EM in Germany

Pre-hospital Emergency Medicine

The German pre-hospital Emergency Physician System is among the most efficient internationally, but has some unique characteristics. It mostly follows a physician-based rendezvous system, where an emergency doctor is dispatched alongside paramedics to provide advanced medical care on-site.

Comparison with other countries:

• Germany: Physician-staffed system where emergency doctors play a central role. High-quality care at the scene but resource-intensive and costly.
• USA & UK: Paramedic-based systems, where highly trained paramedics perform many advanced procedures. Physicians are only involved in exceptional cases. Faster response times but sometimes fewer advanced pre-hospital treatments.
• France & Austria: Similar to Germany, but with stronger integration into hospital-based emergency services (e.g., SAMU in France).

Pros and Cons of the German System:

✅ Pros: High medical quality, skilled emergency doctors, immediate advanced treatment reducing hospital delays.

❌ Cons: High personnel demands, reliance on physician availability, increasing strain due to staff shortages.

Experts are discussing reforms, such as expanding the role of paramedics, to improve efficiency.

Hospital based Emergency Medicine

While in-hospital Emergency Medicine has made significant advancements, it has so far only been organized as an additional qualification in Germany (i. e. supra-specialty). Professional societies are advocating for an independent specialist training program to further improve the quality of care in EDs. However, these efforts have so far been hindered by resistance from existing medical specialties and the federal structures of the training regulations. Some federal states are implementing specialized training programs, but a nationwide standardized solution is still lacking. The German Society for Emergency Medicine (DGINA) and other stakeholders continue to push for reforms. Challenges remain, such as Overcrowding & Exit Block, staff shortages and the need for better integration between hospitals, emergency services and outpatient doctors (i.e. statutory health insurance physicians / primary care physicians).

In the European Union, there are only four countries that have not yet implemented a specialty in Emergency Medicine – unfortunately, this includes all German-speaking countries (Germany, Austria, Switzerland) as well as Greece.