|CARS members John Burruss & Dayton Haugh recently took part in an EMS exchange program between the German Red Cross and the Virginia Association of Volunteer Rescue Squads. In mid-July, our two medics flew to Kassel and spent a week observing the unique German EMS system by participating in a ride-along program. Come along and ride with the German Red Cross (Duetsches Rotes Kruez)...
Kassel, Germany, has a population of 200,000 people and is located 2 hours north of Frankfort. The rescue squad in Kassel is under the direction of the German Red Cross. All personnel on the squad are paid, and they run about 60,000 calls annually. In Germany, the Red Cross handles most aspects of care for the population. They take care of pre-hospital and inter-hospital emergency runs, non-emergency transports, donations of blood & clothing, etc.
According to German law, all male citizens must perform 15 months of duty in the military or other civil service. Working on the ambulance is one of the civil services they may choose. Some EMT's only work through their civil service and then move on to pursue other careers, yet many remain in the Red Cross and pursue a career as a paramedic. Red Cross paramedics must attend two years of training (the Red Cross pays for 1/2) and start at a salary of $24,000 marks ($12,000 dollars) per year. Red Cross paramedics are trained to the level of a CCEMT-P, but cannot perform most advanced techniques until the arrival of a physician on scene. Physicians are paid substantially well for their work and by allowing the paramedics to do ALS procedures on their own would mean less money for the doctors. The Red Cross charges $350 for ALS service, and $75 for BLS service. The physician is paid for whatever procedures they perform plus a base salary. When the physician arrives, he/she asks for the patient's insurance card, which is then inserted into their palm-top scanner and the patient is charged on the spot. By law, all citizens must have insurance or government health care.
German ambulances are markedly different from ours. To start with, they are trimmed with a bright florescent orange that is eye catching from a great distance. Mercedes or Volkswagen manufactures most of the ambulances. Their ambulances are set up to be mobile emergency rooms, with ventilators, IV pumps, pacemakers, etc. All medications are kept in a refrigerator while IV fluids are kept in a warm drawer. The meds are in ample form, not pre-filled syringes like ours. The interior of a Red Cross ambulance is over 6'3" tall, enabling even very tall personnel the ability to stand and work on a patient. The cots are mounted on a lifting device that makes loading heavy patients a breeze and are equipped with a shock absorber system that allows the patients a smooth comfortable transport. The system is very expensive, costing around $12,000 per unit, but the Germans are very proud of this system and the comfort and convenience the system makes it well worth the price. Surprisingly, the ambulances are not equipped with air conditioning. In Germany, air conditioning is considered a needless expense since it is only hot for 3 months out of the year. Also, when the ambulance has arrived on-scene, the medics will shut the motor off immediately. This is to save money since gasoline costs $3-4 per gallon.
Germany also utilizes a network of 52 strategically located helicopters that carry a paramedic, physician and military pilot. These helicopters perform on-scene response as well as inter-hospital transfers and are used very often.
Another intriguing aspect of Germany's EMS system is the utilization of trains. Since many of the German tunnels can stretch ten or more miles, Germany has built 12 "rescue trains." Each rescue train is fully equipped to respond to a mass casualty accident on the railroad. Different sections of the train have been designated for a certain purpose, such as an operating room, communications, triage, extrication, etc. The entire train is built to operate in a hazardous environment and thus, is completely airtight. The trains are funded by the government at an annual cost of millions of dollars per train. All EMS personnel and firefighters are trained and prepared to work on the trains in the event of an emergency.
The fire service in Germany is unique in that they do not respond to EMS calls. They will only respond to auto accidents if there is someone trapped. The fire service only responds to fires and technical rescues. This is slowly changing as several of the fire stations we visited had an ambulance stationed there. The trend to slowly take over EMS is not as strong there as it is here, but the movement is gaining momentum. In Kassel, the fire department has only 2 career stations and they run approximately 7,000 calls per year. The paid department is supplemented by 7 volunteer stations, but the volunteers only run calls when the paid staff is completely tied up.
All in all, it was a very good trip. The people in Germany are very friendly and went out of their way to make sure we were accommodated. We not only rode along with their paramedics on calls, but they made sure we had ample time to visit the historical castles nestled atop the mountains, try authentic German cuisine, and of course, revel in the beer gardens.
Go here to hear a German medic unit dispatched to a reported heart attack.
For our friends in Kassel, click here to see the German edition of our index page.