For this study, rescue missions were analyzed during the period July 1, 2022, to June 30, 2023. The chosen method involved a quantitative document analysis of the deployment protocols to investigate the use of invasive and pharmacological measures by emergency paramedics and the reasons against their use. During the period, N = 10,102 (100%) rescue missions could be evaluated. Analysis of the data revealed that invasive medical measures were used by emergency paramedics in n = 1,211 (11.9%) missions and pharmacologic measures were used in n = 1,403 (13.8%) missions. Most frequently, emergency paramedics concluded that invasive medical measures were not required. Volume 1 - 2023 | https://doi.org/10.3389/femer.2023.1302613 Introduction: German emergency paramedics are to avert serious damage to the patient's health in the event of acute illness or accidents they have a variety of invasive medical and pharmacological measures at their disposal in addition to their three-year professional training The aim of this thesis is to investigate the use of invasive medical and pharmacological measures by emergency paramedics in the German rescue service by means of instruments of professional scientific research the motivations of emergency paramedics to refrain from using these measures will be investigated for the first time rescue missions were analyzed during the period July 1 The chosen method involved a quantitative document analysis of the deployment protocols to investigate the use of invasive and pharmacological measures by emergency paramedics and the reasons against their use N = 10,102 (100%) rescue missions could be evaluated Analysis of the data revealed that invasive medical measures were used by emergency paramedics in n = 1,211 (11.9%) missions and pharmacologic measures were used in n = 1,403 (13.8%) missions emergency paramedics concluded that invasive medical measures were not required the use of invasive medical measures is not a standard part of the emergency medical services mission the focus is on diagnostics and transport of patients to an appropriate destination hospital An adjustment of prehospital care structures based on evidence-based data and an update of the catalog of indications for emergency physician interventions would be elementary for this goal Further studies of professional fields of action in emergency and rescue medicine are necessary in order to analyze and optimize care structures This would not only allow conclusions to be drawn about the future education further education and training of rescue service personnel but also allow care structures to be adapted to the current state of science and the care needs of patients as well as declining employee satisfaction the resulting staff turnover and an increase in sick days are consequences of this development An essential part of the German healthcare system is the emergency rescue service According to the Thuringian State Rescue Service Act (2018) its main task is the medical care of patients with acute illnesses or injuries but also the qualified transport of patients between different care facilities of the German healthcare system A central task of the rescue service is the provision of an infrastructure that ensures comprehensive economical and demand-oriented rescue service provision for the population in the Social Code Book Five (V) under § 60 and § 133 the rescue service is not considered an independent service area This means that the costs of out-of-hospital rescue services are covered by the health insurance funds and that the refinancing of the rescue service is based on this only those services for which there is a transport condition for the patient may be billed The term “medicine” is defined in the law on the professional practice of medicine without a license (Heilpraktikergesetz “The practice of medicine within the meaning of this Act is any professional or commercial activity undertaken to diagnose even if it is carried out in the service of others.” The HeilprG classifies measures to diagnose an illness on the basis of complaints and symptoms as well as measures to heal and alleviate physical and mental complaints as medicine Therapeutic measures can be differentiated into invasive and non-invasive measures when placing a peripheral venous access (i.v Non-invasive therapeutic measures include all measures that do not violate the integrity of the patient Participants in emergency rescue services in Thuringia are required by Section 3 Sentence 3 of the Thuringia Rescue Services Act to carry out all measures to save lives or prevent serious damage to the health of emergency patients at the scene of the emergency Another key objective of the rescue service in Thuringia is to reduce mortality and the consequences of serious illnesses and injuries by providing rapid and qualified first aid and rapid transport to suitable medical facilities In order to be able to fulfill these tasks rescue service employees in Thuringia must have the appropriate training and regularly attend advanced training courses This study investigates the frequency of use of invasive medical and pharmacological measures by emergency paramedics in the rural German ambulance service area of the Eichsfeld district the motivations that lead emergency paramedics not to use invasive medical measures or not to transport patients despite the presence of a patient are investigated a quantitative document analysis of the deployment protocols of the DRK Kreisverband Eichsfeld e was carried out in order to investigate the use of invasive and pharmacological measures by emergency paramedics and the reasons against their use The chairmen of the board as well as the chairmen of the works council of the DRK Kreisverband Eichsfeld e as well as the medical director of the rescue service of the district Eichsfeld were asked by e-mail in April 2022 whether the study may be carried out Every rescue service operation carried out in Germany must be documented the documentation is done analog or digitally on mission logs If an emergency physician is involved in the care he or she must take over the documentation non-invasive and pharmacological measures are written down on the protocols a diagnosis or suspected diagnosis is identified The deployment protocols are collected at the ambulance stations and forwarded at regular intervals to the medical directors of ambulance services for checking and archiving The documentation of operations in the rescue service of the Eichsfeld district is carried out analogously Data collected during the survey period from July 1 2023 were then analyzed descriptively using Microsoft Excel The study protocol was submitted to the Ethics Committee of the Medical Faculty of the Martin Luther University Halle/Wittenberg and positively reviewed (Edit In N = 10,102 (100%) deployments, invasive measures were performed in n = 1,211 (11.9%) deployments and pharmacologic measures were performed in n = 1,403 (13.8%) deployments (Tables 1, 2) Invasive measures performed by emergency paramedics Pharmacological measures performed by emergency paramedics For the justification for not using invasive and pharmacological measures, N = 8,295 (100%) feedback was provided by the emergency paramedics. Multiple responses also occurred. With n = 6,198 (74.8%), emergency paramedics most frequently indicated that no invasive measures were required (Table 3) Justifications for the