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Paramedic is the highest non-academic medical qualification in the ambulance service ( paramedic ). The job title has existed in Austria since 2002, in Germany since 2014. The counterpart in Switzerland is the qualified paramedic . Paramedic has a similar meaning in the English-speaking world . Emergency paramedics are among the paramedics .

Emergency paramedic in Germany

Education and position

The profession of emergency paramedic (usually abbreviated NotSan in Germany ) has replaced the previous paramedic as the highest professional, non-medical qualification in the rescue service and is one of the health professions . In order to take into account the medical development in the rescue service also in the training, the training to become an emergency paramedic differs in that it has been extended from the previous training as a paramedic from two to three years. The Emergency Paramedic Act (NotSanG) and the training and examination ordinance issued on the basis of this law came into force on January 1, 2014. The previous Paramedic Act expired on December 31, 2014 to enable a one-year transition phase in training.

As an entry requirement, at least an intermediate school-leaving qualification must be presented. Secondary school students must also have completed at least two years of vocational training (Section 8 No. 2 NotSanG).

According to § 4 Paragraph 1 Clause 1 NotSanG, the new training goal is: "The training to become an emergency paramedic should, in accordance with the generally recognized state of rescue service, medical and other scientific knowledge, have professional, personal, social and methodological skills for self-responsible implementation and team-oriented participation in particular mediate in emergency medical care and the transport of patients. "

The training to become an emergency paramedic takes three years in full-time form, regardless of the time of the state examination, and a maximum of five years in part-time form. It consists of theoretical and practical lessons and practical training. The training concludes with a state examination consisting of three written supervisory papers of 120 minutes each, three oral examinations of 30 to 45 minutes each and four realistic case studies, each of which is supplemented by a technical discussion. In the examination, the examinee has to prove that he is able to carry out the emergency care tasks defined in § 4 NotSanG.

Theoretical and practical lessons are carried out in state-approved schools. In the countries in which the training is subject to school law according to this law, the approval to carry out the training is granted to the schools in accordance with the school law of the federal states and in accordance with § 6 NotSanG. The practical training is carried out at an approved teaching rescue station and at suitable hospitals. The school bears the overall responsibility for the organization and coordination of the theoretical and practical lessons and the practical training in accordance with the training objective § 4 NotSanG. The school supports practical training through practical support. The Bundeswehr recognizes the training and enables recruitment to a higher rank or the corresponding promotion of an assigned reservist .

The following points are written down as training goals in the Emergency Paramedic Act:

  • 1. Carry out the following tasks independently:
    • a) Establishing and recording the situation at the place of use and immediate initiation of necessary general measures to avert danger,
    • b) Assessing the state of health of sick and injured persons, in particular recognizing a vital threat, deciding on the need to request an emergency doctor, other staff, other rescue equipment or other medical help, and implementing the necessary measures,
    • c) Carrying out medical first aid measures for patients in an emergency and applying measures learned and mastered in training, including invasive measures, in order to prevent the patient's situation from deteriorating until the emergency doctor arrives or the beginning of further medical care, if a life-threatening one Condition exists or significant consequential damage is to be expected,
    • d) Appropriate handling of people in emergency and crisis situations,
    • e) Establishing and securing the transportability of the patient in an emergency,
    • f) Selecting the appropriate transport destination and monitoring the medical condition of the patient and its development during transport,
    • g) Appropriate transfer of the patient to further medical treatment, including description and documentation of their medical condition and its development,
    • h) Communicating with persons, institutions or authorities who are or are to be involved in the operation,
    • i) Implementation of quality assurance and organizational measures in the rescue service as well as documentation of the emergency medical and tactical measures used and
    • j) Ensuring that the rescue equipment is operational and operational, including observing and complying with hygiene regulations and legal work and accident protection regulations;
  • 2. to perform the following tasks as part of the cooperation:
    • a) Assisting with the medical emergency and acute care of patients in an emergency,
    • b) independent implementation of medically initiated measures for patients in an emergency and
    • c) Independent implementation of therapeutic measures for which the medical director of the rescue service or the responsible doctors in certain emergency medical status pictures and situations are given, checked and responsible as standard;
  • 3. to work patient-oriented with other professional groups and people at the place of deployment, during transport and handover, taking appropriate account of the overall situation, from individual medical individual cases to major damage and disaster cases.

