EMS in Germany

Here's are Post I just wrote at Chronicles of EMS. Enjoy.

I just recently joined this site and I instantly fell in love with the project. I think this is great way to facilitate social media to broaden our horizons by looking across borders, exchange valuable information and education, and to see how the same thing, namely EMS, is done in a completely different fashion elsewhere.

So I would like to take up some of your time and explain our EMS system here in Germany.
While EMS in the USA is very heterogen and varies from state to state, sometimes even from county to county, the German EMS system is very homogen throughout the whole country. From the North Sea to the Alps, it's pretty much done the same way.

To understand where we are coming from, we must first look at the roots of our system. Basically EMS over here developed from the notion of doctors doing house calls, back in the days when there were no ambulances. When someone was sick a doctor (GP) was summoned and he would then treat a patient at his house and only in severe cases would he be taken to a hospital.
Whereas in the US, from my understanding, EMS has it's roots in the military. During the many wars, the US military sought for systems to rapidly expedite wounded soldiers from the battle field and bring them to some kind of definitive care system. EMS evolved from that and took a lot of notions from the military.

In general it's safe to say that while Americans are more likely to "scoop and run" or "load and go", we are more prone to "stay and play". Meaning, and this is a major difference right there, we bring a physician on scene to treat patients and to evaluate the necessity of hospital treatment. As far as I know the only EMS systems to bring doctors on scene are found in a handful of countries in central Europe. Germany, Switzerland (some parts), and Austria are such examples.

Having physician on scene has many advantages. Not only does that give us the full ALS scope, but beyond that also gives us treatment options unavailable elsewhere in the world outside of a hospital setting. On the other hand it leaves us Paramedics, although extensively trained, a very confined skillset. While we are trained and educated in ALS, our scope of practise is merely comparable to an Intermediate level in the US.

Educational Levels of care providers:

Rettungssanitäter (literally "Rescue Medic"; equivalent to EMT-Basic):
A Rettungssanitäter (RS) education is a 520-hour-programm consisting of 160 hours in-class education, 160 hours of hospital internship (preferably ED, intensive care and anesthesiology), 160 hours of field intership (3rd rider) and 40 hours of exams (exam week). The scope of practise includes what you would consider BLS skills, defibrillation with an AED, and O2 administration. LT-D insertion is beeing discussed at the moment and likely to be implemented into their scope of practise.

Rettungsassistent (literally "Rescue Assistant"; equivalent to EMT-Paramedic):
A Rettungsassistent (RettAss.) education is a two year programm (with bridge programm from RN) consisting of one year in-class education, including 11 weeks of hospital internship within that first year. Subsequently followed by a one year 1600 hour field internship as 2nd rider (driver) under supervision of a field instructor.
Scope of practise includes: IV cannulation, Intubation (no RSI), epinephrin for cardiac arrest and anaphylactic shock, glucose for hypoglycemia, betamimetics for acute asthma, benzodiazepines for seizures (mostly Lorazepam these days) and isotonic or full-electrolyte infusions.

Notarzt ("emergency physician"):
A medical doctor with a supplemental education in emergency medicine. Emergency Medicine however is not a stand-alone medical dicipline in Germany. So an emergency physician will likely be an anesthesiologist, internal medicine physician or surgeon, with an extra education in emergency medicine.

EMS Vehicles and staffing:

In general there are only four types of vehicles in our EMS system.

BLS Ambulance:
staffed with EMTs, for non-emergent transports and transfers. Such as transports to for from doctor's offices, non-emergent hopital transfers, nursing home transfers, etc. Sample Image below.

Medical Intensiv Care Unit (MICU):
staffed by at least one Paramedic, some states require dual-medic. All emergency transports and transfers. In life-threatning scenarios an emergency physician will be brought on scene by a seperate chase car (see below) and accompany the transport. Sample image:

Physician Response Vehicle:
staffed by an emergency physician, and an EMT or Paramedic as driver. Usually a station wagon type car or small minivan capable of transporting the staff and medical equipment. Dispatched by default to all life threatning calls, i.e. cardiac arrest, severe shortness of breath, chest pain, MVA with entrapment, etc. Sample image:

HEMS (Helicopter EMS):

Medevac helicopter staffed with a pilot, a paramedic and an emergency physician. Their main purpose are time critical primary (meaning from scene to hospital) and secondary (interhospital) transports. There are approx. 93 HEMS stations nationwide ensuring a coverage grid, that every station has a maximal primary radius of 100 KM. HEMS helicopter are usually in service from sunrise to sunset, with a few HEMS stations keeping up a 24 hour service. Sample image:

(all pictures courtesy of wikipedia)

That should be all for now. Feel free to ask questions. I will answer them as best I can.

Be safe.