Paramedic

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The paramedic ( RettAss or RA ) was the first state-recognized occupation in the rescue service in Germany . With effect from January 1, 2014, he was replaced by the emergency paramedic , who is governed by the Emergency Paramedic Actwas introduced. Until December 31, 2014, however, there was also the possibility of starting paramedic training and completing it in accordance with the old law. The training of the previous paramedic was standardized nationwide at vocational schools and lasted a total of two years (three years for the so-called "island solution"). The paramedic in Germany roughly corresponds to the emergency paramedic in Austria, the qualified paramedic in Switzerland, the Emergency Medical Technician-Paramedic ( Paramedic ) in the United States and the Emergency Medical Technician in England. In Germany, the general names are often incorrectly used for non-medical members of the rescue serviceParamedic or paramedic used, but both are not state-recognized training occupations.

tasks

The tasks of the paramedic include the independent care of emergency patients until the emergency doctor arrives , assistance in the actions of the doctor and independent implementation of missions in which the presence of a doctor is not possible until arrival at the hospital or qualified care is required. The paramedic is also responsible for properly carrying out patient transports.

education

The two-year training was regulated by the Paramedic Act of July 10, 1989, which expired on December 31, 2014. A new start of training was still possible up to this date; already started could be continued according to the previous law.

The paramedic training was divided into two parts, which could be completed full-time or part-time: The course consisted of at least 1,200 hours (full-time: 12 months) and included teaching theory at a state-recognized paramedic school as well as an internship in various departments a clinic. This part of the training ended with a state examination, which mostly consisted of a practical part (this part could e.g. be structured as follows: cardiopulmonary resuscitation , internal medicine, surgical), a theoretical part and a written part. The test was carried out under the supervision of the competent authority (e.g. health department). Among other things, paramedics and registered nursing staff , medical NCOs of the Bundeswehr as well as medical officers of the police and federal police have the opportunity to have part of their previous training credited. The Bundeswehr recognizes the training according to §22 Soldiers' Career Ordinance (SLV) and enables the recruitment with a high rank or the corresponding promotion of an assigned reservist .

The practical work following the course and the state examination comprised at least 1,600 hours (full-time: 12 months), which the student must spend at a teaching rescue station. There, the practical skills were deepened under the supervision of a paramedic (usually with an additional educational qualification as a teaching paramedic or practical instructor). Paramedics can have parts of their previous rescue service work credited. The practical part ended with a so-called “final interview”, in which the trainee is checked again to determine whether he or she is suitable for this job. Only then did the trainee receive the certificate on application from the competent authority of the federal state in which the theoretical part of the training was completed (usually, if available, from the respective regional council) on the "Permission to use the professional title of emergency assistant" .

In addition, there was also a three-year paramedic training as an isolated solution. The paramedic trainee was permanently employed by an ambulance service organization, received training remuneration, teaching materials and uniforms and, in addition to training as paramedic, acquired additional qualifications such as MPG officer or the upgrade of the class B driving license to class C1 (a A large number of ambulance vehicles exceed the 3.5 ton limit, which covers class B). Since these were initiatives of individual departments and rescue service schools, they were also responsible for the organizational process and the additional qualifications. However, this was by no means an extension of the paramedic training itself: The basis for the training content remained the Rescue Assistants Act (RettAssG) and its training and examination regulations. This did not result in an often required, extended competence to act with appropriate legal protection.

The prerequisites for starting an apprenticeship were suitability for health, completion of the 18th year of life and a secondary school leaving certificate , equivalent schooling or completed vocational training. Often, however, the secondary school leaving certificate or a secondary school certificate plus completed vocational training was required. Furthermore, a certificate of good conduct of document type N (for private) was requested.