The practical training takes place on the one hand in a state-recognized rescue station for 1960 hours and on the other hand in a suitable hospital for 720 hours. It includes in detail:

  • Ambulance
    • Service at a rescue station
    • Implementation and organization of patient transport
    • Implementation and organization of emergency rescue operations

Free times are to be used to deepen the school lessons.

  • hospital
    • Nursing department
    • Interdisciplinary emergency department
    • Anesthesia and surgical department
    • Intensive care department
    • Obstetrical, pediatric or pediatric surgical department / intensive care unit or ward with corresponding patients
    • Psychiatric, geriatric psychiatric or gerontological department

The training concludes with a state examination, which includes a written, oral and practical part. The exam must be taken at the school where the training is completed.

Supplementary exams for paramedics

Paramedics are permitted to use the professional title of emergency paramedic if they pass the state supplementary examination by December 31, 2023. The state supplementary examination comprises three oral parts of 10 to 15 minutes each and two realistic case studies, one of which must come from the field of internal emergencies and one from the field of surgical emergencies. The aim of the supplementary examination is that the examinee proves that he not only meets the requirements of a paramedic but also the increased requirements of an emergency paramedic.

In addition, depending on their professional experience, paramedics must take part in further training before they are admitted to the supplementary examination. Paramedics with more than five years of professional experience can go directly to the state supplementary examination, paramedics with between three and five years of professional experience must take part in 480 hours of further training, and paramedics with less than three years of professional experience have to take part in 960 hours of further training.

Protection of the job title paramedic

In some cases, the regulations of the Emergency Paramedic Act are met with incomprehension among the professional group of paramedics, since the Emergency Paramedic Act does not provide for professional recognition or transition to an emergency paramedic. A constitutional complaint remained inconclusive. In the justification of the Federal Constitutional Court , the judges did not see any disadvantage according to Article 3, Paragraph 1 of the Basic Law and Article 12, Paragraph 1 of the Basic Law . Paragraph 30 of the NotSanG protects the professional title of paramedic and, based on professional experience, paramedics do not have to complete any further training. The Rescue Assistant Act (RettAssG) expired on December 31, 2014 after a one-year transition period. The deployment and activities of the paramedic professional group are now regulated by the provisions of the Emergency Paramedic Act and the state rescue service laws.

Standard skills

The job description of emergency paramedics differs significantly from the previous training for paramedics according to the Paramedic Act (RettAssG) of July 10, 1989. The Bundestag's scientific service writes: “The central regulation of the Emergency Paramedic Act is § 4 NotSanG, which regulates the training objective. [...] In § 4 Para. 2 No. 1 NotSanG those activities are described which represent the core area of ​​the rescue service tasks and which the paramedics are supposed to carry out independently, i.e. on their own responsibility, in later professional life due to their training . "

In particular, § 4 Paragraph 2 No. 1 Letter c NotSanG should be mentioned here: "Carrying out medical first aid measures for patients in emergencies and applying measures learned and mastered in training, including invasive measures, to prevent the situation from worsening to prevent the patient until the emergency doctor arrives or the start of further medical care, if a life-threatening condition is present or significant consequential damage is to be expected. "

This gives the paramedic a legal basis for his actions and does not have to justify his actions by the existence of a justifying emergency according to § 34 StGB , as the paramedic does. In addition, the medical director of an ambulance service or the physicians responsible according to Section 4 (2) No. 2 (c) NotSanG have the option of transferring medical measures to the paramedic, even outside of situations in which the patient is at risk of serious health or death .


In recent years, the rescue service has suffered from massive problems with young people. The reasons for this include the lack of opportunities for advancement and development, shift work with corresponding on- call times and the very high physical and psychological stress. In a study by the Rhineland-Palatinate DRK it was found that only 1.3% of paramedics are 60 years and older. Many rescue service employees are retraining or are retired early with high discounts . Nationwide studies by the AOK have shown that rescue workers over the age of 60 are sick more often and for longer than employees of the same age in other professional groups. In order to make the job of the emergency paramedic more attractive, the professional group was given the opportunity to obtain the academic degree Bachelor of Science at some universities . This qualification enables the graduates to take on more administrative tasks or to work in training at an emergency service school.

Professional firefighters

Professional firefighters only practice the profession of paramedic if their fire brigade is performing the tasks of the rescue service. As a rule, this training only takes place after the final examination of the fire service training. Thus, in fact, two professions are practiced.


