References
Reforming the paramedic profession? Two weeks with paramedics in Germany
Abstract
While paramedics in Anglo-American emergency medical services enjoy relative autonomy, paramedic practice in the Franco-German model deployed in Germany depends heavily on emergency physician input. Increasing demand, especially from low-acuity incidents, causes challenges in these countries. To address this, German politicians plan to implement extensive emergency care reforms and consider an update of regulations around paramedic practice. A 2-week placement allowed for practice observation, discussions with stakeholders and a review of various resources to identify current issues in Germany. These include legal discrepancies, significant local differences in scope of practice, limited career opportunities and influence on clinical guidelines. Although the update and reforms are intended to resolve some of these problems, a groundbreaking evolution of the profession from its current restrictions is not expected. Possible development of the emergency physician role and associated specialities as a response to emergency care challenges is less debated.
Among the developed countries that are experiencing increased pressure on emergency medical services (EMS) through demographic changes is Germany. As a result of enquiries in recent years, the emergency care system is about to undergo extensive restructuring.
This also affects the Franco-German prehospital care model, which, unlike the Anglo-American model that is used in the UK, relies on emergency physicians (EPs) with paramedics adopting a vital but less autonomous role (Al-Shaqsi, 2010).
Amid these developments, the paramedic's position is being hotly discussed, especially regarding their legal position and scope of practice in connection with the traditional dependence on EPs. A proposed reform of EMS could have a lasting effect on the role of paramedics and EPs in tackling health problems.
This article aims to provide a perspective of emergency care in Germany and the paramedic profession in times of change, alongside future expectations among staff and in politics. It outlines the current role of paramedics and EPs within the EMS system, examines issues in the system, including historic discrepancies in the paramedic role, and introduces the proposed changes and examines their possible impact on paramedics, EPs, and identified issues in the EMS.
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