From the "Training and Examination Ordinance for Paramedics (of November 7, 1989)":

General medical basics

General emergency medicine

Special emergency medicine

  • internal emergencies including intoxication
  • traumatological emergencies
  • thermal emergencies
  • Radiation emergencies
  • neurological emergencies
  • pediatric emergencies
  • gynecological and obstetric emergencies
  • psychiatric emergencies
  • other emergencies

Organization and tactics

  • Rescue service organization
    • Rescue appliances / rescue systems
    • Emergency operations and ambulance transport, control center, handover / takeover, transport of non-emergency patients, transport of emergency patients, transport in special cases, cooperation with third parties
  • Means of communication
  • Management tasks in the rescue service
  • Dangers at the place of use
  • Large numbers of injured and sick
    • causes
    • Alerting
    • Procedure of the emergency rescue service
    • Involvement of the emergency services in disaster control

Professional, legal and civic education

  • Professional studies including ethics
  • The health system in the Federal Republic of Germany
  • current professional issues
  • Paramedic Act ; statutory regulations for other health care professions
  • Labor and professional regulations, insofar as they are important for the practice of the profession
  • Accident prevention, maternity leave , occupational safety
  • Medical Devices Ordinance , Medical Devices Act (MPG)
  • Road traffic law, especially special rights in road traffic
  • criminal and civil law regulations that are important in the practice of the profession; Legal status of patients and guardians
  • Introduction to hospital law
  • The foundations of the state order in the Federal Republic of Germany
  • Inheritance law

Competencies

A paramedic is obliged to carry out certain medical measures in the context of omission offenses and, due to the justification of the justifying emergency and the presumed consent , even though these measures are generally reserved for doctors. Due to a legally meaningless recommendation by the German Medical Association , locally different lists of such measures, which are part of the so-called emergency competence , have been created. The German Medical Association names the following measures:

In addition, the following measures should be allowed in some rescue service areas:

Even before the Paramedic Act came into force in 1989, this law had been viewed as unsatisfactory in specialist circles with regard to the unregulated competencies of paramedics. But until today these changes could not be found in legal form. In this respect, large parts of other European countries (e.g. Denmark, Great Britain, Ireland, Switzerland, Austria, the Netherlands, Hungary, the Scandinavian countries and the Czech Republic) and other nations (e.g. South Africa, Singapore) differ , South Korea, Australia, New Zealand, Canada and the USA) differ considerably from the German legal situation. Thanks to the clearly defined competencies of the rescue personnel, they can provide emergency patients there with invasive measures approved for them without having to wait for a doctor to arrive at the emergency center. However, it must be ensured that the patient is immediately referred to medical treatment (e.g. by requesting the emergency doctor). This often involves regular training with repeated certification for certain measures. It must be taken into account that other rescue systems pursue different strategies: some generally work with doctors in every emergency or have no emergency doctor-assisted rescue service at all.

Opponents of a legally strict regulation, on the other hand, argue that a rescue service employee currently enjoys an unusual freedom in Germany in which he can decide on more far-reaching measures himself based solely on his professional competence, even if he has to bear the associated consequences himself.

Compulsory training

For working paramedics in the (commercial) public rescue service i. d. Usually a further training obligation that is not regulated nationwide. There are different regulations in the rescue service laws of the federal states, usually a time frame for the training is given, but no minimum requirements. As a rule, it is left to the municipalities themselves how the staff is trained consistently and continuously, or what requirements are placed on the rescue service providers of the regional authority. The actual requirements and requirements for the paramedics can therefore also be very different within a federal state. The private aid organizations and commercial providers usually have additional internal regulations: For example, the Presidium and Presidial Council of the German Red Cross decided in 1995 that working paramedics should receive at least 30 hours a year of training in order to continue to be deployed in the emergency rescue of the German Red Cross to be able to. Legal regulations for the training of paramedics outside the rescue service, especially when deployed in disaster control or medical services, do not exist in most federal states.

