What should paramedics be allowed to do?

The Federal Council calls for emergency paramedics to be allowed invasive interventions such as injections. A move that doctors criticize

First aid: Without a doctor, paramedics can only provide limited help. They are usually the first to arrive at the scene

© W & B / Nina Schneider

Two cars collide, an emergency call comes in - and the paramedics are the first to arrive. This is a common scenario, especially in rural areas. Emergency paramedics are organized in a decentralized manner and are therefore often faster at the scene of the accident than the emergency doctor.

A head start with disadvantages: because without a doctor, paramedics can only provide limited help. You are allowed to stop bleeding. But unlike doctors, they are not allowed to put on infusions or administer medication. For example, they do not have access to strong pain relievers. Such measures are usually the responsibility of the medical professional, according to the regulation. Paramedics do not observe these legal regulations, they make themselves a criminal offense.

"Necessary Offense"

In an emergency, however, paramedics also have to do everything necessary to save a patient - in other words, in case of doubt, carry out a measure that is usually criminal for them. If paramedics fail to intervene in life-threatening situations, the patient may be harmed - and there is a risk of being charged with failure to provide assistance.

If paramedics act accordingly in an emergency, they are on legally thin ice. "Justifying emergency" is the term used in technical jargon for the crutch that the Criminal Code provides for such a case. If there is no doctor on site, but a possibly life-saving measure is required, then someone can take it - provided that he can be shown to have mastered it.

In case of doubt, a judge will decide retrospectively whether all of these points apply to a situation. The potential lifesaver therefore bears the risk of being prosecuted for what he does afterwards.

Legal crutch for exceptional cases

This does not apply to people who may have to provide first aid once in a lifetime. Professional rescuers, on the other hand, increasingly perceive this risk as unreasonable. "We are the only professional group in Germany that has to regularly perform its task in a justified state of emergency," says Marco König, chairman of the German Rescue Service Association (DBRD).

This legal crutch is intended for exceptional circumstances such as the final rescue shot, i.e. the targeted lethal use of firearms by the police in an emergency. "The last one was in Germany in 1996," explains König. In contrast, paramedics would act many thousands of times a year in justifying emergency.

Politics advises on changes to the law

Politicians now also see a need for action. According to an application by the Federal Council that the states of Bavaria and Rhineland-Palatinate submitted in October 2019, the regulation is forcing paramedics to accept "considerable legal uncertainty and thus also uncertainty in action".

They want to change the law that regulates training to become an emergency paramedic. According to the will of the federal states, it should be added that paramedics are expressly permitted to practice medicine in situations that are life-threatening for patients. Everyday life in a state of emergency would be off the table.

Too Much Responsibility?

Anything that meets with approval at the DBRD triggers concern in specialist medical societies. "The emergency paramedics are our important partners, but this law would overload them with responsibility," says Professor Dietmar Pennig, General Secretary of the German Society for Trauma Surgery (DGU).

According to the doctor, turning the exception into a rule would result in significantly greater legal uncertainty: "Then the paramedic himself would no longer be responsible for diagnoses and interventions."

But the paramedics are not prepared for this. "During their training, they are only five weeks in the operating room and two in the intensive care unit," says Pennig. It is an illusion to believe that someone can learn something in such a short time that he can safely apply under pressure in an emergency situation.

Save costs

Incidentally, Bavaria and Rhineland-Palatinate are not aiming for improvements for paramedics, Pennig believes: "These countries have problems filling emergency doctor positions and are trying to save costs."

Bavaria is actually already going its own way: since December, a law has allowed the medical directors of the emergency services to delegate simple medical measures to paramedics.

A good first step, says Professor Uwe Janssens, President of the German Interdisciplinary Association for Intensive Care and Emergency Medicine. He also supports the Federal Council's proposal and believes that many medical colleagues are simply afraid that their work will soon be superfluous. "But that is unfounded. Nobody is asking for the emergency doctor to be abolished. It's all about legal security," says Janssens.

Unclear wording

He sees the reason for the gray area in which emergency paramedics work today in an improperly formulated law. The legislature must define what "independent implementation within the framework of participation" means in concrete terms, says Janssens.

For Hans-Martin Grusnick, Medical Advisory Council of the DBRD, clarification would also be helpful for patients and their safety: "Emergency paramedics could play more freely in the future if the sword of Damocles no longer hovered over them.

Objective the discussion

Dietmar Pennig considers such statements to be pure scare tactics: "So far, a paramedic has never been convicted of an act of rescue," emphasizes the DGU General Secretary. However, there have already been several dismissals - for example because of unauthorized dispensing of medication.

The federal government has now presented its own draft law - and withdrew it shortly afterwards. At the time of going to press, the Ministry of Health said that the aim was to make the discussion more objective and bring both sides into a dialogue.