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ALLEMAGNE

COUNTRY INFORMATIONS:

 

CAPITALE BERLIN
REGIME République parlementaire

16 états fédérés

SUPERFICIE 356 980 km²
POPULATION 82 400 000
MEDECINS (pour mille) 3.6

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E.M.S. ORGANISATION:

Administration du système de santé fédérale et régionale (chaque Land possède un gouvernement interne), l'assurance maladie est obligatoire si les revenus sont inférieurs à un plafond, sinon libre choix.

Taux de copaiement le plus bas d’Europe;

Dépenses de santé par rapport au PIB les plus élevées d’Europe (10,7 % en 1998);

Baisse du nombre de lits d’hospitalisation aiguë 8,3/1000 habitants en 1991 et 7 en 1998

Soins ambulatoires publics (centres sanitaires) mais surtout privés, dispensés par les médecins de famille (généralistes, internistes, pédiatres);

En allemagne, la médecine générale est une spécialité, il est le “filtre” vers les soins secondaires

Unions professionnelles de médecins, peu de liberté d’installation, et le choix du médecin limité pour le patient (liste).

Système uniforme pour chaque Land et financement public avec conventions;

Centres de régulation non médicalisés (“techniciens d’urgence médicale”);

Pas de service d’urgence autonome (sauf Karlsruhe) mais zones d’accueil et d’orientation;

Sous-spécialité de médecine d’urgence (2 ans).

Organisés avec associations, pompiers et compagnies privées, 90% de volontaires d'organisation humanitaire (croix-rouge, arbeiter samariterbund, die johanniter, et malteser hilfswerk).

Les pompiers fournissent à l'ensemble des unités le consommable ainsi que les procédures de désinfection.

Les personnels décalent par Pager ou radio et tout action est codifié par les systèmes informatiques embarqués réduisant aux plus simple l'utilisation de la radio.

L'informatisation des centrales permet une gestion par visualisation en temps réel.

S'organise en secteurs de secours, équipe en caserne propre à leur structure, et coordonnés par le 112 ou leurs propre centre de contrôle.

Des contrats entre l'état, les assurances, et les EMS permettent de prendre en charge à 100% les frais de secours financés par l'état mais aussi par les communautés locales ou régionales ( environ 20 euros/hab/an).

le fonctionnement est différent en fonction des régions, et les protocoles ne sont pas les même.

La loi fédérale fédérale sur la protection contre les catastrophe précise que les corps publics de sapeurs pompiers ont l'obligation de participer à la lutte contre les catastrophes au même titre que certaines organisations privés (associatifs) qui s'occupent plus particulièrement de l'assistance médicale et sociale;

En cas de moyens dépassé la Loi permet de faire appel aux citoyens majeurs qui sont réquisitionnés par l'autorité et dédommagé comme des volontaires.

En matière d'hôpitaux, seuls les I.C.U. accueillent les urgences.

L'ensemble du territoire est sous couverture des hélicoptères assurant des rayons d'interventions de 50 km

Paramedics in Germany

The development of the German prehospital EMS system is largely based on the history of the unique influence of volunteer aid organizations, particularly the German Red Cross. After 1945 especially, surgical departments of several German universities played a major role in developing an Advanced Life Support system. Due to the heavy volunteer involvement the government was very passive in regulating the EMS system development, as this was mostly done by the volunteer aid organizations themselves. As volunteers cannot meet the demands for paramedic education anymore, EMS is changing its face in Germany. The so called volunteer aid organizations employ 90 % of all paid EMS professionals. Volunteers are mostly only seen as First Responders, the role of EMS physicians developed because of the largely Samaritan oriented work of volunteers. Most of the costs of today’s EMS are covered by the health insurance system as well as through taxes, and fees. In the last 10 years German EMS has made a large step towards maturity. The development of a paramedic profession, the increased scientific research in the area of emergency medicine, the integration of European emergency services and professions as well as economic demands have already influenced EMS in the last few years and will continue shaping the development of EMS in the future.

