[Nationwide comparison concerning medical measures by emergency paramedics in Germany]

The medical treatment by emergency paramedics without the presence of an emergency physician in Germany is based primarily on 1) delegation by the Medical Director of Emergency Medical Services (AELRD) or 2) the independent practice of medicine according to § 2a of the German Federal Emergency Paramedic Act (NotSanG). Both possibilities differ with respect to the responsibility for the diagnosis and treatment decision. This article provides for the first time a nationwide overview of who bears which responsibilities for treatment specifications for emergency paramedics.

The treatment algorithms for five clinical pictures were evaluated for all German federal states with respect to their geographical validity, the declaration and objective character as the delegation by the AELRD or the practice of medicine (§ 2a NotSanG) and the extension to narcotics. The data collection took place between December 2020 and June 2022.

In this study 112 algorithms with 403 individual measures were analyzed. For 11 German states unified treatment specifications were found and in 5 federal states treatment specifications differing from region to region were identified. The AELRD delegation or § 2a NotSanG status was explicitly declared in only 40% of the individual measures. This declaration was consistent with the objective character of the measure in 93%. An independent narcotics administration by paramedics is established in six states.

In the majority of measures intended for paramedics it is not obvious whether they are to be applied according to AELRD delegation or § 2a NotSanG. Such a declaration by the preparers could provide more clarity with respect to the responsibilities. Both an AELRD delegation and the administration of narcotics by paramedics without the presence of a physician are not established in all German states. Due to the continuously developing legal situation, the investigated endpoints may have changed in the meantime in some regions.