Emergency paramedics are assigned to the pay group EN specially created for this occupation in TVÖD. An emergency paramedic with a relevant academic degree has the opportunity to move up to pay group 9 with appropriate use. There is a regular step up. In addition, there may be shift and function allowances. During the training, the paramedic receives a training allowance in accordance with Section 15 NotSanG. In Germany, depending on the federal state, this amounts to around 700–1000 euros in the first year of training, around 850–1100 euros in the second year of training and around 900–1200 euros around the third year of training.

Professional firefighters receive civil servant pay instead of pay, which differs from state to state. As a result, professional firefighters receive full salary during their paramedic training. In some fire brigades, however, it is also possible to become an emergency paramedic as an employee or civil servant without having to complete a fire service training. Depending on the city and depending on other qualifications, emergency paramedics are assigned to the salary groups A 7 to A 9 in the fire brigade . This corresponds (using the example of North Rhine-Westphalia) to gross monthly payments of 2134 to 3137 euros, plus a monthly fire brigade allowance of € 127.38, annual special payment , night and weekend supplements and a family allowance for married couples or parents, which can amount to several hundred euros. For salaried employees, the legal bases may vary depending on the employer or the employing corporation. The entitlement to a fire brigade allowance only arises if the employee works predominantly in the fire service, § 46 TVöD special regulation for employees in the municipal fire service. The highest court ruled in 1965 that the rescue service and the ambulance do not belong to the fire service. An exclusive activity as an emergency paramedic in the rescue service at a professional fire brigade is therefore not sufficient for the receipt of the fire brigade allowance, since these activities do not serve to directly fight fire on site. Correspondingly, § 47 No. 3 Paragraph 1 TV-L does not apply to these employees , which enables the fire-fighting technical employees concerned to apply by means of a transitional payment for fire-fighting services that have been performed for at least 15 years, like comparable civil servants in the intermediate fire-fighting service to retire at the age of 60.

Emergency paramedic in Austria

Emergency paramedics (NFS) are people trained in rescue and emergency medical services in Austria. During the training, the basics of emergency medicine and techniques for caring for injured or sick people are learned.

In addition to the general tasks of a paramedic (looking after the patient during transport, providing assistance in acute situations and carrying out emergency life-saving measures), your task is to support the emergency doctor . Emergency paramedics are deployed on all emergency medical equipment ( NAW , NEF , NAH and ITW ).

The paramedic training builds on that of the paramedic and allows the paramedic to take additional measures, such as the administration of certain medications (list of drugs 1) and the use of emergency skills (see below).

The terms paramedic and emergency paramedic or the respective training courses have only been legally regulated and recognized by the state since 2002 by the Paramedic Act (SanG).

The most common "work equipment" used by emergency paramedics in Austria, the emergency doctor vehicle

Training in Austria

The training builds on that of the paramedic and, apart from the status of an emergency doctor, represents the highest qualification in the Austrian rescue service. It comprises a further 480 hours and is divided into three parts:

  • theoretical training of 160 hours,
  • a hospital internship of 40 to 120 hours as well
  • a 280-hour internship in emergency medical systems, of which up to 120 hours can be completed as a hospital internship.

People who apply for admission to training as an emergency paramedic must meet the following requirements:

  • an active authorization as a paramedic,
  • Confirmation that the applicant has completed at least 160 hours of work in the ambulance and ambulance service, which confirms suitability for training as an emergency paramedic and
  • the positive completion of an entrance test.

The curriculum of the paramedic training is deepened, additional content relates to tactics and drug theory. The training ends with an oral and practical exam before an examination board.

After completing their training, NCCRs are entitled to administer drugs on drug list 1 . This includes paracetamol , various beta 2 sympathomimetics or anticholinergics and pre-filled adrenaline syringes (EpiPen).

Emergency paramedics are usually trained by the aid organizations ( Red Cross , Samaritan Association , Johanniter ), the Viennese professional rescue service and the Austrian Armed Forces . There are no private rescue service schools like in Germany. The trainers are primarily paramedics , but also doctors and other “suitable people”.

There is no automatic recognition of foreign training courses in Austria. In order to gain recognition, a nostrification from the Federal Ministry for Health and Women is required.

Emergency skills

Legal classification

Emergency paramedics can acquire so-called emergency skills through additional training . This allows them, under certain circumstances, to perform actions normally reserved for doctors. In contrast to the German emergency competence , the emergency competence in Austria is regulated by a federal law (SanG), which means that the emergency paramedic who uses it has a clearly prescribed legal framework for the application. If the prerequisites for the application are met, the regulated and indicated medical measures must be carried out.