Paramedic Profession
In 1989 the German government issued the Federal Paramedic Act (RettAssG), introducing a state regulated two year training program for paramedics (Rettungsassistent = rescue assistant). The goal was to create a qualified assistant to the ambulance physicians that occasionally run on EMS calls. The fact that in 70% of all emergency calls only ambulance personnel respond was neglected.
In 1995 the Federal Physicians Chamber, granted paramedics (RettAss) the right for intubation, IV canulization and drug administration if a physician is not present at the scene of emergency and the paramedics are qualified and supervised. In practice paramedics already performed many of these skills as it was included within their curriculum, but based on a poor legal basis. The physician chamber's recommendation has no legal status but is observed as a very important expert opinion. The legal status of the above mentioned measures can only be obtained when acting in accordance with § 34 Strafgesetzbuch "Rechtfertigender Notstand" (German Penal code; "State of Emergency"), namely commiting a felony (i.e. causing bodyly harm - IV canulization) for the benefit of a higher good (preserving the patients life). This specifically requires the paramedic to have called in for an emergency physician, the absolute need for the measures he is about to take and proven skill.
Due to rising costs in health care, today many ambulance physician systems are in jeopardy. In 2005 or 2006 the government wants to revise the Federal Paramedic Act and extend the training into a three year comprehensive training program, specifically granting paramedics legal rights to perform certain medical procedures (e.g. midwifes, health practitioners, psychotherapist). These skills will be extended based on local medical director authorization.
IN German EMS nurses do not play a role. Most critical care transport and all helicopter EMS only employs paramedics. This is also true for air medical transportation (fixed wing) or long distance medevac (stretcher).

Invasive Skills of paramedics based on various current local protocols:
· IV canulization
· ET intubation without relaxation
· needle decompression
· defibrillation
· drug administration (nitroglycerine, analgetics, diazepame, salbutamol, glucose 40%, IV fluids, etc.)
· other skills

EMS professionals in Germany
There are about 60.000 EMS professionals in Germany (BAST).
· RH - Rettungshelfer (280h training program)
· RS - Rettungssanitaeter (560h training program)
· RettAss - Rettungsassistent (2800h training program)
· EEMSP - European EMS Paramedic (additional training offered by some paramedic colleges)
· NA - Notarzt(physician min: resident,one year experience on ICU, several skill tests, 160h course)

Roles of paramedics:
Team leader on emergency ambulance, Assistant to physician on doctor staffed MICU, Air rescue paramedic (HEMS Crew member), Paramedic on Critical Care Transport Team (2 paramedics, 1 physician), EMS dispatcher (RettAss + 2 years experience + course), EMS Supervisor / Station commander, EMS Manager, EMS instructor/educator, Development and humanitarian project work (Latin America, Africa, Central Asia), Work in neighbouring countries (Switzerland, Austria, Spain, etc.).

 

 

LÉGISLATION AVERTISSEURS:

Pas de législation

2 TONS

NUMERO D'APPEL:

POLICE - FIRE - AMBULANCE

112 - 110

AMBULANCE

19222

MOYENS:

AMBULANCE EMT 1 + EMT-B ou EMT-P
BLS EMT-1 ou EMT-B + EMT-P

ALS

EMT-B + EMT-P

NOTARZT

MEDECIN

voir l'Autriche pour les différents types de moyens RTW (pour les urgences) et KTW (pour les transferts)

 

NIVEAU FORMATION:

EMT-1 (Rettungshelfer)

2 mois - 280 h

EMT-B (Rettungsanitater)

3 mois - 560 h

EMT-P (Rettungsassistant)

2 ans - 2800h

MEDECIN (Nortartz)

18 mois expérience clinique + 80h de classe

10 missions

 

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SPÉCIAL:

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INFOS:

inter-medical-service

 




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