decision against invasive and pharmacological measures During the survey period, n = 1,032 (10.2%) of the missions across the county were completed without transporting a patient. On the population of missions, it can be seen that n = 599 (6%) of the patients encountered showed no indication for transport by the ambulance service and n = 333 (3.3%) of the citizens seeking help refused transport by the ambulance service (Table 4) As already described by Lechleuthner and Neupert, intravenous access and the administration of whole electrolyte solution are also the most frequently performed invasive and pharmacological measures by emergency paramedics in the present study (10) This is due to the fact that intravenous access is the essential basis for further pharmacological measures The clear trend that emergency paramedics also performed invasive medical measures in just over one-fifth of the independently performed missions similarly raises the question of competency retention of the learned invasive curative measures (7) The discrepancy between the competencies taught in the 3-year emergency paramedic training program and the professional reality was highlighted by the present data These data underscore the suggestion that invasive paramedic competencies are difficult to obtain this could additionally lead to frustration among emergency paramedics Although the measures were learned in training by emergency paramedics it is questionable whether they will continue to be mastered without adequate performance In the current development of deployment types, the ambulance service is increasingly encountering patients with non-life-threatening illnesses or injuries for whom hospital admission is not indicated and who are not transported to a hospital by the ambulance service. The proportion of these patients is around 10% (11) This is where a change in the patient clientele is most clearly visible which recognizes the ambulance service as a separate service area The handling of so-called “sub-acute emergencies” and the outpatient treatment of patients is not a regular subject in emergency paramedic training and is often neglected in the vocational training of emergency paramedics For more far-reaching analyses and better comparability primary and further studies are lacking in all federal states and rescue service areas Further studies of professional fields of action in emergency and rescue medicine are necessary to analyze and optimize care structures training and continuing education of emergency paramedics but care structures could also be adapted to the current state of science and care needs The present study exclusively discloses the invasive and pharmacological measures performed by emergency paramedics from a rural German rescue service area of the Eichsfeld district over a short study period No generally valid statements for the entire German rescue service can be drawn from the discussion that has thus arisen further Germany-wide investigations in the rescue service would have to follow Another limitation is the analogous documentation of operations The quality of the documentation depends on the emergency paramedics Both errors due to unclear legibility of the protocols and incomplete documentation can be assumed non-invasive and pharmacological measures were performed but these were not documented on the deployment protocols When comparing the results of this study with similar studies the work situation for emergency paramedics is a similar one The training and examination for emergency paramedics only reflects the realistic working life to a limited extent The results of the present and cited studies can be used to improve job satisfaction and job loyalty of trained emergency paramedics in order to adapt framework curricula as well as school-internal curricula Another approach to improving working conditions in the emergency medical services would be to reduce the number of so-called “bagatelle” missions This would require a survey of the reasons given by the citizen seeking help for using the resources of the rescue service and a subsequent conception of suitable care strategies from a professional scientific point of view in the German emergency rescue service The original contributions presented in the study are included in the article/supplementary material further inquiries can be directed to the corresponding authors The author(s) declare that no financial support was received for the research The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher CrossRef Full Text | Google Scholar The Emergency Paramedic Law - Pros and Cons From an Expert Perspective Neubrandenburg: Neubrandenburg University of Applied Sciences (2017) Google Scholar Staged Care System in Rescue Services (GVS) Cologne: Institute for Rescue Engineering and Hazard Prevention (2017) Google Scholar On the study of work process knowledge - expertise of interviewers as a determinant in semi-structured interviews Working and Learning in Computer-Based Work Systems in Industry Google Scholar Vocational science research and its empirical relevance for curriculum development Google Scholar The tension field of “Berufswissenschaftliche Forschung” In: Berufswissenschaftliche Forschung - Ein Arbeitsbuch für Studium und Praxis Google Scholar On the Implementation of Invasive Healing Measures - A Retrospective Study in the German Ambulance Service Google Scholar On the implementation of analgesia in the german ambulance service by emergency paramedics and emergency physicians - a retrospective study based on the protocols of use in the German ambulance service Google Scholar Nothing for the ambulance service - and now Das Fachmagazin für den Rettungsdienst CrossRef Full Text | Google Scholar Legal Certainty (Not Only) for Emergency Paramedics Google Scholar Development of the frequency and spectrum of rescue service deployments in Germany Herwig M and Kahl D (2023) Application of invasive medical and pharmacological measures by German emergency paramedics Received: 26 September 2023; Accepted: 10 November 2023; Published: 06 December 2023 Copyright © 2023 Koch, Herwig and Kahl. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) distribution or reproduction in other forums is permitted provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited in accordance with accepted academic practice distribution or reproduction is permitted which does not comply with these terms *Correspondence: Sebastian Koch, c2ViYXN0aWFuLmtvY2hAc3JoLmRl Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher 94% of researchers rate our articles as excellent or goodLearn more about the work of our research integrity team to safeguard the quality of each article we publish The Sunday TimesThis article was first published on May 5 It is a spring evening in the small town of Leinefelde-Worbis and a man denounced by his critics as a fascist and as a Nazi who dreams of becoming Germany’s next Führer is telling a cheering audience of several hundred people how their homeland is going to the dogs “Is our democracy dying?” is the theme of the meeting in a community centre called Obereichsfeldhalle According to 52-year-old Björn Höcke the threat comes not from his party which is being closely watched by the domestic intelligence service but from an all-powerful state determined to strip away the rights of its citizens The meeting is billed as a Bürgerdialog (a dialogue with citizens)