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Paramedics in Germany are the main providers of emergency care in emergency medical services in Germany. There exist two professional levels regulated by federal law, the ''Rettungsassistent'' (two year education, effective 1989 until 2014) and the ''Notfallsanitäter'' (three year education, starting 2015). Both are able to provide the first level of pre-hospital emergency care. Additionally, they can get backup by an emergency physician on scene. Thus the German paramedic scope of skills include a set of advanced life support (ALS) treatments, which they have to perform until an emergency doctor is on scene. Then the paramedics (and other medical staff on scene) act under direct medical supervision of the physician. Non life-threatening emergencies are handled solely by the paramedic ambulances without a physician on scene. Other regulated qualifications in German EMS are ''Notarzt'' (emergency physician) and the more basic emergency technician level ''Rettungssanitäter''. ==History== The development of ambulance services in Germany started in the late 19th century. Typically volunteer aid organizations, some private companies in larger cities and so called rescue corps provided ambulance services mostly with very little training or medical background. This more or less lasted until the 1960s: emergency care was provided by volunteer organizations or untrained "ambulance men". In the late 1960s and early 1970s, however, it became obvious, that a more professional approach is needed. The sending of physicians to the scene was introduced, following the concept ''"bringing the doctor to the patient, not the patient to the doctor"''. The development of the system ''"emergency physician"'' (''Notarzt'') started, bearing the need for somewhat qualified assistance on scene. A law to establish the occupation of ''Rettungssanitäter'' has been discussed, with a 3-year training curriculum.〔Gesetzentwurf der Bundesregierung über die Definition und das Anforderungsprofil des Berufes ´Rettungssanitäter´ (BT-Drucksache 7/822)〕 The government however saw difficulties in financing the training of this new profession. So, eventually in 1977 the original idea was introduced as a 3.5 month (520 hours) training curriculum common to all Länder (federal states) of Germany.〔(Grundsätze zur Ausbildung des Personals im Rettungsdienst - Basic Standards of the Training of Personnel in Emergency Medical Service (1977) )〕 This led to a more professionalized approach, but clearly below the level of the intended original law. By the 1980s it became clear that many situations were occurring in which the knowledge level of the ''Rettungssanitäter'' was inadequate, especially in cases where a ''Notarzt'' wasn't available in time. The developing of pre-clinical procedures demanded additional qualification for treating patients in the field. It was deemed necessary to find a new profession with even more knowledge and skills. This was when, in 1989, the profession of the ''Rettungsassistent'' was created, introducing a two-year education program. In contrast to the ''Rettungssanitäter'', the Rettungsassistent was a state-certified profession with a job title protected by law.〔(Gesetz über den Beruf der Rettungsassistentin und des Rettungsassistenten - German Federal Paramedic Act of 1989 )〕 Since then, EMS in Germany has evolved into a formal, well organized structure, with standards for staff training, vehicles, and service delivery. Formerly ''Rettungssanitäter'' trained providers could get an upgrade to the new profession with proof of 2000 hours experience in EMS. The ''Rettungssanitäter'' still exists as a common entry/assistance level for EMS, for volunteer work and industrial emergency medicine. However, the ''Rettungsassistent'' remained subject to discussion, especially regarding length of education, scope of practice, autonomy in emergency situations and differentation to other medical professions, including paygrade. The problems mainly were seen in the early state exam after just one year in EMS school (the additional internship in EMS wasn't part of examination), the more or less undefined curriculum, the main focus on bare assistance to an physician, the possible side entry for other medical professions and the de facto requirement for students to pay for the entire education. Around 20 years after the introduction of ''Rettungsassistent'' law, the German EMS community targeted to an enhanced qualification. Eventually in the year 2013, the law about the ''Notfallsanitäter'' came into effect.〔(Gesetz über den Beruf der Notfallsanitäterin und des Notfallsanitäters - German Federal Paramedic Act of 2013 )〕 With January 2015, no more starting courses for the old ''Rettungsassistent'' were possible. The ''Notfallsanitäter'' law addressed much of the concerns, thus providing a real three year education with a well defined curriculum targeted more on autonomous handling of emergency situations, requirement of a (paid) contract with an employer during education and no side entries for other professions. Former ''Rettungsassistenten'' can decide to stay in their duty (the title still is protected) or upgrade to ''Notfallsanitäter'' by taking courses and a supplemental state exam. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Paramedics in Germany」の詳細全文を読む スポンサード リンク
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