Training opportunities

Paramedics and paramedics have numerous training opportunities and additional qualifications available:

  • Group / platoon / association leader rescue service (DRK-LV Nordrhein)
  • Head of rescue service
  • Organizational Head
  • Trainers rescue service / teaching paramedic
  • State-recognized lecturer at a rescue service school
  • Disinfector
  • Anesthetist
  • Medical device officer or consultant according to MPG
  • Control center dispatcher
  • Head of emergency services
  • Ambulance chief
  • HEMS crew member ("HCM") (air rescue assistant)
  • Expert advisor for crisis intervention and emergency aftercare
  • Advanced Cardiac Life Support Provider
  • European Pediatric Life Support Provider
  • International Trauma Life Support Provider
  • Basic Trauma Life Support Provider
  • Prehospital Trauma Life Support Provider
  • Europa-Paramedic ("EEMSP") European Emergency Medical Service Paramedic
  • European Critical Care Paramedic Specialist rescue assistant for intensive care transports
  • Certified Flight Paramedic
  • Certified Critical Care Paramedic
  • Checked Specialist in health and Social affairs (IHK)
  • Checked Pharmaceutical representative (IHK)


Furthermore, there is the possibility of taking special courses if you are suitable:

Often, however, the interested parties have to pay for the costs of the respective courses themselves, unless their employer or employer has provided them for such specialist training or the state pays for the training.

Professional organization and professional associations

In contrast to other European countries, the paramedic profession has just as little as the other qualification levels of rescue specialists in the Federal Republic of their own professional organization. The training and the state examination are supervised by the regional councils or state school authorities. The different employers (e.g. aid organizations, professional fire brigades or private entrepreneurs) monitor the exercise of their profession themselves, but usually the supervision of state rescue service providers, such as districts or large cities, for their respective RD area (this is regulated in the various state rescue service laws ). In individual cases (e.g. in the federal states of Hesse, Rhineland-Palatinate and Lower Saxony) a medical director for the rescue service can also be authorized by the provider or the Rescue Service Act prescribes this function.

The Professional Association for the Rescue Service eV (BVRD) was founded in 1983 to protect the professional interests of the rescue personnel . The statutes of the BVRD stipulate, among other things, that statements on new legislative projects at federal and state level can be submitted if these affect the rescue service.

In 2006, another professional association was founded: The German Association of Rescue Service eV (DBRD). The association is now represented in all committees that affect the rescue service and currently also provides a deputy chairman of the "Standing Conference for the Rescue Service" (SKRD).

The rescue specialists, i.e. the actual occupational group owners, are currently organized particularly within the Ver.di trade union responsible for them , regardless of the respective employer. For example, through participation in collective bargaining (e.g. collective agreement for the public service TVöD, DRK reform collective agreement), but also through participation in professional groups and participation of ver.di in the so-called "permanent conference" (here, for example, . drafted a key issues paper for the amendment of the Paramedic Act), paramedics had a direct influence on their own professional interests. Ver.di was also represented in the state school committee in Lower Saxony to develop framework guidelines for the training of paramedics (the state of Lower Saxony issued a corresponding guideline in April 2008 www.bbs.nibis.de).

There is also a specialist group in the komba union that represents rescue service personnel. Komba is represented on the same committees as ver.di. It is particularly committed to maintaining or reintroducing the 24-hour service at the request of employees. At the komba seminar "The Professional Fire Brigades" in April 2011 in Berlin, a federal worksheet was drawn up, which once again clearly underlines the common focus of the rescue service fire brigade. The representation of the rescue service from the "non-fire department" has thus been highlighted even more clearly. Many rescue service employees as well as those of the aid organizations are organizing themselves with the increasing trend at komba.

Fundamental reorganization of the job description and training from 2014

With the passing of the Emergency Paramedic Act (NotSanG) on May 22, 2013, paramedic training and the job description were newly regulated on January 1, 2014. The new job titles of " emergency paramedic " and "emergency paramedic" were introduced. The duration of the training was extended from two to three years, new training objectives were formulated and the structure of the training was changed. The quality requirements for the practical training facilities have been redefined.

The entrance requirement was now the middle school leaving certificate. Applicants with a secondary school diploma must provide evidence of successfully completed vocational training of at least two years. A legally regulated minimum age for exercising the profession of 18 years, as it had often been demanded, was not decided.

In addition, a right to payment of a training allowance was introduced over the entire duration of the training.

Transitional provisions

Paramedics who have a permit under the Paramedic Act may continue to use this professional title. Schools that were officially recognized before the NotSanG came into force on the basis of the Paramedics Act are generally still considered to be officially recognized.

