triage, treatment and transport functions, as well as coordinating and directing the activities of others during those events. Although this is a 2-week course, most municipalities demand additional leadership training in disaster units (i.e. leader of a medical platoon) before the certification in this role will be granted.
In the newest development, the Rettungsassistent can also train to become an Emergency Room Specialist (Kranken-und Gesundheitspfleger / Schwester)(http://www.printernet.info/nurs_scien923489-ETERZ/LW08aSchTLM.pdf)
Furthermore university degrees like Bachelor and Master Programs in Rescue Engineering or Health Care Management offer opportunities for German paramedics to take leadership roles in emergency health care systems and the general health care field. An example is the Bachelor of Arts
Emergency Practitioner programme offered at the akkon Hochschule für Humanwissenschaften in Berlin
.
The job includes all aspects of the training that has been received. Basically, in absence of a physician, the paramedic is responsible for diagnostics and treating the patient. Unlike many examples of the Anglo-American model, the Rettungsassistent/Rettungssanitäter does not have 'de facto' permission to perform any application of medication or invasive techniques. Invasive skills are often seen as being reserved for physicians.
Under supervision of a physician, however, the Rettungsassistent or Rettungssanitäter is allowed to perform every technique that has been learned in school and training.If the Rettungsassistent is not available the Rettungssanitäter ia allowed to perform every technique that has been learned Should the need arise to perform such skills without supervision, there exists a rule called Notkompetenz (Emergency powers), which theoretically allows this. This includes, but is not limited to:
It should be noted that this rule does not qualify as a law, but merely a guideline by the Ärztekammer (Federal Board of Physicians) and is always subject to local procedures and guidelines.
In theory at least, a Rettungsassistent/Rettungssanitäter will violate several federal laws when performing treatment alone. However, when treatment is necessary to avert death or severe disability of a patient, the state of emergency laws will usually take precedence.
Emergency medical services in Germany
Emergency Medical Service in Germany is a service of public pre-hospital emergency healthcare, including ambulance service, provided by individual German cities and counties...
. The position is called Rettungsassistent in German
German language
German is a West Germanic language, related to and classified alongside English and Dutch. With an estimated 90 – 98 million native speakers, German is one of the world's major languages and is the most widely-spoken first language in the European Union....
. The Rettungsassistent is the primary profession in emergency-type prehospital care. It is a rather new profession, being introduced by law in 1989 by the German Bundestag
Bundestag
The Bundestag is a federal legislative body in Germany. In practice Germany is governed by a bicameral legislature, of which the Bundestag serves as the lower house and the Bundesrat the upper house. The Bundestag is established by the German Basic Law of 1949, as the successor to the earlier...
.
History
The development of ambulance services in Germany started in the late 19th century. 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 IIWorld War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
, prehospital care in Germany was in its infancy; the idea to professionalize emergency health care was picked up by several university medical centers in the late 1950s and 60s (Cologne, Frankfurt, Heidelberg and Munich). The idea to bring the doctor to the patient, rather than the patient to the doctor was already born before World War II. The result was the evolution of a type of ambulance physician called a Notarzt who dealt primarily with providing emergency medical care in the out-of-hospital setting. The service delivery model that this approach describes is commonly referred to as the Franco-German model.
After World War II in most predominately rural areas the German Red Cross
German Red Cross
The German Red Cross , or the DRK, is the national Red Cross Society in Germany.With over 4.5 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...
provided an ambulance service. In West Germany
West Germany
West Germany is the common English, but not official, name for the Federal Republic of Germany or FRG in the period between its creation in May 1949 to German reunification on 3 October 1990....
the Fire Departments provided 24/7 service as a professional service in some cities and urban centres or towns. With the increase in individual motorized traffic at the beginning of the 1950s, road accidents also increased, leading to greater numbers of both injuries and fatalities. This encouraged the formation of several emergency services, one of the first being the Johanniter-Unfall-Hilfe e.V., a subsidiary of the German Order of St.John
Order of St. John (Protestant Continental Europe)
The Bailiwick of Brandenburg of the Chivalric Order of Saint John of the Hospital at Jerusalem , or simply the Order of Saint John , is the German Protestant branch of the Knights Hospitaller, the oldest chivalric order, which generally is considered to have...
. These services not only transported patients, but had limited means of treating them on-scene, as well as being able to arrive at the scene of accidents more quickly.
