Emergency medical services in Germany

Emergency Medical Service (German: "Rettungsdienst", lit. "Rescue Service") in Germany is a service of public pre-hospital emergency healthcare, including (but not limited to) ambulance service, provided by individual German cities and counties. It is primarily financed by the German health insurance companies.

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 II, prehospital care in Germany was in its infancy; 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 other emergency services, for example the Johanniter-Unfall-Hilfe e.V., a subsidiary of the German Order of St.John. 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. However, more and more it became evident, that not only transport saves live of patients, but treating them on-scene.

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). The idea to "bring the doctor to the patient, rather than the patient to the doctor" was already born before World War II, now rediscovered mid-1960s. The result was the evolution of a type of emergency 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.

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 first emergency medical technicians were trained by some fire departments, organizations and even universities. 1977 the first nationwide educational standard for non-physician emergency medical providers was introduced, the Rettungssanitäter.

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