On-site helpers

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On-site helpers ( HvO ), also first responders (FRP) or paramedics on site ( SanvO ), in Bavaria officially first- aid groups or local facilities of organized first aid , in Hessen advance helpers , in North Rhine-Westphalia called emergency helpers , are a supplement to the Rescue chain . There are at least extended first aid and i. d. As a rule, people with basic medical or rescue service training who, in emergencies , should bridge the time until the arrival of a rescue aid with qualified basic medical measures.

The general term first aider, on the other hand, describes anyone who happens to be present in an accident and provides assistance; in English this corresponds to the general term first responder (“first aiders, first responders ”).

In English , the terms Emergency Medical Responder, Emergency First Responder , Medical First Responder , Ambulance First Responder and Certified first responder are common. The abbreviation First Responder ( FR ), derived from this, is sometimes used in Germany, Austria and Switzerland, which literally means first responder and is identical in English to the general “first responder”.

Magen David Adom (MDA) first aid scooter in the old city of Jerusalem

term

In Germany , the term “Certified First Responder” was initially mostly only used by fire departments . In the meantime, however , it is also widespread among aid organizations , where the German term “local helpers” is also used. The meaning is synonymous in the German-speaking area , which differs from the Anglo-American area, where Certified First Responders are sometimes more highly qualified than most local helpers. There is also the term “paramedic on site” (SanvO). This is to make it clear that the personnel deployed have completed a regulated, medical service training and that the assistance reaches a level well above that of lay assistance (this is also the case with the other names, only it is not emphasized by the term).

The Bavarian State Ministry of the Interior names the helpers on site as first aid groups or local facilities for organized first aid . In Hesse there is now the official designation “ advance helper” and the Hessian Ministry of Social Affairs issues recommendations for training and personal suitability. In North Rhine-Westphalia, the local helpers are officially referred to as emergency helpers , which is not exactly the same as the Maltese training of the same name .

The English term "first responder" is also becoming increasingly established in military parlance. So the army exist three different levels of training for the so-called soldiers Einsatzersthelfer and Combat First Responders , so for particularly paramedical official trained staff that first (poly) with a traumatized soldier arrives or is already on site.

tasks

The helper on site

Sense and purpose

On-site helpers (HvO) and paramedics on site (SanvO) should shorten the time interval between the dispatch of an emergency by the control center and the first medical care. The period between the receipt of an emergency call in the control center and the arrival of the emergency services is called the therapy-free interval . The faster qualified measures are carried out, the cheaper the healing process and the shorter the subsequent necessary treatment time on average.

The fibrillation is a common form of cardiac arrest . It is believed that every minute that ventricular fibrillation is not treated with cardiopulmonary resuscitation , the chances of successful recovery decrease by ten percent. Severe irreversible damage to the brain occurs after just six to eight minutes, caused by a lack of oxygen and glucose supply . In cardiac arrest with ventricular fibrillation, a defibrillator should be used for resuscitation. Since it takes two minutes to make an emergency call and to be placed in the rescue control center , and it can take up to twelve minutes plus the time limit for assistance, the emergency services of an ambulance may not reach the patient for a defibrillator until 14 minutes after the onset of ventricular fibrillation. The longer the therapy-free interval until resuscitation with the use of a defibrillator, the greater the risk that the patient will have a serious medical need.

A resuscitation could be initiated after a few minutes by an on-site helper or a paramedic with the appropriate equipment. In the case of cardiac arrest with ventricular fibrillation, this is primarily an automatic external defibrillator . By shortening the response time, many patients can make full recovery even after a heart attack or stroke . In the event of accidents and accidents, the on-site paramedic is also responsible for a more specific assessment of the situation at the scene of the accident and can request emergency services via BOS radio or a cell phone so that help can be provided more effectively.

origin

This facility arose from the knowledge that the organized rescue service often takes too long to get to the scene of an emergency in order to avert serious damage to the health of emergency patients , but the lack of emergency frequency in this area does not justify the establishment of an additional rescue station .

The background is probably also the fact that in many mostly rural areas volunteer assistants from various aid organizations and groups are already established on site. So it happened and it happens again and again that a person seeking help contacted a locally known qualified volunteer of an aid organization or fire brigade privately by telephone. He then came to the emergency site as part of his extended duty of assistance - of course not without informing the responsible rescue control center about what was happening. This citizen aid was and is of course not viewed uncritically by the rescue coordination centers, because the operation is not coordinated from the start. On the other hand, this behavior of the citizens in acute medical emergencies is also very common and understandable.

Especially in the USA , with its large and relatively sparsely populated area counties the local structures and the availability of organized forces in the form of were volunteer firefighters and patrol cars of the police used early to the first measures of until the arrival of emergency medical services to take over with very long journey times . Members of the American Women's Voluntary Service Organization also volunteered.