Anyone who began training to become a paramedic before the RettAssG came into force (January 1, 2015) can also complete it in accordance with the RettAssG. After completing the training, the applicant is given permission to use the professional title "Paramedic" or "Paramedic" if the requirements are met.

Paramedics who can prove that they have been working in the rescue service for at least five years are allowed to use the professional title "Emergency Paramedic" if they pass a supplementary state examination by the end of 2023.

Anyone who has worked as a paramedic for at least three years can use the new job title if they have attended a further 480 hours of training in preparation for the supplementary examination.

Anyone who has been employed for less than three years or who cannot prove that they have worked as a paramedic after training as a paramedic must have taken part in a further 960 hours of training in preparation for the supplementary examination.

Further training can be completed full-time, part-time or part-time.

literature

Excerpt from the standard training literature for aspiring paramedics:

  • Bodo Gorgaß , Friedrich Wilhelm Ahnefeld , Rolando Rossi, Hans-Dieter Lippert, Werner Krell, Georg Weber: The rescue service textbook. 8th edition including online access, Springer Verlag Heidelberg Berlin, 2007, ISBN 978-3-540-72277-9
  • Kersten Enke, Andreas Flemming, Hans-Peter Hündorf, Peer G. Knacke, Roland Lipp (eds.): LPN - textbook for preclinical emergency medicine in 5 volumes. 3rd edition 2005, ISBN 3-938179-14-7
  • Dietmar Kühn, Jürgen Luxem, Klaus Runggaldier (eds.): Ambulance service today. 5th edition, 2010, ISBN 978-3-437-46192-7 (with online version and bonus material)

Legal comments on the Paramedic Act:

  • Hermann Kurtenbach, Bodo Gorgaß, Wolfgang Raps: Rescue Assistant Act: with training and examination regulations for paramedics - commentary with a detailed appendix including the rescue service laws of the federal states (excerpts). 2nd edition, Kohlhammer, Stuttgart, 1997, ISBN 3-17-014817-6
  • Hans-Dieter Lippert: Paramedic Law (RettAssG): Law on the profession of paramedic (Paramedic Law - RettAssG) of June 30, 1989 (Federal Law Gazette I p. 1384) last amended by the law of September 21, 1997 (Federal Law Gazette I p. 2390). 2nd edition Springer, Berlin, 1999, ISBN 3-540-65492-5

History of the job description:

  • Nils Kessel: History of the ambulance service 1945–1990. From the “people of life savers” to the job description “paramedics”. History of Medicine in Context Vol. 13, Verlag Peter Lang , Frankfurt am Main et.al., 2008, ISBN 978-3-631-56910-8
  • Rainer Schmidt: From lay rescuer to paramedic. The emergence of a job description and the requirements for modern, needs-based didactics in the rescue service. Bachelor thesis Carl Remigius Medical School, Frankfurt am Main, 2019.

See also

Web links

Wiktionary: Paramedic  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ Section 32 (1) NotSanG in conjunction with Section 25 NotSan-APrV
  2. ↑ http://www.bundesaerztekammer.de/downloads/BAEK_Stellungnahme_Rettungsassistenten.pdf Statement of the German Medical Association on emergency competence from November 2, 1992
  3. ↑ http://www.bundesaerztekammer.de/downloads/Notfallkompetenz__Medikamente.pdf Statement of the German Medical Association regarding medication, the application of which can be carried out within the scope of emergency competence
  4. ↑ Full quotation: "Paramedics Act of July 10, 1989 (Federal Law Gazette I p. 1384), which was last amended by Article 19 of the law of December 2, 2007 (Federal Law Gazette I p. 2686)", repealed by Art. 5 sentence 2 of the law of May 22, 2013 BGBL. I p. 1348 with effect from January 1, 2015.
  5. ↑ § 32 Transitional Provisions (1) Training to become a paramedic, which was completed before the Paramedic Act of 10 July 1989 (Federal Law Gazette I p. 1384), which was last amended by Article 19 of the law of 2 December 2007 (Federal Law Gazette I P. 2686) has been changed, has been started, is completed according to the provisions of the Paramedic Act.
  6. ↑ a b § 32 NotSanG