The robust and highly touted aeromedical system that supports EMS operations throughout Germany and Austria was in full swing at the head-on train crash that killed 10 people and injured dozens in southern Germany in Bad Aibling, some 60 kilometers (40 miles) southeast of Munich, with at least eight helicopters being on scene and continually being loaded to transport critical and seriously injured patients. I have previously visited Germany and witnessed the capabilities of the German system. The coordination between the Notarzt (German doctor system) and ÖAMTC systems is phenomenal and an important asset throughout the region.
EMS in Germany, referred to as Rettungsdienst (“Rescue Service”), is a service of public prehospital emergency healthcare, including ambulances and helicopters. It is provided by individual German cities and counties and is primarily financed by the German health insurance companies. The ÖAMTC, system operated by the Austrian Motorist Club, is the main provider of EMS helicopters in Austria.
The emergency physician, Notarzt , is a highly specialized physician with emergency medicine board certification, issued by the State Chamber of Physicians. Notarzt physicians complete a residency related to critical care medicine and receive additional training in techniques of anaesthetics and critical care medicine. They must then pass a board examination in order to obtain the board certification.
While the Notarzt position is technically open to any physician who completes the board certification process, due to the interdisciplinary nature of medical emergencies, most of the physicians employed as Notarzt are anesthesiologists.
On scene, the Notarzt performs all tasks associated with physicians in the field, acts as the on-scene crew chief and provides necessary medical direction. Notarzt physicians are dispatched along with paramedic ambulances according to standard dispatch criteria (an indication catalogue, Notarzt-Indikationskatalog) including myocardial infarction, dyspnea, potential severe trauma, unconsciousness, life-threatening intoxification and needed pain management. Usually the emergency physician gets to the scene via a separate car, a Notarzt-Einsatzfahrzeug (NEF, emergency physicians vehicle).
There are two non-physician emergency professions in Germany on the paramedic level. The Rettungsassistent (a two-year education level, which ended on a certification level at the end of 2014) and Notfallsanitäter (three-year education, effective since 2015).