Trends in the Application of Invasive Prehospital Interventions by Paramedics: A Six-Year Descriptive Analysis of the...

The Emergency Paramedic Act (EPA; Notfallsanitätergesetz), implemented in 2014, expanded the legal authority of German paramedics to independently perform defined invasive and pharmacological interventions under specific conditions. However, real-world implementation of these competencies within the physician-based German Emergency Medical Services (EMS) system remains insufficiently described.

The aim of this study was to evaluate the frequency, type, temporal development, and regional variation of invasive and pharmacological/therapeutic interventions performed independently by paramedics over a six-year period.

A retrospective, descriptive multicenter analysis of digital EMS documentation was conducted across three districts in Saxony, Germany, from January 1, 2019 through December 31, 2024. All missions were screened (n = 197,842). Paramedic-led missions without physician presence were included; physician-attended missions and non-emergency interfacility transports were excluded. Interventions were classified according to the 2024 Federal Association of Medical Directors of EMS competency catalogue. Frequencies were analyzed by year and district. Temporal trends were assessed using the Mann-Kendall test, and regional differences were explored using one-way ANOVA with Tukey HSD post hoc testing. All inferential analyses were exploratory.

Of 197,842 missions, 156,417 (79.1%) were paramedic-led without physician presence. Invasive procedures occurred in 7.6% of missions and were predominantly peripheral intravenous (IV) access (5.7%). Advanced airway management and intraosseous (IO) access were rare (<0.1%). Pharmacological/therapeutic administrations occurred in 11.3% of missions and increased from 9.4% in 2019 to 12.1% in 2024 (Mann-Kendall test), whereas overall invasive procedure rates remained stable.

Ten years after implementation of the EPA, invasive and pharmacological interventions performed independently by German paramedics remain relatively infrequent and largely confined to basic measures. Advanced procedures are rarely applied, reflecting continued structural characteristics of the physician-based EMS model.