Rescue specialists
Rescue specialists (also called rescue specialists ) is the collective name for non-medical specialists employed in emergency rescue and qualified ambulance transport . Members of this group have undergone special emergency medical training that qualifies them to work in the rescue service. In some federal states, rescue equipment can in part also be manned by non-specialist personnel, so that rescue service personnel do not necessarily have to be rescue specialists everywhere.
There are major differences in the duration and quality of training for emergency personnel across Europe and worldwide. For example, most Anglo-American rescue service systems work almost entirely without emergency doctors and only use non-medical personnel (the “ paramedics ”) in the pre-clinical area . In Germany, Austria and Switzerland, as well as some other Central European countries, a system has developed, mainly for historical reasons, in which specially trained doctors (" emergency doctors ") are also deployed outside the hospital. The various training courses for both emergency physicians and non-medical personnel differ greatly between the individual countries.
Germany
Apart from the emergency doctor as a medical rescue service personnel, there are three qualifications in Germany for specialist personnel in the non-medical rescue service. An emergency doctor is always authorized to issue medical instructions to them.
Paramedic and paramedic
The highest non-medical qualification in the rescue service is represented by the emergency paramedic and, until the end of 2013, the paramedic . The paramedic goes through a three-year training program, which was introduced in 2014 and is more extensive than the two-year paramedic training. The training to become an emergency paramedic comprises 1920 hours at a state-recognized vocational school, 720 hours in several departments of a suitable hospital and 1960 hours at a recognized rescue station. The training concludes with a final state examination made up of 10 parts. Relevant here is the Emergency Paramedic Act, which came into force on January 1, 2014, and the training and examination ordinance issued on the basis of this Act. In the meantime , at least one paramedic / paramedic is required in all federal states in the emergency rescue service , i.e. usually on an ambulance. The majority of the federal states meanwhile also prescribe at least an emergency paramedic / paramedic qualification for the driver of the emergency doctor vehicle .
Paramedic
The paramedic has a much shorter training than the paramedic and paramedic (at least 520 hours). "Paramedic" is not a recognized training occupation, but training is regulated by state law in many federal states. The training consists of at least 160 hours of a basic paramedic course (content: basic knowledge of anatomy and physiology, general and special emergency medicine, rescue and transport techniques, legal principles, etc.), 160 hours of internship in a hospital (anesthesia, intensive care unit, emergency room), 160 hours Internship in the rescue service at a recognized rescue station and at least 40 hours of paramedic final course with a written, oral and practical final examination. The paramedic is used in emergency rescue operations as the driver of the ambulance (now almost exclusively with a C1 driver's license) and team partner of the emergency paramedic or paramedic, while in almost all federal states he is used as a highly qualified crew member with an ambulance and takes care of the patient. Until 1989 paramedics were the most highly qualified personnel in the rescue service, which was then changed by the Paramedic Act.
Rescue workers
The training to become a rescue worker is only regulated by state law in some federal states. Originally it is a joint description of qualifications for the aid organizations . Rescue workers are used almost exclusively in the field of qualified patient transport. However, a few states they can, together with paramedic or emergency workers an ambulance or with an emergency physician and a paramedic / paramedics one ambulance occupy. The qualification is aimed at volunteers or FSJler . Accordingly, it is often offered as a course spread over weekends.
Competencies and tasks
Basically, the task of non-medical rescue personnel is to carry out transports, provide first aid to emergency patients up to the assumption of treatment by an (emergency) doctor, assist the (emergency) doctor, monitor patients during the transport and the Independent implementation of missions in which the patient does not require treatment by an (emergency) doctor but requires professional care until arrival at the hospital. As part of the so-called emergency competence , a paramedic can also carry out measures in emergencies that are usually reserved for doctors. However, this is a legal construct based on the justifying emergency for which the helper has to expose himself to legal risks. Paramedics can also make use of this regulation, however, due to their relatively short training, this is only necessary in extreme emergencies and is very rare in rescue service practice, as ambulances must be manned by a more highly qualified paramedic or paramedic. The emergency paramedics, on the other hand, have significantly more extensive training, more extensive powers and greater legal certainty, but when they actually carry out medical measures, they continue to work largely on the basis of the justifying emergency.
paramedic
Paramedics are often mistakenly assigned to the emergency services personnel. However, this is a non-protected term that is used in particular for medical personnel. Paramedics have completed medical training , which differs in scope and content depending on the aid organization and generally does not correspond to the above qualification levels. In some federal states, paramedics can be deployed in the rescue service, but are still not rescue specialists.
