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Emergency competence (rescue service)

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The so-called emergency competence (of the paramedic or emergency paramedic) is a buzzword in German rescue service training to convey in layman’s terms the justifications of the justifying state of emergency and presumed consent, furthermore the criminal offence of failure to render assistance as well as the guarantor’s duty (in connection with offences of omission). The concept was taken up in 1992 by the German Medical Association in a letter recommending that paramedics carry out certain medical measures if emergency medical assistance is not available in time at the scene of the emergency. Legally, this recommendation has remained meaningless, partly because it oversimplifies the complex legal situation. In practice, however, it is usually followed. There is no case law on the question of emergency competence itself.

Recommendation of the German Medical Association

The German Medical Association recommended that paramedics

  • endotracheal intubation without relaxation,
  • the placement of peripheral venous accesses or intraosseous accesses,
  • the administration of crystalloid solutions
  • Early defibrillation (with semi-automatic equipment)
  • as well as the administration of selected drugs[1]

but only to the extent that

  • a less invasive measure has already failed or is not promising,
  • medical assistance is not available in time,
  • the measure is urgently necessary and reasonable for the preservation of life or the prevention of serious damage to health in order to avert danger to the life or health of the patient, and[2]
  • the paramedic has learned these measures and is proficient in them.

If the patient is conscious and capable of giving consent, he must be informed that the person providing treatment is not a doctor. No measures may then be taken against the patient’s will.

Other comments

In addition to the German Medical Association, other bodies have also taken a position on the issue of emergency competence[3] on the question of emergency competence, which also want to allow paramedics or even “all sufficiently qualified persons” (theoretically, therefore, also paramedics and paramedics with a corresponding level of knowledge) to perform such emergency competence measures.[4] However, since the training to become a paramedic is significantly shorter than the training to become a paramedic, significantly fewer medical measures are to be considered as emergency competence measures for paramedics than for paramedics. Exceptions are to exist in individual cases for paramedics who have been active in emergency rescue for many years and who have received above-average further training, but this is to be reviewed on a case-by-case basis.

Literature

  • Arno Keipke, Physician reservation and emergency competence in the rescue service (dispute presentation until 2008; PDF file; 44 kB)
  • Brose, Johannes, Aufgaben und Befugnisse nichtärztlichen Rettungsdienstpersonal, 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, Das neue Notfallsanitätergesetz: Mehr Rechtssicherheit für Rettungsfachpersonal?, MedR 2013, p. 221 ff.

Individual references

  1. Medications whose administration can be carried out within the scope of emergency competence(Memento of 8 August 2018 in the Internet Archive) (PDF file; 23 kB), as of 11 March 2004, German Medical Association: Accordingly, the decision on the type of medication is borne by the medical director of the emergency medical services. In its recommendation on emergency competence, the German Medical Association names 6 emergency medications with conditions that can be administered by paramedics within the scope of emergency competence. These are: Adrenalin in resuscitation and allergic shock, Beta 2 sympathomimetics in obstructive respiratory conditions, Nitroglycerin as a spray or capsule in acute coronary syndrome (myocardial infarction, angina pectoris attacks), Benzodiazepines in severe seizures, Glucose 40% in hypoglycemic shock and Analgesics (painkillers) in severe pain conditions. The recommendation of the German Medical Association serves as an orientation for paramedics as to which medical measures can actually be taken within the scope of emergency competence. If the paramedic is proficient in other medical measures and the legal requirements are met, the paramedic can also take measures that are not covered by the recommendation.
  2. Statement of the German Medical Association on the emergency competence of paramedics and on the delegation of medical services in the rescue service(PDF; 36 kB) German Medical Association. 2 November 1992. archived on Original 9 August 2018. retrieved 19 January 2020.
  3. Statement of the BVRD e. V. on emergency competence (Mementoof 21 April 2004 in the Internet Archive); Recommendation of the federal physicians of the aid organisations ASB, DLRG, DRK, JUH, MHD: Action of paramedics/paramedics within the framework of emergency competence (PDF file; 22 kB) (Memento of28 April 2016 in the Internet Archive)
  4. Cf. Erik Hahn: Die Bedeutung der Physiotherapeuten-Entscheidung des BVerwG für die Diskussion um das Verhältnis von HPG und RettAssG im Rahmen der Notkompetenz. Emergency & Rescue Medicine 2011, pp. 51-56.