Welche heilkundlichen in der Ausbildung zum Notfallsanitäter oder zur Notfallsanitäterin vermittelten und geprüften Handlungskompetenzen werden in der Praxis der Notfallrettung wie häufig durchgeführt? Status Quo nach 10 Jahren und Implikation für die Zukunft.
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Abstract
Since the enactment of the Emergency Paramedic Act (Notfallsanitätergesetz) in 2014,
the professional role of emergency paramedics in Germany has undergone continuous
transformation. The legal changes have significantly expanded their training, scope of
practice, and professional responsibilities. In particular, the delegation of medical
procedures aims to strengthen paramedics’ autonomy and to relieve the burden on
emergency physicians. The aim of this dissertation was to examine how these extended
competencies are implemented in daily practice and to determine whether the frequency
of documented medical procedures corresponds to the reference values recommended
by the Federal Association of Medical Directors of Emergency Services (BV-ÄLRD).
The analysis was based on anonymized operational records from the digital
documentation system MedicalPad used in the district of Nordsachsen. The observation
period covered the years 2019 to 2024. A total of 28,894 medical procedures and 26,639
drug administrations performed by emergency paramedics in the service areas of
Delitzsch, Oschatz, and Torgau were included. These interventions were conducted in
accordance with the pyramid process and the applicable standard operating procedures.
Statistical evaluation employed descriptive and inferential methods (ANOVA, KruskalWallis test, regression analysis, Mann-Kendall trend test) to identify temporal and
regional differences.
The findings indicate that paramedic practice is largely dominated by basic procedures.
The insertion of a peripheral intravenous line was by far the most frequent intervention
(55–63%), followed by wound care and dressing application. Advanced airway
techniques such as suction, airway clearance, or the use of supraglottic devices occurred
only rarely. Significant regional differences (p < 0.05) were observed, for example higher
rates of suction and airway clearance in Delitzsch and an above-average frequency of
wound care in Oschatz. Trend analyses revealed slight increases in invasive procedures
such as cardiopulmonary resuscitation, mechanical ventilation, and video laryngoscopy
over time. However, comparison with the BV-ÄLRD reference values showed substantial
deviations. Except for intravenous access, most medical procedures remained well
below the recommended target frequencies. Highly invasive or infrequent procedures
such as intraosseous puncture, thoracic decompression, or CPAP ventilation were
documented only sporadically. Even basic interventions such as suction or mask
ventilation reached only about one quarter of the target numbers. The intravenous line
was the only measure exceeding expectations, with averages of more than fifty
procedures per person and year at all locations.
In total, over 26,000 drug administrations were recorded. Balanced electrolyte solutions
(E153) accounted for the largest proportion, followed by analgesics and sedatives. The
administration of oxygen declined steadily over the years, reflecting current guideline
recommendations for restrictive oxygen therapy. At the same time, the use of low-risk
medications such as paracetamol, S-ketamine, dimenhydrinate, urapidil, and midazolam
increased, while classic emergency drugs like morphine, glyceryl trinitrate, and
amiodarone declined. This trend suggests a growing emphasis on standardized and
safety-oriented pharmacotherapy. The results highlight a clear discrepancy between
formal competence and real-world practice. The low frequency of rare invasive
procedures is less attributable to a lack of qualification than to the structural
characteristics of the physician-based emergency medical system. Although paramedics
are legally and professionally qualified to perform advanced interventions, real
opportunities to apply them remain limited in daily operations. From a methodological
perspective, the study is based on retrospectively analyzed routine data, which may
contain inaccuracies due to self-documentation, unclear contextual information, or
duplicate entries. Furthermore, individual factors such as professional experience or
team composition were not available for privacy reasons. Pandemic-related changes in
case volume between 2020 and 2021 may also have influenced the results. These
limitations restrict the generalizability of the findings but do not compromise their overall
validity. The study underscores the need to complement routine data analyses with
prospective studies, structured observations, and simulation-based competency
assessments. Simulation training, particularly for rare but critical procedures, should be
recognized as an equivalent component of practical competency maintenance.
Moreover, realistic benchmark figures reflecting actual operational conditions, as well as
digital quality assurance systems and telemedical support, could help to enhance
procedural safety and data quality. In summary, emergency paramedics demonstrate a
high level of routine competence in performing fundamental procedures, while complex
or rarely indicated interventions are seldom practiced. The findings point not to individual
shortcomings but to systemic challenges within the current emergency care structure.
Ensuring long-term procedural confidence and quality of care will require binding
continuing education structures, realistic performance targets, and the integration of
modern training and telemedicine approaches. The present work thus provides an
empirical basis and practical contribution to the further development of paramedic
education and competency assurance in Germany.
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Issued: 2026-03-18
Faculty
FB20:Medizin
Language
de
Keywords
Rettungsdienstpräklinische NotfallmedizinHandlungskompetenzenNotfallsanitäter
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Nix, Steffen Wolfgang: Welche heilkundlichen in der Ausbildung zum Notfallsanitäter oder zur Notfallsanitäterin vermittelten und geprüften Handlungskompetenzen werden in der Praxis der Notfallrettung wie häufig durchgeführt? Status Quo nach 10 Jahren und Implikation für die Zukunft.. : 2026-03-18. DOI: https://doi.org/10.17192/openumr/586.
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