Emergency competencies may be used if:

  • they are suitable for averting a danger to life and health of the patient,
  • the same goal cannot be achieved by less intrusive measures and
  • a doctor notifies or the notification is arranged.

A distinction is made between the general emergency competencies NKA and NKV from the special emergency competency NKI. The emergency competencies build on each other, which means that an emergency paramedic with the NKI must already have NKA and NKV.

General emergency competence

  • Emergency competence in drug teaching (NKA): Administration of drugs according to drug list 2
  • Emergency competence venous access and infusion (NKV): puncture of peripheral veins and administration of crystalloid infusion solutions

The drug list 2 includes (here for example at the Red Cross) the following drugs:

Special emergency competence

  • Emergency competence endotracheal intubation (NKI): Insertion of a ventilation tube into the trachea without a muscle relaxant. The knowledge must be proven every two years through a recertification.


Further emergency competencies can be defined by ordinance of the Federal Minister of Health ( Federal Ministry of Health ).

The use of emergency competencies is often more precisely defined by the respective carrier organizations of the rescue service and regulated by internal algorithms: For example, at the Austrian Red Cross, the crook of the arm as a puncture point was reserved for medical staff for a long time, the NFS-NKV was only allowed to puncture the back of the hand and forearm. However, such regulations are of no legal significance.

The WCC regional associations Burgenland, Carinthia, Lower Austria, Upper Austria, Salzburg, Vorarlberg, Tyrol and Styria (with the exception of NKI rescue doctors in Graz / Styria) currently do not offer NKI training, unlike other organizations. Because of the low frequency of use, endotracheal intubation by paramedics is controversial among Austrian rescue services; the NFS / NKI often use the larynx tube as an alternative . In the context of resuscitation, the use of the laryngeal tube is permitted for all paramedics (RS and NFS without emergency skills).

Compared to Germany

The profession of emergency paramedic in Austria differs greatly from its German counterpart in terms of qualifications and the significantly shorter training duration, in Austria 780 hours of regular training, in Germany 4600 hours of training. Only the job title is the same.

See also

Portal: Rescue Service  - Overview of Wikipedia content on the subject of rescue service


  • Christoph Redelsteiner et al. (Ed.): The manual for emergency and paramedics. 2nd updated edition. 2011, new academic press Vienna, ISBN 978-3-70-031775-3 .
  • Jan-Thorsten Gräsner et al. (Ed.): Become an emergency paramedic! 1000 saving answers for exams and practice. 1st edition. 2016, Thieme Stuttgart, ISBN 978-3-13-201461-9 .

Web links

Individual evidence

  1. § 22 SanG occupation and activity titles on Jusline accessed on August 17, 2018
  2. Law on the profession of emergency paramedic as well as amending other regulations of May 22, 2013 ( Federal Law Gazette I p. 1348 )
  3. Training and Examination Ordinance for Emergency Paramedics (NotSan-APrV) of December 16, 2013 ( Federal Law Gazette I p. 4280 )
  4. Article 5 of the law on the occupation of the emergency paramedic and the amendment of other regulations of May 22, 2013 ( Federal Law Gazette I p. 1348, 1357 )
  5. § 32 Emergency Paramedic Act (NotSanG): transitional provisions
  6. ^ Decision of the Federal Constitutional Court of July 10, 2015
  7. Scientific service: The training objective stipulated in § 4 Paragraph 2 No. 2 Letter c of the Emergency Paramedic Act. In: WD 9 - 3000 - 042/16. German Bundestag, accessed on March 17, 2017 .
  8. ^ Skilled workers and qualification initiative for health professions 2012–2015. Ministry of Social Affairs, Labor, Health and Demography of the State of Rhineland-Palatinate, accessed on April 19, 2020 .
  9. Training as an emergency paramedic azubify . In: azubify . ( [accessed November 30, 2017]).
  10. Emergency paramedic training in direct entry with the Berlin fire brigade - designation "112 Medic". Retrieved July 13, 2018 .
  11. ^ Salary table North Rhine-Westphalia 2016
  12. Federal Labor Court ruling v. 06.10.1965, Az .: 4 AZR 189/64
  13. Legal information system: Federal law: Entire legal regulation for the Paramedic Act, version of December 10, 2009
  14. Federal Ministry of Labor, Social Affairs, Health and Consumer Protection: Recognition of paramedics. Retrieved July 13, 2018 .
  15. Federal law consolidated - general emergency competencies. Federal Ministry for Digitization and Business Location, accessed on November 17, 2018 .
  16. Drug list as PDF