Prehospital emergency care systems that bring emergency physicians (EPs) to the patient in potentially- and real life-threatening situations are often referred to as the “Franco-German System”. The principle of the German doctor-based system was introduced in 1938 by the German surgeon, Martin Kirschner. It has been developed further in the 1950’s trying to provide adequate medical care, primarily for emergency patients, by a qualified and specially skilled physician. In the 1970’s France and Germany developed similar concepts of delivering structured care to patients with life-threatening diseases or injuries in the prehospital setting. The primary consideration to treat a patient effectively and efficiently at the scene, during transport and in the hospital by a qualified physician has always been the basis of the FGS. The basic principle behind the development of a nationwide infrastructure was the idea that the treatment of life-threatening diseases or injuries should begin without delay, meaning at the emergency site. The most qualified person to diagnose and treat diseases/injuries is a doctor, in the FGS specially trained EPs are sent by vehicle or helicopter to the patients. EPs are usually assigned to an advanced life-support (ALS) ambulance or travel to the scene separately to meet with other members of the ALS crew at the patients side (“rendezvous system”). Basic life-support (BLS) calls are usually responded to by a team of “Rettungsassistenten” (RAs), the German version of a paramedic, and/or EMTs without the on-site presence of physicians. Inside the hospital, the FGS considers emergency medicine as an interdisciplinary activity that does not require special status. After examining the patient, the EP works out a definite diagnosis on which a triage is based to determine the medical specialty which dictates the further treatment once the hospital is reached. For that reason, in countries with the FGS, most hospital ERs either do not exist, or are present but primitive. Countries that implemented this system of emergency care, or equivalent models, are colored blue in the world map (see Videoconference Based Emergency Medicine).
The German system distinguishes among basic ambulances, emergency ambulances, and mobile life support units (MLSU). A driver and an EMT transport non life-threatening patients in MLSUs that are staffed with either two RAs, or one RA and one EMT, and provide care for urgent patients who are not in need of advanced levels of care. Or they support an EP, providing care for emergency patients who may need advanced support. These units respond to complex cases such as victims of poly-trauma, acute myocardial infarction (heart attack), stroke, status asthmaticus, etc. In some units where the EP is not riding together as a member of the MLSU, he is brought in a separate emergency ambulance which is usually a smaller, faster car with the equipment for ALS, but without the possibility of transporting a patient.