Austria
Emergency doctor
The emergency doctor is a specially trained doctor who intervenes medically on site in emergency situations. In order to be allowed to work as an emergency doctor, the cycle or specialist training must be completed (i.e. the jus practicandi acquired) and an emergency doctor course must be completed. The emergency doctor is authorized to give instructions to all other rescue service employees in medical matters. In the case of non-life-threatening emergencies, an emergency doctor is usually not required (with the exception of pain therapy, for example).
Paramedic
Since 2002, the training for paramedic regulated and recognized in law paramedics - it is 260 hours. In Austria, paramedics are deployed both in emergency rescue and in qualified ambulance transport. Paramedics are not allowed to administer any medication other than oxygen. Their competence therefore includes the basic medical assistance of non-life-threatening ill patients, as well as the assistance for the emergency doctor on site in cooperation with the emergency paramedic (s) present. Ambulances in Austria are often manned by two paramedics, who are usually the first rescue equipment to ensure the patient's medical assistance (e.g. wound care, splinting of fractures, rescue, medical history, basic resuscitation measures, ...). When the emergency doctor team arrives, the paramedics act as assistants as much as possible.
Paramedic
The emergency paramedic training (NFS) builds on the paramedic training and, in combination with the emergency skills to be acquired, represents the highest qualification in the Austrian rescue service. In Austria, the NFS (like the paramedic) is a legally regulated and recognized profession. In addition to being a paramedic, the training includes 480 hours and allows the NFS to administer some selected drugs (drug list 1). With the training courses based on the emergency paramedic - NKA / NKV (emergency competence in drug theory and vein access, 90 hours), as well as NKI (emergency competence intubation, 110 hours) - the emergency paramedic may administer further medication (drug list 2) and puncture peripheral veins as well as a patient without intubate the use of relaxants . The last two training levels mentioned are not without controversy in the Austrian rescue service and are not trained or recognized everywhere.
Switzerland
Emergency doctor
In Switzerland, training is regulated by the Swiss Society for Emergency and Rescue Medicine (SGNOR). The requirements are:
- Federal or recognized foreign medical diploma
- Membership in the FMH
- Three years of clinical activity at a further education institution recognized in the respective field: at least one year of anesthesiology, one year of internal medicine, one year of surgery or another clinical subject
- Completion of an emergency doctor course recognized by SGNOR
- Successfully passed courses in ACLS -AHA and PALS -AHA
Anesthesia nurse
This is an anesthesia nurse with additional training to become a qualified paramedic , who largely grants the trained person on site the skills of an emergency doctor. The competencies of the nurse are determined by the respective medical director of the rescue service.
The anesthetist is supposed to replace the emergency doctor and is mainly employed in the emergency services that are integrated into a hospital.
Qualified paramedic
The training to become a qualified paramedic HF takes three years and is recognized as a tertiary training. She graduates with the title of qualified paramedic HF . HF stands for "higher technical school". The competencies of the qualified paramedics are determined by the respective medical director of the rescue service; In many emergency services, for example, paramedics are allowed to intubate reflexless patients or independently perform analgesia with ketamine or potent opiates.
Whether and when an emergency doctor is called in or when an emergency physician is called out is also a matter for the medical management, unless this is regulated by the cantonal authority.
Transport paramedic
The training as a transport paramedic corresponds to the first year of training as a qualified paramedic HF . In emergencies, it is used to support a qualified paramedic . Under instruction, he can independently carry out invasive measures such as venipuncture and administration of medication. The paramedic can carry out ambulance transports on his own responsibility.
Transport helper
The transport helper, who is sometimes employed in Switzerland with a qualified paramedic (mostly applicable in private rescue service or ambulance transport companies), is similar to the German rescue worker . The training, which was officially six days until 2013, mainly related to making the patient ready for transport, vehicle and radio technology, basic emergency medical measures as well as the assistance of the qualified paramedic on site, which could vary greatly depending on the duration of the transport assistant course or previously completed medical professions (e.g. .: Establish venous access, apply medication). (For comparison, in Baden-Württemberg a rescue worker undergoes a four-week theoretical training course with more focus on medical knowledge. He then does a two-week internship at a rescue station.)
