Leipzig Fire Dept. emergency doctor car + KTOW ambulance responding [GER | 13.8.2022]

A Leipzig Fire Department emergency doctor car and a Leipzig KTOW ambulance responding to a call.
Leipzig, Sachsen (Saxony), Germany, August 13, 2022.

[@coover65]

Just curious, what percentage of calls would these doctors cars be sent to? We have emergency physicians employed by our ambulance service here in Australia but they only attend to the most serious trauma cases. In a city of 2 million they might attend 2 jobs per shift. In 99%,+ of cases, only paramedic attend.

[@Rummeltobi]

In Germany it slightly depends on the state and even the city. Some areas allow their medics more than others. While doing a quick search I found the numbers from Dresden, a city with a population of 560,000. In 2022 they had 85,613 ambulance responses of which 25,076 required an emergency physician, so around 29% of calls required a physician. I also found numbers for a Czech region with a population of 1.2 million. They had 112,000 ambulance responses and less than 22,000 required a doctor car, so 19%. In my opinion physicians are over-used in the German EMS system. Especially when comparing it to other EMS systems like in Australia, Japan, the UK and the US. I’ve also talked to a Czech emergency physician very recently about this exact matter. She was saying that usually 2 out of her 5 daily responses are calls that really require a physician.

[@coover65]

@@Rummeltobi You have me now wanting to dive deeper into the reasons why. Offhand I'm going to say culture and training. Admittedly I think ours is one of two of the most progressive ambulance service in Australia. We have specialist crews trained in blood infusions, field amputations and suturing. All paramedics are trained to do 12-lead ECGs. In Germany I think culture and attitude might be the first reason. "Why train staff to do the work of a Doctor? ".

[@Rummeltobi]

​@@coover65 It is really interesting to see how well different systems work and especially what specialist crews are trained in. In Germany it's mostly due to legal limitations. There's the German Medical Association (or German Physician Association) which has a strong influence on these regulations and what German medics are allowed to do. This association is working hard to keep the system as it is - in my opinion this is being done for monetary interests, power and ego and absolutely not for better patient care. There have been German medics standing in court for administering drugs and performing lifesaving procedures that they were not allowed to, even though they were trained for these cases and the fact that no doctor was available or still too far away.
I hope this will change someday but progress is usually (very) slow in Germany. Today Germany faces a major lack of physicians in general, especially on the countryside. I'm asking myself why this system keeps so many emergency physicians and uses them to handle medical calls that would be mostly handled by well trained paramedics in other EMS systems. Availability of emergency physicians in the field is another big concern since they sometimes cover large areas and response times can be long, even in cities and especially on busy days.

[@coover65]

@@Rummeltobi Our top doctors have had the opposite opinion. Our Medical Director spent some 6 months working on the London HEMS . On return he convinced our state's top surgeons to develop a program to train elite paramedics to perform the likes of blood infusions, on scene limb amputations and administer a wider range of drugs, especially for cardiac, trauma and stroke patients. I did a ride along a few years back with a supervisor with the Berliner Feuerwehr Rettungsdienst. I recall asking him if staff were trained in something why not give them clinical authority to perform the skill unsupervised. It's all just a cultural thing I imagine.

[@coover65]

@@Rummeltobi I forgot to ask to, what are the wages like for EMS workers in Czechia and Germany?