In the 1950s and 1960s, the EMS role was primarily done on a voluntary basis by individuals with only minimal training in emergency health care. The first emergency medical technicians were trained jointly by some fire departments and universities. In the 1970s, however, it became clear, that are more professional approach is needed. A law to establish the occupation of Rettungssanitäter has been discussed, with a 3 year training curriculum (Gesetzentwurf der Bundesregierung über die Definition
und das Anforderungsprofil des Berufes ´Rettungssanitäter´ (BT-Drucksache 7/822)). The government however saw difficulties in financing the training of this new profession. Unfortunatelly than in 1977 the original idea was introduced as a 3,5 month training curriculum common to all Länder
Länder
Länder or Bundesländer may refer to:* States of Germany, the 16 federal subdivisions of Germany* States of Austria, the 9 federal subdivisions of Austria...
(federal states) of Germany. 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 knowledge level of the Rettungsanitater was inadequate, and the developing role of the ambulance physician (Notarzt) needed additional assistance in treating patients in the field. 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 is a state-certified profession. Over the past 25 years EMS in Germany has evolved into a formal, well organized structure, with standards for staff training, vehicles, and service delivery.
Training
Individuals who want to become a paramedic in Germany are required to undergo two years of training at a vocational college, most of which are privately-owned, but are controlled by the state. In many federal states, with the exception of ThüringenThuringia
The Free State of Thuringia is a state of Germany, located in the central part of the country.It has an area of and 2.29 million inhabitants, making it the sixth smallest by area and the fifth smallest by population of Germany's sixteen states....
and Sachsen
Saxony
The Free State of Saxony is a landlocked state of Germany, contingent with Brandenburg, Saxony Anhalt, Thuringia, Bavaria, the Czech Republic and Poland. It is the tenth-largest German state in area, with of Germany's sixteen states....
, which cover some or all of the tuition fees, the students have to pay for their own training. Tuition fees range from € 2.500 to € 4.500, depending on the college, state and organisation. Typically, firefighters, policemen and members of the armed forces who undergo training do not pay tuition; their employer covers the fees.
Curriculum
The paramedic training consists of two major parts, vocational college and EMS internship. These are almost evenly divided into two one-year terms.In the first year, the student learns the theoretical basics of this profession, including invasive procedures. Incorporated are several weeks of in-hospital internships, typically in emergency department
Emergency department
An emergency department , also known as accident & emergency , emergency room , emergency ward , or casualty department is a medical treatment facility specialising in acute care of patients who present without prior appointment, either by their own means or by ambulance...
s, operating rooms and trauma unit
Trauma center
A trauma center is a hospital equipped to provide comprehensive emergency medical services to patients suffering traumatic injuries. Trauma centers grew into existence out of the realization that traumatic injury is a disease process unto itself requiring specialized and experienced...
s.
The theoretical training is divided into several major parts:
- basic anatomyAnatomyAnatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy , and plant anatomy...
- body functions
- internal medicineInternal medicineInternal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...
- neurologyNeurologyNeurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
- gynaecologyGynaecologyGynaecology or gynecology is the medical practice dealing with the health of the female reproductive system . Literally, outside medicine, it means "the science of women"...
- urologyUrologyUrology is the medical and surgical specialty that focuses on the urinary tracts of males and females, and on the reproductive system of males. Medical professionals specializing in the field of urology are called urologists and are trained to diagnose, treat, and manage patients with urological...
- paediatrics
- disease patterns of the above
- traumatological injuries
- pharmacologyPharmacologyPharmacology is the branch of medicine and biology concerned with the study of drug action. More specifically, it is the study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function...
- law, rights and duties
Furthermore, the student is taught skills in treating patients. These include:
- basic diagnostic skills (blood pressureBlood pressureBlood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
, heartrate, glucose levelBlood sugarThe blood sugar concentration or blood glucose level is the amount of glucose present in the blood of a human or animal. Normally in mammals, the body maintains the blood glucose level at a reference range between about 3.6 and 5.8 mM , or 64.8 and 104.4 mg/dL...
, oxygen saturationOxygen saturationOxygen saturation or dissolved oxygen is a relative measure of the amount of oxygen that is dissolved or carried in a given medium. It can be measured with a dissolved oxygen probe such as an oxygen sensor or an optode in liquid media, usually water.It has particular significance in medicine and...
) - advanced diagnostic skills (using and interpreting ECG, auscultationAuscultationAuscultation is the term for listening to the internal sounds of the body, usually using a stethoscope...
, neurological examination) - intravenous, subcutaneous and intramuscular application of medication
- treatment of internal diseases like myocardial infarctionMyocardial infarctionMyocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
, pulmonary edemaPulmonary edemaPulmonary edema , or oedema , is fluid accumulation in the air spaces and parenchyma of the lungs. It leads to impaired gas exchange and may cause respiratory failure...
, hypertensionHypertensionHypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and... - treatment of traumatic injuries like fractures, amputations, cuts and bruises
- endotracheal intubation and ventilationVentilation (physiology)In respiratory physiology, ventilation is the rate at which gas enters or leaves the lung. It is categorized under the following definitions:-Sample values:...
The first year ends with a board examination which covers all the knowledge a paramedic must have.
In the second year, students have to do a minimum 1600-hour internship in the EMS to further their skills. Usually, they start as a third person on a transport ambulance in order to observe and learn from the trained professionals. Sometimes, paramedic students who also have the qualification of Rettungssanitäter are used as a second on a two-person team. However, at all times the student will be under supervision by a Lehrrettungsassistent.
After completing their year of internship, there is a closing meeting after which, should the student be deemed fit, he or she is awarded the vocational title of Rettungsassistent. The certificate is issued by the Ministry of Health.
The training can be shortened under specific circumstances. Students who hold the title of Rettungssanitäter are allowed in most states to shorten their theoretical training and, if they have already worked in EMS for some time, they only need to do a shortened internship, depending on the state in which they do the training. In Sachsen-Anhalt
Saxony-Anhalt
Saxony-Anhalt is a landlocked state of Germany. Its capital is Magdeburg and it is surrounded by the German states of Lower Saxony, Brandenburg, Saxony, and Thuringia.Saxony-Anhalt covers an area of...
, the internship usually consists of only 480 hours.
Certification and training required in Germany
Besides the Rettungsassistent, there are three other professions in German EMS.The least-trained would be the Rettungshelfer(BLS) with only basic skills, followed by the Rettungssanitäter(between ILS and ALS), which used to be the most advanced pre-hospital care role.Short course is being phased out.
Ranking above the Rettungsassistent (ACLS) is the Notarzt, a physician with extra training in emergency medicine
Emergency medicine
Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute...
. However, within Germany emergency medicine does not exist as a recognized medical specialty. As a result, the Notarzt is most often an anaesthetist (although occasionally an internist or surgeon) performing this work in addition to their regular practice >
All professions are normally deployed according to their skills
There is some pressure in Germany to eliminate the qualifications of Rettungshelfer or Rettungssanitäter in the non-voluntary areas of the German EMS. This is driven by the assumption that even today these two do not possess the skills for today's modern and complex emergency medicine. Every state has different reqirements to staff an ambulance or emergency physicians vehicle (Notarzt-Einsatz-Fahrzeug, NEF).To phase out short courses
| Roles in German emergency medicine | |||||||
|---|---|---|---|---|---|---|---|
| Job title | English counterpart | Training | Normal roles | ||||
| School | Hospital internship | Ambulance Internship | Ambulance (KTW-Krankentransportwagen) | Emergency Ambulance(RTW - Rettungstransportwagen) | Emergency Physicians Vehicle(NEF-Notarzteinsatzfahrzeug) | ||
| paramedical | |||||||
| Rettungshelfer(EMT-B) | EMT-BLS | 160 hours | none | 80 hours | driver | driver (occasionally) | driver (occasionally) |
| Rettungssanitäter(Paramedic-German: RS) | Paramedic between(ILS and ALS) | 160 hours | 160 hours | 160 hours + 40 hours for exam | Paramedic crew chief | Paramedic(ILS/ALS) | driver |
| Rettungsassistent(Paramedic-ACLS-German:RA) | Paramedic EMT-P ACLS | 12 months | 10 weeks | 1 year | ACLS crew chief for back up | crew chief | driver |
| medical | |||||||
| Notarzt | Emergency physician Emergency physician An emergency physician is a physician who works at an emergency department to care for acutely ill patients. The emergency physician is a specialist in advanced cardiac life support , trauma care such as fractures and soft tissue injuries, and management of other life-threatening situations.In... |
6 years | 2 years | 60 runs | - | - | crew chief |
Some German states and/or some organizations (employers) require yearly training (mostly around ~30 hours) for serving in professional EMS.
Other possible professional roles are EMS leader on scene, emergency dispatcher, shift or group leader, supervisor/trainer and EMS chief or positions outside the classic EMS field such as consulter or salesman for EMS equipment.
