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Regulations and protocols may be developed and issued at the discretion of the medical director, who is required to govern their actions according to the general guidelines and financial guidance provided by his county or municipality.
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In addition to regular emergency and non-emergency services, there are mobile intensive care units MICU stationed in most of the major cities. These units correspond to the critical care transport function found in other places. They are brought into action whenever a patient with a serious and complex medical condition, requiring advanced levels of support during transit, needs to be transferred between hospitals. This service usually applies to intensive-care unit patients, hence the German name Intensivtransport.
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While not formally affiliated with the EMS system, the general practitioner GP frequently interacts with that system. In Germany, it is still commonplace for physicians to make house calls for those patients who are not able to visit a medical practice. The physician will not only respond to patients from their own practice, but will also visit and treat patients all over the area. The availability of this service provides a better treatment option to those patients who, in other EMS systems, might generate low-acuity ambulance calls or emergency department visits.
Occasionally, the visiting GP will contact the EMS dispatcher and order a Krankentransport , should it be determined following medical assessment, that the patient could be cared for in a safer and better manner in a hospital. The nationwide emergency number for the fire brigade and emergency medical services in Germany is This number can be called toll-free from any phone fixed-line, mobile or phone booth.
The German police is available toll-free at or alternatively via the operator. Dispatchers speak German and the languages of neighboring countries in border areas;  in some bigger cities i. Berlin, Hamburg, Cologne or Munich , they might also understand English and other language s.
Although it is not official, some mobile phones accept the American " " as an emergency number in Germany, but it will not work from fixed-line phones or phone booths. In German EMS system, the first level of pre-hospital emergency care is given by paramedics, in life-threatening situations backupped by an emergency physician on scene.
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Thus the paramedic scope of skills include a set of advanced life support ALS treatments, they have to perform until an emergency doctor is on scene. Then the paramedics and other medical staff on scene act under direct medical supervision of the physician. Other non life-threatening emergencies are handled solely by the paramedic ambulances without a physician on scene.
The emergency physician, in German Notarzt , must be a Physician with a Notfallmedizin Emergency Medicine board certification, issued by the State Chamber of Physicians. In order to obtain the board certification, a minimum term of residency in a specialty related to critical care medicine, additional training in techniques of anaesthetics and critical care medicine and the passing of a board examination is required.
While the position is technically open to any physician who completes the board certification process. Once on scene, the Notarzt performs all tasks associated with physicians in the field, acts as the Crew Chief , and provides medical direction to all subordinate EMS staff. Emergency physicians are dispatched along with a paramedic ambulance according to several standard dispatch criteria indication catalogue, "Notarzt-Indikationskatalog" , including myocardial infarction , dyspnoea , potential severe trauma , unconsciousness , life-threatening intoxication and needed pain management.
Usually the emergency physician gets to scene with a separate car, a Notarzt-Einsatzfahrzeug abbr. NEF, emergency physicians vehicle.
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For detailed description see article " EMT's in Germany ". Whilst the education and scope may match paramedic level in some countries, this is not true for Australia, the UK, and US. The scope of practice is restrictive and education does not match. For instance Bsc entry in the UK, and a fully autonomous role. There are usually only one or two doctors available in London for nearly 9 million people.
This is because paramedics have the training and skills to manage on their own.
The US has a shorter training that the UK, but the skills they possess are large. For instance being able to RSI a patient — which involves giving an opioid usually fentanyl, an anaesthetic agent usually ketamine and a paralytic usually rocironium or sux. Key skills in the UK include the use of a wide range of pharmaceuticals which are allowed under the Human Medicine Regulations , IO, intubation, needle cricothyroidotomy and needle thoracostomy. Critical care paramedics can perform full surgical airways, and chest drains using scalpel.
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Both are not protected titles by federal law, but based on a national agreement of the German state ministry boards of The level is not well defined varies from state to state or organization to organization , but mostly includes the hours theoretical course and 80 hours of the EMS internship, but no state exam. In the German system, not only EMT's, but also physicians have recognized roles and skill levels.
The following table will give a brief overview about the major qualifications for both physicians and technicians, and their place within the German EMS structure. The German EMS system's vehicles come in a wide variety of shapes and sizes.
The visual identity requirements of the European standard are not yet being followed. The three major types of vehicle are:. Additionally, the Mehrzweckfahrzeug MZF , or multi-purpose vehicle — often referred to as a Notfallkrankenwagen or Kombinationsfahrzeug KOM — serves a dual role as patient transport vehicle and as backup for emergency responses and usually conforms to type B of DIN EN Other vehicles that are also employed include neonatal units for special pediatric care and transport, ambulances for obese patients, special infectious transport units and disaster response supply vehicles.
A modern ambulance used for non-emergency transport Krankentransportwagen.