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Doctors newspaper online, 16.10.2019
rescue
emergency paramedic expressly equip with the permission to medical science, or not? The initiative of the Bundesrat leads to a discussion within the medical profession.
By Anno Fricke and Thomas Hommel
© Maria.P. / Fotolia
BERLIN. The initiative of the Federal Council to allow emergency paramedics to inject, puncture or even take invasive measures in the event of an emergency has triggered a split echo in the medical profession. At its meeting on Friday, the Federal Council had introduced a proposal for amendment of the emergency paramedic law into the Bundestag. Emergency paramedics should therefore be "entitled to perform medical work" as long as there is no on-site medical assistance and a patient is in a life-threatening condition. Background of the Bundesrat advance are legal and action uncertainties on the part of the paramedics and the question of who would be liable in the event of damage.
The majority of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) is behind the Federal Council initiative. "The DIVI expressly does not share the concern of other professional associations, which oppose the independent implementation of invasive measures by emergency paramedics in acute emergency situations in the sense of transferring medical tasks," said the DIVI. Already on Friday, the associations of trauma surgeons, surgeons and orthopedic surgeons had voiced clear reservations against the proposal of the Federal Council.
DIVI: No erosion of the emergency medical system
"There is no danger that the emergency medical system could be eroded," DIVI President Professor Uwe Janssens told the "Ärzte Zeitung". The DIVI emphasizes the need for an ambulance-assisted rescue system. In international comparison, emergency-based systems are leading the way in patient survival.
However, it can not be conveyed that suitably trained and continuously trained paramedics should not take any life-saving measures when they arrive at the scene of the accident, as long as the ambulance has not yet arrived, according to DIVI's statement.
The President of the German Society for Anaesthesiology and Intensive Care Medicine (DGAI), Professor Rolf Rossaint, does not see any need for action.
Problem: Legal Uncertainties
It is questionable, it is said in a statement distributed by the DGAI and the professional association of German anaesthesiologists, whether the desired legal certainty is not already established by the applicable law. This also allows trained emergency attendants to "carry out medical measures independently in an emergency until the arrival of the emergency physician."
Current figures from Baden-Wurttemberg also showed that emergency paramedics would only have to perform activities that are extremely rare under the supervision of a physician. In addition, the emergency physicians with simultaneous alerts in the median rather before the rescue teams at the scene of the accident.
The anesthetist associations therefore warn against a "risk of lack of experience" among the emergency staff and a possible patient risk. If the change in law nevertheless comes, a clear definition of "emergency situations" would have to be made in an indication catalog.
Ulrich Schreiner, Managing Director of the private Björn Steiger Foundation, also fits into this score. Experience is the be-all and end-all in the rescue service – this applies equally to emergency physicians and paramedics alike, emphasized Schreiner. To be properly clarified, the question must be, "when may the paramedic do something?". Here, the current law has gaps and must be "reformed."
Björn Steiger Foundation for more competences of paramedics
In principle, Schreiner spoke in an interview with the "Ärzte Zeitung" for lending more powers to paramedics. "It is crucial that they see real emergencies and have routine". A fundamental problem of the rescue system in Germany is its fragmentation, emphasized Schreiner. "Federalism harms the rescue service, everyone does his bit." In some regions emergency care is alarmingly bad.
The "telenot doctor" developed at the University of Aachen represents a "huge opportunity" for better emergency care, says Schreiner. Emergency physicians receive video pictures of the paramedics' helmet camera live on site from the condition of the injured person. The paramedic can then act as instructed by the doctor. The telenot doctor is already being tested, for example in the district of Vorpommern-Greifswald.
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