Tino Jacobson & Markus Salzmann
For weeks, emergency medical services (EMS) across Germany have been on the verge of collapse. Extremely high rates of deployments and scant staffing are pushing ambulance crews to their limits daily, at mortal risk to patients.
For months now in Hamburg, EMS teams have responded to more than 1,000 calls per day. Many of the city’s 80-plus ambulances have exceeded 20 daily deployments. So many rescue missions once occurred only on New Years Eve. According to the Komba trade union, there are near daily resignations of ambulance staff who have been taxed beyond their means.
The situation is particularly dramatic in the capital. In Berlin’s Marzahn district, a patient had to wait over three hours for an ambulance on the night of December 10. On that Saturday night, as on so many others, “exceptional circumstances in emergency medical services” prevailed. This state of emergency is declared as soon as 80 percent of the ambulances are on assignment and the prescribed 10 minute response time can no longer be met. These exceptional circumstances have all but become the rule.
As a result, fire truck crews have been reassigned to ambulances. As a result, the fire department is understaffed, a recipe for disaster in the case of simultaneous and serious fires.
One firefighter said of the Marzahn case, “I suspect our colleagues in dispatch were overwhelmed and this somehow slipped by them.” He continued, “The tools they have are not meant to permanently maintain a state of emergency.”
On that same Saturday night, a serious accident in the Lankwitz neighborhood killed a 15-year-old and seriously injured a 14-year-old. The two teenagers had been hit by a Berlin city bus, pinning both of them. An emergency doctor was at the scene of the accident in nine minutes, but the ambulance required fully 20 minutes to arrive.
An “exceptional circumstance” had likewise prevailed in Berlin just the day before. Of 94 available ambulances, at times every last one was in use. In the Reinickendorf neighborhood that evening, an elderly man required emergency assistance. First responders from the fire department arrived about eight minutes after the emergency call, but the ambulance had to drive from the Friedrichshagen district, that is, from the east across the city to northwest Berlin, taking 42 minutes. All ambulances in the vicinity were already on assignment.
The shortage of ambulances and personnel is long known. In Berlin, EMS deployments increased by nearly 40 percent between 2013 and 2021, from 305,000 to 425,000 per year.
Since the abolition of protective measures against the coronavirus, cities and counties have seen massive increases in EMS deployment counts. In the city of Dortmund, the fire department was called to 13,378 more emergencies between January and November of this year than in the same period last year. This represents an increase of around 20 percent. At the same time, 115 positions in the city’s fire department are vacant.
Understaffing in emergency services is commonplace across the country. In Frankfurt, there is an official shortage of 26 paramedics and 33 emergency doctors. In addition, there are acute absences due to infections with the coronavirus or influenza. This is a consequence of an intentional policy of mass infection. At the onset of the winter wave, the last remaining protective measures have been repealed.
Frank Flake of the German Professional Association of Emergency Medical Services (DBRD) said of the drastic situation, 'The pressure to act is enormous. It’s five past 12, the system is collapsing. It is happening evermore often so that no one can drive out to an emergency.' The reasons for this, he said, are a lack of specialized personnel as well as overburdened emergency rooms.
“Just a few years ago, it was unthinkable that you would treat a patient for an hour in an ambulance outside an emergency room because hospitals were so overloaded. And now there are downright traffic jams there sometimes,” Flake added.
He assessed the consequences for the medical staff: “It can’t be that in a 24-hour shift you drive to 15, sometimes 20 calls with an average duration of one hour per call. There's no time to eat or sleep.” That’s the cause of the current “occupational exodus,” he said.
Emergency rooms have been hopelessly overloaded for months. Several emergency rooms, such as the one at Leipzig University Hospital, have appealed in recent days for patients to come only in urgent cases. Cancellations of emergency services are the order of the day nationwide. Emergency rooms can deregister from emergency care for a short time in extreme situations, but this is being done more and more frequently as care can no longer be assured. In some cases, patients must be driven to far distant clinics.
The city of Hamburg recently reacted to the catastrophic situation by summarily prohibiting the clinics from deregistering. The obvious consequence is that the patients admitted are not adequately cared for and the staff is even further overburdened.
The dramatic situation in emergency rooms was long foreseeable. In 2019, even before the coronavirus pandemic, a study found that 94 percent of Germans consider emergency rooms at German hospitals to be overloaded. Among those over 60, who have had more frequent experiences with emergency rooms, the figure was as high as 98 percent. The main reason identified was the shortage of staff in emergency care.
It is obvious that the miserable and dangerous situation in emergency care is deliberately accepted. It is therefore not surprising that federal and state governments have done nothing despite the tense situation. The Berlin Senate, consisting of the Social Democrats, Greens and the Left Party, now means to pass a new rescue service law. It has long been the case that Berlin's rescue service has been unable to meet the prescribed quality criteria generally to be at the scene of an accident within 10 minutes.
It would be necessary to invest massively in personnel and equipment, yet the state coalition government has instead decided to extend an existing exemption until 2029. It allows less-intensively trained assistant paramedics to be deployed in emergency vehicles instead of the fully trained emergency paramedics required by law. Moreover, vehicles from patient transport companies are to be more frequently permitted in emergency situations. In short, the response of the government to its self-inflicted situation is to permanently lower the quality of emergency care.
The indifference of the established parties to human life can be seen in the state of the entire health care system. Hospitals, especially pediatric hospitals, are in dire straits due to a wave of respiratory infections from this year’s respiratory syncytial virus (RSV) surge and the coronavirus.
Intensive care beds in children's hospitals across Germany are at full occupancy, resulting in some critically ill children having to travel far and wide to find an intensive care bed. Meanwhile, doctors and hospital staff must to resort to triage, forcing them to choose which patients to treat, or not.
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