GERMANY | Emergency | Cultural issues

Different roles and responsibilities of staff working in emergency medical care

In Germany, there are five types of rescue vehicles:

• The Rettungswagen (RTW) is used in case of accidents or an emergency. An RTW is staffed with at least one paramedic
• The Notdiensteinsatzfahrzeug (NEF) is staffed with one paramedic and one emergency doctor; an NEF will go to the patient independently of other rescue vehicles
• The Notarztwagen (NAW) is similar to an RTW but has an emergency doctor; NAWs are usually stationed at hospitals, so that doctors are readily available in case of emergency
• The Intensivtransportwagen (ITW) has equipment similar to an intensive care unit at a hospital; it is used to transport patients requiring intensive care between medical institutions
• The Rettungshubschrauber (RTH, helicopter) moves emergency doctors independent of other emergency vehicles to sites where someone is in a life-threatening condition; the patient will then be taken to the nearest hospital with a helipad

While NAWs, ITWs, and RTHs are usually managed by hospitals, RTWs and NEFs are usually provided by the Bundesarbeitsgemeinschaft Erste Hilfe (BAGEH), which includes different medical aid agencies, such as fire brigades, Arbeiter-Samariter-Bund e.V., Deutsches Rotes Kreuz e.V., Johanniter-Unfall-Hilfe e.V., or Malteser Hilfsdienst e.V.

In Germany, patients in emergency situations are stabilized as much as possible in situ before being transported to hospital.

Germany does not train doctors in emergency medicine as a separate specialization. This means that emergency departments are usually run as a joint operation between specialists in different medical fields.

Cultural or religious issues

Patients’ rights are based on the 1981 Declaration of Lisbon, meaning that:

• Everyone in Germany has the right to suitable and high-quality health care without regard to religion, nationality or other factors
• Every patient has the right to self-determination (see below for a definition of this in a medical context)
• Patients have the right to claim confidentiality as regards information about their medical and physical condition
• Patients have the right to be fully informed about their health condition

These are the tenets which underpin the professional work of health care professionals. Patients must be informed and give written consent for all medical interventions. If the patient is not capable of expressing consent in a life-threatening situation, doctors may pursue the treatment that is in the best interest of the patient.

Based on the concept of self-determination, patients are entitled to refuse certain treatments such as transfusions and/or organ transplants by oral agreement or with documents such as patient directives, organ donor cards or a medical power of attorney. In such cases, doctors are then obliged to act in accordance with the patient’s will without risk of prosecution (i.e. for failure to give assistance).

There are additional specific provisions for religious minorities such as Jehovah’s Witnesses. Jehovah’s Witnesses have the right of full confidentiality if they agree to organ transplantation. In recent years, sub-groups of Jehovah’s Witnesses like the “Association of Jehovah’s Witnesses for Reform on Blood” (AJWRB) have allowed transfusion of non-cellular blood components (e.g. coagulants).

Religious concerns regarding medical treatment and care also have to be taken into account. Muslim women might, for instance, request that they are treated by female medical staff or ask for a female staff member to be present if they are going to be examined by a male doctor. Christian employers are allowed to prohibit healthcare professionals from wearing symbols of other religions such as headscarves. This does not apply to hospitals run by non-Christian organizations.

If parents refuse treatments of vital importance on behalf of their under-aged children, doctors may refer the matter to a custody court, if there is evidence of endangerment to the welfare of the child.

Form of address

In Germany, it is usual for doctors to address patients formally, i.e. "Mr/Mrs" + family name. The use of titles is common in medical situations, both for patients and doctors.

For more information on general medical cultural standards, click here.