Recertification
After completing training, paramedics do not need to be recertified after a specific time like in other countries. This means that, at least theoretically, someone having been certified as a Rettungsassistent/Rettungssanitäter in 1991 might very well be on the educational level of that time. While recertification is not legally required, most municipalities order their EMS staff to do a certain amount of additional inservice training every year. Such training is typically in the range of 30–40 hours. However recertification exists for courses like ALS, PALS, BTLS which are increasingly required by employers within the EMS system.Added skills training available
Paramedics can acquire further qualifications, enabling them to apply for different or higher paid jobs within EMS.One of them is the HEMS
Air ambulance
An air ambulance is an aircraft used for emergency medical assistance in situations where either a traditional ambulance cannot reach the scene easily or quickly enough, or the patient needs to be transported over a distance or terrain that makes air transportation the most practical transport....
crew member training, after which the Rettungsassistent is certified to work on a rescue helicopter. This role includes assisting both the pilot (i.e. navigating, spotting landing sites) during flight, and assisting the emergency physician with medical care. Another qualification is that of Lehrrettungsassistent, a Rettungsassistent qualified to teach and supervise paramedic students during their training. Those seeking this role receive special training in which they learn education theory and the use of teaching strategies. (PPEd & PGCE)
For senior paramedics with a lot of expertise there is the qualification of Organisatorischer Leiter Rettungsdienst (OrgL). This qualification is closely related to mass casualties. A Rettungsassistent assuming this position will be responsible for the triage, treatment and transport functions, as well as coordinating and directing the activities of others during those events. Although this is a 2-week course, most municipalities demand additional leadership training in disaster units (i.e. leader of a medical platoon) before the certification in this role will be granted.
In the newest development, the Rettungsassistent can also train to become an Emergency Room Specialist (Kranken-und Gesundheitspfleger / Schwester)(http://www.printernet.info/nurs_scien923489-ETERZ/LW08aSchTLM.pdf)
Furthermore university degrees like Bachelor and Master Programs in Rescue Engineering or Health Care Management offer opportunities for German paramedics to take leadership roles in emergency health care systems and the general health care field. An example is the Bachelor of Arts
Bachelor of Arts
A Bachelor of Arts , from the Latin artium baccalaureus, is a bachelor's degree awarded for an undergraduate course or program in either the liberal arts, the sciences, or both...
Emergency Practitioner programme offered at the akkon Hochschule für Humanwissenschaften in Berlin
Berlin
Berlin is the capital city of Germany and is one of the 16 states of Germany. With a population of 3.45 million people, Berlin is Germany's largest city. It is the second most populous city proper and the seventh most populous urban area in the European Union...
.
Restrictions on practice
After training has been completed, the Rettungsassistent(ACLS)or Rettungssanitäter(between ILS and ALS will work as team leader on emergency- and patient-transport-ambulances. He or she may also act as driver of an NEF, a special vehicle used for transporting an emergency physician (Notarzt) to the scene, and for assisting the Notarzt during treatment.The job includes all aspects of the training that has been received. Basically, in absence of a physician, the paramedic is responsible for diagnostics and treating the patient. Unlike many examples of the Anglo-American model, the Rettungsassistent/Rettungssanitäter does not have 'de facto' permission to perform any application of medication or invasive techniques. Invasive skills are often seen as being reserved for physicians.
Under supervision of a physician, however, the Rettungsassistent or Rettungssanitäter is allowed to perform every technique that has been learned in school and training.If the Rettungsassistent is not available the Rettungssanitäter ia allowed to perform every technique that has been learned Should the need arise to perform such skills without supervision, there exists a rule called Notkompetenz (Emergency powers), which theoretically allows this. This includes, but is not limited to:
- Application of specific medication
- Adrenalin during CPR
- Dextrose GlucoseGlucoseGlucose is a simple sugar and an important carbohydrate in biology. Cells use it as the primary source of energy and a metabolic intermediate...
when treating hypoglycaemia - β2-Sympathomimetic drugs as aerosol against obstructive pulmonary disorders
- BenzodiazepineBenzodiazepineA benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...
s for epileptic seizures - Nitroglycerin for an AMIMyocardial infarctionMyocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
- certain Analgesics against pain
- IV-Electrolytes against hypovolaemic shock
- IV-cannulation
- DefibrillationDefibrillationDefibrillation is a common treatment for life-threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator...
- endotracheal intubation without the assistance of neuromuscular relaxant medication (e.g., succinylcholine, rocuronium, etc.).
It should be noted that this rule does not qualify as a law, but merely a guideline by the Ärztekammer (Federal Board of Physicians) and is always subject to local procedures and guidelines.
In theory at least, a Rettungsassistent/Rettungssanitäter will violate several federal laws when performing treatment alone. However, when treatment is necessary to avert death or severe disability of a patient, the state of emergency laws will usually take precedence.
See also
- Paramedics
- AmbulanceAmbulanceAn ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...
- Emergency medical servicesEmergency medical servicesEmergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
- Emergency medical services in GermanyEmergency medical services in GermanyEmergency Medical Service in Germany is a service of public pre-hospital emergency healthcare, including ambulance service, provided by individual German cities and counties...