For similar reasons, predecessors emerged in Germany in the early days of the modern ambulance service at the beginning of the 1970s: the ambulance service was not as expanded back then as it is today - the local volunteer fire brigade often worked alone at the scene of the accident for a long time and therefore asked members of a local one Aid organization to move out with. The alerting was often very tedious, as neither portable radio receivers nor sufficient telephones were available. With the shortening of the rescue service deadlines, this concept then became meaningless.

It was not until the mid-1980s that volunteer disaster control units were increasingly equipped with portable radio receivers. It made sense to use this option for quick help on site. This meant that one no longer only practiced for imaginary emergencies or catastrophes, but that the emergency medical skills and knowledge acquired and practiced could be actively used for the initial care of emergency patients.

In 1993 the DRK local association Rheinstetten-Mörsch e. V. carried out a first pilot attempt of modern character in Germany with the then so-called "Rapid Response Teams" , which was published in a trade journal in 1995. The BRK local group Glonn then founded one of the first teams in Germany in 1998 and presented the idea and integration with a rapid deployment group at a specialist congress, which still exists today. One of the first first responder organizations in Germany was also founded in northern Germany through a private initiative, inspired by several visits to the USA from 1992 to 1995. From the mid-1990s onwards, this type of aid became very widespread. So were z. In 2005, for example, 60 first responder groups were reported ready for action at the rescue control center in the Karlsruhe rescue service area alone and were regularly alerted to operations.

Reasons for this are:

  • The means of alerting were now suitable and available (since the beginning of the 1990s: largely switching from siren alarms to wireless receivers, availability of cell phones ).
  • The idea was recognized and some pilot projects showed good results.
  • The legal conditions were largely clarified after controversial discussions (e.g. insurance cover, vehicle permits).
  • The fire brigades (as the largest emergency organization) recognized the opportunity to create an interesting opportunity for committed helpers, especially for less stressed units in remote areas. The aid organizations also discovered this facility as a motivating and useful service for their local chapters.

Today the system is recognized.

organization

The organization is not standardized, it is based on the voluntary commitment of the aid organizations that provide it. For this reason, there are no overarching, uniform equipment or training regulations for this service (there are, however, internal organizational regulations, in North Rhine-Westphalia there is a recommendation from the state advisory board for organized emergency aid). Often times, volunteer and full-time rescue workers are on duty.

There are various alternative characteristics of the different forms of organization:

Status: Volunteers , rarely full-time staff (such as professional fire brigade and police , who are often out and about in public)
Alerting: Radio transmitter , (mobile) telephone
Performing: Aid organizations , fire brigade , technical aid organization
Personnel strength: one or more people who are alerted at the same time; A maximum of 3 of them go to the patient, the rest are ready
Vehicle: Private or company vehicles: cars, crew transport vehicles, fire engines or ambulances / ambulances
Vehicle location: at the helper on duty (at home, at work), vehicle hall or guard

Alerting

The facility is alerted by the responsible control center via SMS or radio receiver .

Use indication

The indications for use are regulated differently from one location to the next; the FR / HvO is usually used when the next regular rescue equipment takes significantly longer than the FR / HvO and there is therefore a risk that the necessary help will not arrive quickly enough. This indication usually exists for all emergency medical operations . In some places, the on-site helpers are even alerted every time an emergency is deployed, especially where there is no rescue station nearby.

This can also be the case if the rescue service complies with the statutory aid deadline and is the main reason for the existence of the FR / HvO. The bridging of the arrival time is particularly valuable when the regular rescue service is busy caring for other patients or is tied up for a longer period of time due to an incident or needs an unusually long time to arrive due to weather conditions or the like.

In addition to the on-site helper, a rescue device from the regular rescue service is always used; the FR / HvO is only a supplement, not a substitute for the rescue service.

Directions to the place of use

Since first responders are not part of the rescue service, the prevailing legal opinion is that the regulations for special rights according to Section 35 (5a) of the Road Traffic Act that only apply to rescue service vehicles do not apply. Thus, first responders are generally not entitled to any special rights when traveling to the site (exception: first responders are members of an authorized authority or organization, e.g. fire brigade - for these, Section 35 (1) of the StVO is usually considered relevant). However, the approaching first responder can refer to the general emergency regulations, which u. a. are standardized in § 16 OWiG and § 34 StGB. To a certain extent, a violation of traffic regulations (exceeding the maximum speed, etc.) can be justified under criminal law or administrative offense law. In Bavaria there is a regulation by the Ministry of the Interior which allows the use of special signaling devices for service vehicles of the First Responder units under certain conditions. Right of way is only mandatory for first responders if they have special signal systems (blue light and siren) switched on.

