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The system of emergency care in Germany


Ben Sierra, paramedic, first aid instructor in Germany and volunteer firefighter.

He first came to Ukraine in March, 2016 to participate in the International Conference on Tactical Medicine organized by Patriot Defence. Prior to this he had also been introduced to our own instructors during the International Combat Lifesaver course held in Germany.

During Ben’s second visit to Kyiv, he offered to present a lecture on the system of emergency care in his country for instructors from Patriot Defence, as well as to other organisations.

The Federal Republic of Germany is a nation with the largest population and the largest economy in the European Union. The population of Germany – 81.1 million people. The average life expectancy is 77.93 years for males and 82.58 years for females. (In Ukraine male life expectancy is 62.37 while women live to 74.5 – PD).

Ben began his presentation by noting that the introduction of the system of emergency care in Germany was a lengthy process.

The system of emergency aid in all 16 regions of the Federal Republic vary somewhat (including the manner in which heads of departments implement their systems) and normally, the positions are held by doctors with additional paramedic qualifications.

All emergency calls in Germany are received by one call centre, which refers them to the appropriate service brigade.

Such ambulances, as shown on this slide, operate in Germany

There are several types of ambulances in operation: there are ambulances with two paramedics, vehicles where there are two paramedics and a doctor, light vehicles which are operated by one paramedic and a doctor. Helicopters are also used. They were introduced in the 1970’s and 1980’s for the purpose of reducing the time taken to bring a doctor to the scene of an emergency as well as to transport the injured to hospital.


Emergency Care Doctors train for 6-8 years and also undertake an additional course in emergency medicine, which normally incorporates one week of lectures and practical exercises, so that they are able to understand the differences between working in a hospital (emergency) environment and that as required in an ambulance.

Most accidents in Germany occur in the home (32%). The rest arethe result of motor vehicles accidents (5%), work related (14%), at schools (15%), or whilst participating in leisure activities (16%)

In 1991 a law was passed which regulated the training of paramedics. They are trained over a period of two years. 1600 hours (over 60 days) are dedicated to lectures, practical exercises, training in hospitals, and an additional 1600 hours is practical training in real life situations in an ambulance. The final sessions include written, verbal and practical exams. Two years ago, it was decided to enhance the training of paramedics and thus training was increased to three years.

Paramedics also undertake refresher training and recertification. If they fail the recertification testing, they are unable to continue working in the area of emergency aid.

Emergency Medical Technologists (EMTs) train for 520 hours. Together with this they undergo 160 hours of Emergency Medical Technology school, 160 hours of practical training in an ambulance and the same number of hours in a hospital. Following this they must complete a complex exam.

Amongst the personnel there is also a general medic (doctor), who as a rule is the third in line in an ambulance, and provides support at large scale emergencies.

Hesse Region

Ben works in the Hesse Region, the centre of which is Frankfurt-on-Maine. In this region there are 25 areas and 240 emergency aid stations, as well as 70 – 80 stations with doctors and 4 helicopters.

The region employs 5600 paramedics and emergency medical technologists and 1200 emergency care doctors but they don’t all work simultaneously. For example, the doctors mostly work in hospitals and spend between two and 10 days per month in the ambulance service.

The operating centre in Hesse receives almost one million calls annually. Helicopters undertake some 4-5 thousand flights a year. Doctors are called out to a little less than 50% of the calls.

Doctors are required to gain marks from the Association of Doctors, publish articles and attend conferences and courses. In this regard the association encourages their development which in turn has a positive influence on the whole system.

A person who fails to provide assistance to another person in need is liable to criminal negligence. The issue here is first aid at the start of an emergency which, for example, begins at the time of the call-out of the ambulance.

In Germany much emphasis is placed on the training of basic life support of the general population. For example, even to obtain a driver’s license you must provide a document indicating that you have attended a first-aid course. And large businesses commit to ensuring that some 10% of their workforce are able to provide first-aid.

During courses participants are trained in ensuring that they provide support in the correct sequence

Last year, the basic course for citizens was reduced by half to 8 hours in order to simplify it. The aim of such training is to ensure confidence and understanding about what is required to ensure personal safety in the first place.

In a similar system utilised by Patriot Defence, (those who have successfully completed the Combat Lifesaver course, can attend the course for a special services defence force medic - PD), the training centres select the best trainees and enable them to undertake a more intensive course which is undertaken over 40 hours.

Traditionally, such training courses cost in the tens of Euros, which for the citizens of the country is not a large sum at all.

The training is conducted by such organisations as Red Cross, Good Samaritans, the Fire Brigade, as well as by private companies. The training is based on the principle: “Look. Decide. Act.”

     • Read also: Principles of working in emergency medicine in Sweden