The highest lay training (until 2013: ResQ level III) served to support professional rescuers. Since the basic guidelines regarding the training according to SRK (transport helper course or SRK level III and ResQ level III: 6 days) were too few for many rescue services, some training centers have agreed on the name of rescue transport helpers. These courses were also based on the concepts of SRK, SRC and ResQ, but went far beyond that. B. instead of 60 hours of training up to 200 hours. The priority was in realistic scenes and in-depth theory in anatomy, physiology and pathology of the human body. The increased further training was checked and confirmed by a course certificate.
According to the Interverband für Rettungswesen (IVR), the original transport helper was only valid until 2013. The job description of the transport paramedic is intended to replace the transport assistant.
With regard to lay training, the FIRST AID label has been in place since 2017. It is controlled by the Interverband für Rettungswesen (IVR). There is a person register with information on training and which IVR level a person has reached. A successfully completed course is valid for two years. Then you have to attend and pass a so-called refresher course so that the recognition can be renewed for another two years.
Various nursing staff can also complete this course in order to work in rescue services or patient transport companies. This is of great importance for pure ambulance companies (cost reduction). In addition, depending on the nursing training, the medical director can grant higher competencies.
The extended training to become a so-called rescue transport helper (up to 200 hours of training and further training and up to 6 months of internship) can be compared with the German rescue worker with additional skills that a paramedic sometimes has.
This training is nowhere to be found, as the name no longer exists (except in a few exceptional cases) and the current course graduate is given an individual name. This can e.g. B. "Paramedics Level 3 IVR" or "First Responder Level 3 IVR". IVR level 3 is still the highest level of layman training in first aid and thus the link to the rescue service.
New regulations have been in effect since 2017. The IVR (Interverband für Rettungswesen (IVR)) has decided that the at least 6-day course is officially called "First Aider Level 3 IVR". Nevertheless, most training centers offer courses with significantly more days and award the titles "transport helper" (still, but rarely), "company paramedic" or "first responder", which are also medically certified. The certification is only valid for two years. Before this expires, the trained person must attend a refresher course in order to always be up to date with the latest emergency medicine.
United States
EMT paramedic
The EMT Paramedic represents the highest qualification in the US emergency rescue service , as no doctors are used in pre-clinical emergency rescue. EMT stands for Emergency Medical Technician , translated as emergency medical technician . The training and qualifications for paramedics in the United States vary greatly in the various states, and the training period can last between twelve months and four years. In contrast to their colleagues in Germany and Austria, paramedics are mostly left to their own devices at the scene and therefore have additional skills, including intubation with and without relaxants (rapid sequence intubation), the interpretation of 12-lead ECGs (and drug therapy), performing a needle cricothyrotomy , retrograde intubation, central venous access, intraosseous access and much more.
First responder
First responders are not rescue specialists, but a function that can be performed by first aiders, medical personnel from disaster control or also by rescue specialists. See also helpers on site . Medical first responders , on the other hand, are always doctors.
Canada
Critical Care Paramedic (CCP)
These paramedics are specially designed for the intensive care of patients; they are mainly used for the intensive care transport of critical patients or on rescue helicopters and ambulance aircraft. Their skills range from interpreting 12-lead ECGs to rapid sequence intubation, administering a wide variety of medications, dealing with intensive care ventilators and emergency surgical interventions (cricothyrotomy, chest drainage ).
Advanced Care Paramedic (ACP)
Many of the paramedics used in preclinical emergency rescue have this qualification. You are allowed to administer a range of medications, intubate patients, interpret 12-lead ECGs and cardiovert patients, among other things .
Primary Care Paramedic (PCP)
This is the lowest level of qualification for a Canadian emergency medical service personnel. PCPs carry out basic measures, are also allowed to administer some selected drugs, defibrillate and interpret 3-lead EKGs.
literature
- Dietmar Kühn, Jürgen Luxem, Klaus Runggaldier (eds.): Rescue Service RS / RH . 2nd Edition. Munich 2010, ISBN 978-3-437-48041-6 .
- Bodo Gorgaß, Friedrich W. Ahnefeld, Rolando Rossi: The rescue service textbook . Berlin 2007, ISBN 978-3-540-72277-9 .
Individual evidence
- ↑ Law on the profession of emergency paramedic as well as amending other regulations of May 22, 2013 ( Federal Law Gazette I p. 1348 )
- ↑ This applies by ordinance for a total of 8 federal states, in Rhineland-Palatinate as an administrative regulation. - Dietmar Kühn, Jürgen Luxem, Klaus Runggaldier (eds.): Rescue Service RS / RH . 2nd Edition. Munich 2010, ISBN 978-3-437-48041-6 , p. 456.
- ^ Austrian Paramedic Act