The rescue service is an important link in the rescue chain: in Germany, its task is to stabilize patients prehospital and transport them to a suitable hospital after initial treatment. This involves the use of medical and non-medical personnel.
What is the rescue service?
The rescue service is an important link in the rescue chain: in Germany, its task is to stabilize patients prehospital and transport them to a suitable hospital after initial care. In the rescue service, rescue specialists stabilize patients in the event of sudden illness or injury and transport them to medical care. Primarily, ambulances according to DIN 1789 and emergency vehicles are used for this purpose. Special areas of the rescue service are air rescue with rescue helicopters, mountain rescue by the mountain guards and water rescue by the water guards. In addition, sea rescue is part of the rescue service. However, the majority of rescue missions are ground-based, using ambulances and emergency vehicles. The medical staff in the rescue service consists of emergency physicians, some with specialized training in a particular field. Training for non-physician rescue personnel was fundamentally reformed in Germany on Jan. 1, 2014: By 2021, emergency paramedics with three years of training and expanded competencies will replace paramedics, who previously represented the highest qualification level in rescue services with two years of training. In addition, the paramedic with 540 hours of training will remain as a basic qualification for use in patient transport or as a driver of an ambulance. The rescue service is alerted via rescue control centers, which can be reached throughout Germany by dialing 112. The financing of the rescue service is borne by the health insurance companies; legal regulations on the rescue service are a matter for the states in Germany. While in some states the rescue services are municipal enterprises, in other states this task is outsourced to the aid organizations.
Treatments and therapies
In principle, the treatment spectrum of the rescue service includes all diseases, ailments and injuries that occur outside a hospital. However, there are serious differences depending on the severity and nature of an illness and injury: While, for example, a hypertensive crisis or hypoglycemia can often be treated sufficiently with the medications carried in the ambulance or on the emergency medical vehicle that the patient does not need to go to the hospital at all, in the case of other illnesses only the symptoms, for example pain or bleeding, are alleviated. The actual treatment then takes place in the clinic, for example the plastering of a fracture or the suturing of a wound. Which methods are used differs depending on the rescue service area, the qualifications of the rescue personnel present and the urgency required. In cases of polytrauma or stroke, rapid transport to an appropriate hospital is often more important than treating individual symptoms on the scene. Even in cases where a patient’s symptoms cannot be treated on site, transport to the hospital takes priority. In many cases, treatment in the ambulance service is now carried out using so-called algorithms: These standardized flowcharts ensure that a particular clinical picture is always treated in the same way and according to the latest medical research. Within the framework of such algorithms, the respective medical director of rescue services can approve the use of certain drugs by rescue specialists for his rescue service area. In general, the rescue service is responsible for acute cases, i.e., sudden complaints or injuries or life-threatening illnesses that require immediate treatment. For so-called sub-acute cases or chronic illnesses, the physicians in private practice or the medical on-call service outside their office hours are responsible. These can also be handled by the rescue service, but this blocks capacities for emergencies and ultimately overloads the rescue service.
Diagnosis and examination methods
Initial diagnostics are performed in the ambulance service either directly on site or in the vehicle.It is important to take a thorough medical history, obtain all vital signs, such as pulse, respiration, consciousness, blood pressure, oxygen saturation and blood sugar, and take the patient’s medical history. A DIN-compliant RTW also already has the equipment on board to establish venous access and draw blood in laboratory tubes, saving valuable time in the emergency room. Imaging diagnostic procedures, for example X-rays, are not available in the ambulance service. Depending on a patient’s symptoms, an ECG can also be written. Portable ECG devices are carried for this purpose, which can also perform semi-automatic defibrillation at the same time. If an emergency physician is on the scene, there is also the option of electrical cardioversion and the creation of a chest drain. Each ambulance also has a portable ventilator and an electric suction pump on board. Emergency physicians can thus perform prehospital anesthesia and intubation. In the rare event of a delivery in the ambulance, surgical instruments are also available for cutting the cord. In the event of circulatory arrest, resuscitation is performed by the ambulance service in accordance with the ERC guidelines, and some vehicles carry an automatic resuscitation aid for this purpose, for example the Lucas II. The medications carried vary depending on the ambulance service area, as do the other equipment and the exact technical specifications of this equipment. The methods used by non-medical personnel in the absence of an emergency physician and whether, for example, emergency paramedics or paramedics are allowed to give medication differ depending on the federal state. In addition to medical equipment, each emergency vehicle carries numerous pieces of rescue equipment to gently transport patients. These include a wheeled stretcher for in-vehicle transport, a scoop stretcher for spine-sparing rescue, and a vacuum mattress for immobilization. A KED system for seated rescue from an accident vehicle with simultaneous stabilization of the spine is also prescribed in the DIN. In addition, so-called spineboards, on which patients can be fixed and gently rescued, are becoming increasingly popular.
