A new study has found that Germany’s emergency medical services are plagued by major inefficiencies and vastly different services across the country, raising serious questions in a country with one of the world’s largest medical workforces.
A survey published this week by the public broadcaster Swarovski Of Germany’s 283 emergency service districts, only 24 said they could arrive at a cardiac arrest case within eight minutes, the recommended time limit for saving a life in urban areas. Around 130 said they could not meet this target, and the rest were unable to provide data. SwarovskiIn Germany, around 10,000 potentially saveable lives are lost each year.
The report also found that standards imposed by German states on emergency services vary widely: Some states, such as Hesse, require emergency services to reach patients within 10 minutes of an emergency call, while in neighbouring Rhineland-Palatinate the target is 19 minutes.
Expensive and inefficient
And yet Germany does not appear to be short on healthcare spending: according to the European Commission, Germany has the highest healthcare spending as a percentage of GDP among EU member states, reaching 12.8% in 2020, and has 7.9 hospital beds per 1,000 inhabitants, compared with an EU average of 5.3. Swarovski The investigation found that emergency services are often overworked and understaffed.
Janos Dahmen, the Green Party’s health policy spokesman, believes the problem lies in inefficiency: “The problem starts with the fact that, unlike the UK, Denmark or the US, when a call comes in to our emergency services, we don’t run a standardised, quality-assured emergency call centre, but instead each call taker does what they think is right, according to their own best judgement and conscience, so to speak.”
Dahmen, who worked as an emergency physician until 2020, said the systemic problems he faced were part of what led him to go into politics. He believes ambulances are too often dispatched to emergencies where they shouldn’t be, and where other medical assistance is far more appropriate. “On the flip side, this also means that very serious emergencies, such as cardiac arrest, can’t always be treated expertly in the time that’s medically necessary,” he said.
Ministry of Health’s view
According to the Health Ministry, around 30% of cases that end up in hospital emergency rooms do not require emergency treatment – and this is precisely the problem that Health Minister Karl Lauterbach is trying to address with new reforms that he presented to the federal cabinet earlier this week.
The central idea of Lauterbach’s plan is to introduce a central desk in some hospitals that will decide whether patients should go to the emergency room or wait for a regular appointment. Similarly, emergency calls will be more carefully guided to the necessary treatment with the help of standardized responses. Doctors will make more use of video and telephone consultations.
“Right now, our country has a relatively large number of paramedics, both in relative and absolute terms, greater than many of our neighbors that have much better-equipped emergency medical systems,” Dahmen said. The goal is to better target those personnel and more closely link alternative, more appropriate forms of care with dispatch centers.
This is already being done in other countries: in the UK there are special services that respond to mental health emergencies and emergencies in elderly care homes, and are often able to deal with specific issues on-site without having to transport patients to hospital.
Denmark, meanwhile, has introduced so-called “sociolances” (a portmanteau of social welfare and ambulance) that are specially trained to serve the homeless and other vulnerable people and are designed to prevent emergencies from happening in the first place.
Doctors’ skepticism
But some medical experts are skeptical that Lauterbach’s reforms will work. Vincent Jolles, a spokesman for the German Association of General Practitioners (HAEV), agreed that the underlying problem is that patients aren’t being directed to the right places, but he believes Lauterbach’s reforms will only make the problem worse by giving patients more choice and a wider range of clinics to visit.
“So in the future we should have regular clinics, hospitals, on-call care in hospitals, 24/7 emergency services and 24/7 telemedicine services,” he told DW.
HAEV is also concerned that much of the extra burden will fall on GPs, as it is not yet clear how many hospitals will set up additional central desks and which staff will be responsible for all these services. “We just don’t have the staff resources,” he says. “The reforms just shift the problem of emergency services onto clinics, and particularly GPs.”
Staffing the medical workforce remains a complex issue. It’s true that Germany has a relatively large medical workforce, but Germans go to the doctor more often than other countries. OECD figures show that the average German visits the doctor 9.8 times a year, compared with an EU average of 6.7. “We think this is because Germans go to too many different doctors because they don’t know where to go for which problem,” Jolles said.
Damen argues that the new reforms will help address exactly that problem, and he believes they are an important step forward. He points out that past attempts to reform emergency care have often failed not because of political debate, but because of jurisdictional disputes between Germany’s different levels of government: federal, state and local. Although questions remain about the reforms, he believes they are an important step towards making emergency services more targeted and relieving strain on the health care system overall.
Editor: Lina Goldenberg
*If you experience a health emergency while in Germany, call 112.
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