Working hours

The offer of the FR / HvO is usually a purely voluntary service of the organization, which is mostly based on voluntary commitment. Therefore, the standby times in some places are limited to nights (e.g. from 6:00 p.m. to 6:00 a.m.) and weekends / public holidays. However, the vast majority of helpers from local groups are on standby 24 hours a day, 365 days a year and are available if an emergency occurs and they can currently be deployed.

The alarm from the control center is still often around the clock, but then it cannot be guaranteed that someone actually moves out. The regular ambulance service is always used, which means that the patient receives at least the help that is regulated by law ( State Rescue Service Act or similar) - if the FR / HvO can move out, then he receives a voluntary additional service.

education

General training

Basic medical training is required for participation in the service, e.g. B. as a paramedic . As a rule, this also includes ongoing (re-) certification for early defibrillation . Often, additional courses for on-site helpers with adapted teaching content are offered. Internships in the regular rescue service improve safety in the field and promote good cooperation on site.

The focus of the training and further education is (from the BRK guideline for on-site helpers from 2002):

The training to become a rescue worker or paramedic as part of an on-site helper is also widespread . Some federal states have their own recommendations or regulations with regard to the minimum qualifications of helpers on site (e.g. Bavaria and Hesse, each two-stage; and North Rhine-Westphalia, one-stage). Most regular medical training courses meet at least the lowest level of the requirement profile.

Special in Bavaria

In Bavaria, according to the guidelines of the Ministry of the Interior, there are two qualification levels for those involved in first aid groups. The first stage comprises a 48-hour medical training (analogous to the medical training at the Red Cross ). In the case of a larger range of activities, a more extensive, 80-hour course is recommended. This corresponds, for example, to the theoretical training of the emergency medical technician (at the Maltese) or the on-site qualification of the Johanniter (which is based on a 60-hour paramedic course). Other aid agencies have developed similar modular training programs.

Special feature in Hessen

There are two levels of advance helpers in Hessen. In addition to a 16-hour first aid course, the basic advance helpers - first aid (Vorhelfer-EH) have completed eight teaching units in advance helper training and have to undergo a corresponding refresher training every year. The second stage comprises the advance helper SAN with a 48-hour medical training course. A 24-hour rescue internship is recommended. The advance helper SAN has more extensive equipment and uses.

Special feature in North Rhine-Westphalia

For the activity in North Rhine-Westphalia a total of "50 teaching units (UE) including an examination comprehensive training as an emergency helper must be proven". In North Rhine-Westphalia, the large, 16-hour first aid course is a prerequisite for access to further HvO training. Emergency workers must have at least 16 hours of medical training and 6 hours of AED training. This 22-hour training is supplemented by at least 10 hours of case study training and a 2-hour final exam. The emergency helper training at Malteser usually goes beyond these requirements.

Special feature in Baden-Württemberg

In Baden-Württemberg, the Ministry of the Interior's ordinance on the participation of on-site helpers in addition to emergency rescue (VOHvO) is a binding legal regulation for helpers working in the state. A special responsibility falls to the executing organization, which must have a medical quality management system (§ 11 VOHvO). Only organizations and facilities active in disaster control (e.g. DRK, MHD, JUH, ASB, fire brigades) are authorized to set up a local HvO system (Section 2 (1) VOHvO).

Basic requirement for the activity as HvO acc. Section 2 (2), Section 4 and Section 5 VOHvO are:

  • Personal and health suitability
  • Of legal age
  • First aid course (9 units)
  • Medical service training (min. 48 TU / recommendation: 72 TU, see appendix to VOHvO)
  • 16 hour rescue service internship
  • Regular advanced training (16 units in two years and rescue service internships)
  • Instruction about journeys with "special rights" i. S. d. StVO (regularly every two years when using blue light emergency vehicles)
  • a written signed confidentiality agreement (see § 12 VOHvO)
  • existing insurance coverage

The mandatory equipment (§ 6 VOHvO) is minimal. The VOHvO prescribes disposable gloves, a binding system ( tourniquet ) and personal protective equipment in accordance with of the organizational regulations. AED and med. Equipment acc. DIN 13155 defined.

The HvO may use emergency vehicles of the executing organization and claim special rights / rights of way according to § 35 and § 38 StVO. The approval for this is given by the control center (§ 8 VOHvO).

The HvOs used are subject to the instructions of the rescue service and the control center. You yourself are not part of the rescue service, but an addition to the emergency rescue service.

Situation in Austria

In Austria, first responders are also an important part of the rescue chain. Basically, they are divided into first responders from the rescue service, from companies or into lay first responders.

The former work for one of the rescue organizations and are alerted in their free time to operations in the vicinity of their place of residence. It is up to them to accept the mission or not. In some federal states (such as Lower Austria), these first responders receive detailed information and coordinates on the relevant emergency by means of an app (ESAPP TM ) and the status is given with this (e.g. on the outward journey, at the place of appointment, etc.) . In most cases, they will have a standard emergency backpack that comes with a resuscitator, stethoscope, blood pressure cuff, bandages and blood glucose meter. Depending on the department, first responders are also equipped with defibrillators. The Gänserndorf district office of the Red Cross was significantly involved in setting up the first responder system and equips every first responder with a defibrillator. In view of the fact that first responders are usually deployed with private vehicles, there is still no permit in Austria to use special signals.

