Emergency competence (rescue service)

The so-called emergency competence (of the paramedic or paramedic) is a catchphrase in German rescue service training to convey the justification of the justifying state of emergency and the presumed consent , as well as the criminal offense of failure to provide assistance and the guarantor's obligation (in connection with omission offenses ) in a layman's way. The term was taken up in 1992 by the German Medical Association in a letter that recommended paramedics to carry out certain medical measures if emergency medical help was not available on time at the emergency location. Legally, this recommendation has remained meaningless, also because it overly simplifies the complex legal situation. In practice, however, it is mostly followed. There is no case law on the question of emergency competence itself.

Recommendation of the German Medical Association

The German Medical Association recommended paramedics

the endotracheal intubation without relaxation,
the laying of peripheral venous accesses or intraosseous accesses,
the administration of crystalloid solutions
Early defibrillation (with semi-automatic)
as well as the administration of selected drugs

to allow, but only so far

a less invasive measure has already failed or is not promising,
medical help is not available in time,
the measure to support life or to avert serious damage to health is urgently necessary and reasonable in order to avert danger to the life or health of the patient, and
the paramedic has learned and mastered these measures.

As far as the patient is conscious and capable of giving consent, he must be informed that the treating person is not a doctor. No action may then be taken against his will.

Other opinions

In addition to the German Medical Association, other bodies have also taken a position on the question of emergency competence, which also want to allow paramedics or even “all sufficiently qualified persons” (theoretically also rescue workers and paramedics with the appropriate level of knowledge) to exercise such emergency competence measures . However, since the training to become a paramedic is significantly shorter than the training to become a paramedic, far fewer medical measures should be considered as emergency competence measures for paramedics than for paramedics. Exceptions should exist in individual cases for paramedics who have been working in emergency rescue for many years and have received above-average training, but this should be checked in each individual case.

literature

Arno Keipke, doctor's reservation and emergency competence in the rescue service (controversy until 2008; PDF file; 44 kB)

Brose, Johannes, Tasks and Powers of Non-Medical Rescue Service Personnel , VersR 2014, p. 1172 ff.

Hellhammer-Hawig, Giso, guidelines for so-called emergency competence measures in the rescue service , MedR 2007, p. 214 ff.

Lubrich, Felix, The new Emergency Paramedic Act: More legal security for emergency medical personnel? , MedR 2013, p. 221 ff.

Individual evidence

↑ Medicines, the application of which can be carried out as part of the emergency competence ( Memento of August 8, 2018 in the Internet Archive ) (PDF file; 23 kB), as of March 11, 2004, German Medical Association: The decision on the type of medication is therefore borne by the medical director of the emergency services. In its recommendation on emergency competence, the German Medical Association names 6 emergency medication with clinical pictures, which can be administered by paramedics as part of emergency competence, these are: adrenaline during resuscitation and allergic shock, beta 2 sympathomimetics for obstructive airway conditions, nitroglycerine as a spray or capsule for acute coronary syndrome (Heart attack, angina pectoris attacks), benzodiazepines for severe seizures, glucose 40% for hypoglycemic shock and analgesics (pain relievers) for severe pain. The recommendation of the German Medical Association serves as a guide for paramedics as to which medical measures can actually be taken within the scope of emergency competence. If the paramedic has mastered further medical measures and the legal requirements are met, the paramedic can also take measures that are not included in the recommendation.
↑ Statement of the German Medical Association on the emergency competence of paramedics and the delegation of medical services in the rescue service (PDF; 36 kB) Federal Medical Association. November 2, 1992. Archived from the original on August 9, 2018. Retrieved January 19, 2020.
↑ Statement by BVRD e. V. on emergency competence ( Memento of April 21, 2004 in the Internet Archive ); Recommendation of the federal doctors of the aid organizations ASB, DLRG, DRK, JUH, MHD: Action of paramedics within the scope of emergency competence (PDF file; 22 kB) ( Memento from April 28, 2016 in the Internet Archive )
↑ Cf. Erik Hahn: The importance of the physiotherapist decision of the BVerwG for the discussion about the relationship between HPG and RettAssG in the context of emergency competence. Emergency & Rescue Medicine 2011, pp. 51–56.

[1] Medicines, the application of which can be carried out as part of the emergency competence ( Memento of August 8, 2018 in the Internet Archive ) (PDF file; 23 kB), as of March 11, 2004, German Medical Association: The decision on the type of medication is therefore borne by the medical director of the emergency services. In its recommendation on emergency competence, the German Medical Association names 6 emergency medication with clinical pictures, which can be administered by paramedics as part of emergency competence, these are: adrenaline during resuscitation and allergic shock, beta 2 sympathomimetics for obstructive airway conditions, nitroglycerine as a spray or capsule for acute coronary syndrome (Heart attack, angina pectoris attacks), benzodiazepines for severe seizures, glucose 40% for hypoglycemic shock and analgesics (pain relievers) for severe pain. The recommendation of the German Medical Association serves as a guide for paramedics as to which medical measures can actually be taken within the scope of emergency competence. If the paramedic has mastered further medical measures and the legal requirements are met, the paramedic can also take measures that are not included in the recommendation.

[2] Statement of the German Medical Association on the emergency competence of paramedics and the delegation of medical services in the rescue service (PDF; 36 kB) Federal Medical Association. November 2, 1992. Archived from the original on August 9, 2018. Retrieved January 19, 2020.

[3] Statement by BVRD e. V. on emergency competence ( Memento of April 21, 2004 in the Internet Archive ); Recommendation of the federal doctors of the aid organizations ASB, DLRG, DRK, JUH, MHD: Action of paramedics within the scope of emergency competence (PDF file; 22 kB) ( Memento from April 28, 2016 in the Internet Archive )

[4] Cf. Erik Hahn: The importance of the physiotherapist decision of the BVerwG for the discussion about the relationship between HPG and RettAssG in the context of emergency competence. Emergency & Rescue Medicine 2011, pp. 51–56.