In Vienna there is a new type of system that enables first responders (mainly paramedics) to be alerted in the event of a cardiac arrest, regardless of where they live. With the Die Lebensretter TM app , several paramedics in the vicinity of the emergency are alerted at the same time and directed either directly to the emergency location or to the nearest public defibrillator to get it. In Lower Austria, Burgenland and Tyrol, this system is run as the Austria Lifesaver Team with the involvement of first aiders with an upright 16-hour first aid course, which also receives alerts in Vienna.

equipment

Fire department first responder vehicle
Typical first responder vehicle

Means of communication

clothing

  • at least one safety vest
  • If possible, operational clothing (helmet, anorak, jacket / pants or overall, boots)

Medical material

  • Medical case according to DIN 13155 or emergency case according to DIN 13232
  • additional equipment with oxygen
  • Automated External Defibrillator ( AED ).
  • If possible, emergency equipment for infants and small children (according to DIN 13233)

vehicle

Come into use

financing

Running costs arise mainly from:

  • Phone calls
  • Consumables
  • Operating materials and maintenance for vehicles

FR / HvO rarely receive public subsidies, as their assistance is not required by law (not a mandatory task of the municipality such as the fire brigade ). The costs incurred cannot be billed to a health insurance company . The FR / HvO teams are largely financed by donations.

See also

literature

  • Bavarian Red Cross : Guideline for helpers on site , state committee of the BRK readiness 2002
  • B. Done: Strategies against sudden cardiac death , 4th edition, Stumpf & Kossendey Verlag, Edewecht 2002
  • P. Poguntke, M. Eichner: Pacemaker in the rescue chain - First Responder ... , Stumpf & Kossendey Verlag, Edewecht 2001
  • Emergency and rescue medicine magazine , Springer Verlag, issue 5, 10th year, pp. 350–356, 2007
  • J. Schöchlin, F. Ayasse, T. Lorch: Helfer vor Ort-The model of the rapid deployment teams, Rescue Service, issue 18, pp. 64–66, Stumpf & Kossendey Verlag, Edewecht 1995
  • C. Lippay Combat Sudden Cardiac Death , Journal Im Einsatz, Issue 8, pp. 82-84, 2001
  • J. Schöchlin, F. Ayasse, C. Lippay: 10 years of first responder teams: Experiences with the DRK Mörsch , Rescue Service magazine, issue 27, pp. 230–237, Stumpf & Kossendey Verlag, Edewecht 2004
  • H. Peter: Standardization in North Rhine-Westphalia: Emergency helpers on a safe basis , specialist journal Im Einsatz, issue 12, pp. 262–263, 2005
  • J. Schöchlin, F. Ayasse: First successes with resuscitation by first responder groups in the rescue service area of ​​Karlsruhe , specialist magazine Rettungsdienst, issue 5, pp. 70–73, 2006

Individual evidence

  1. ↑ a b Bavarian State Ministry of the Interior - First Aid Groups in Bavaria
  2. ↑ a b Hessian Ministry of Social Affairs Recommendations for first-responder systems 2011 (PDF; 28 kB)
  3. ↑ a b Emergency helper training in NRW
  4. ↑ Press release of the Bavarian Ministry of the Interior No. 542/03 of October 24, 2003 ( Memento of March 14, 2007 in the Internet Archive ), accessed on January 7, 2012.
  5. ↑ Bavarian State Ministry of the Interior - Guide for the activities of local organizations of organized first aid (first aid groups) in Bavaria
  6. ↑ state law BW VOHvO | State standard Baden-Württemberg | Ordinance of the Ministry of the Interior on the participation of on-site helper systems in addition to emergency rescue (First Aid Ordinance - VOHvO) of February 12, 2018 | valid from: 02.03.2018. Retrieved February 3, 2020 .
  7. ↑ Who are first responders and what do they do? (No longer available online.) 144 Notruf NÖ, archived from the original on September 25, 2017 ; Retrieved September 25, 2017 .
  8. ^ Mario Krammel: First Responder. (PDF) Retrieved October 24, 2016 .
  9. ^ First responder. Red Cross, accessed October 24, 2010 .
  10. ↑ Vilimsky; DI Deimek: Blue light for first responders. (PDF) National Council Austria, accessed on October 24, 2016 .
  11. ↑ Dr. Mario Krammel: The lifesavers. Retrieved October 24, 2016 .
  12. ↑ Team Austria Lifesaver. Austrian Red Cross, accessed September 25, 2017 .