Objective The aim of this study was to investigate the affective commitment of emergency medical service (EMS) personnel in Germany and to identify key factors influencing employee retention. Methods In 2024, an open online cross-sectional survey was conducted among EMS personnel. Sociodemographic data, affective commitment (OCQ-G), individual career resources (CRQ), and work-related factors were collected. Data were analyzed descriptively, using analysis of variance and one-sample t-tests. Free-text responses were analyzed using Mayring's content analysis. Results The analysis included 1060 complete data sets. Affective commitment was moderate (M = 3.05; SD = 0.34). Career development opportunities were rated low. Salary, leadership, working conditions, and professional development emerged as key factors influencing commitment. Conclusion The results highlight an urgent need to improve retention management in emergency medical services, focusing on salary, career development, health-oriented workplace design and leadership.
Controlling difficult airways is a core competence for physicians in pre-hospital patient care. Acute situations, such as impairment of step A (Airway) within the xABCDE care protocol, require immediate intervention. Airway obstruction caused by vomit or foreign body aspiration can often be resolved adequately by manual measures. If the airway is obstructed by severe swelling, the urgency for intervention increases significantly, as safety measures such as pre-oxygenation become difficult to perform. This case report describes a trauma-related airway obstruction caused by a retropharyngeal haematoma, which was resolved by intubation, and highlights the relevance of this differential diagnosis in the pre-hospital setting.
Transport refusal and non-transport decisions are frequent challenges in emergency medical services (EMS). This article outlines the medical, legal, and ethical dimensions of transport refusal (patient declines an indicated hospital transport) and non-transport (no medical indication for transport), analyzed from the perspectives of a paramedic and an emergency physician. Central to both scenarios are the assessment and documentation of decision-making capacity, structured clinical evaluation (e.g., ABCDE, SAMPLER), adequate patient counselling, and clear communication of risks. Particular complexity arises when capacity is impaired due to intoxication, neurological or psychiatric conditions, or trauma, requiring physician involvement and, in critical cases, police assistance to ensure patient safety. The article emphasizes the EMS provider's legal duties - especially the guarantor obligation - and the necessity of meticulous documentation to mitigate liability risks. Case vignettes illustrate the spectrum from low-acuity presentations allowing non-transport to high-risk situations in which refusal cannot be accepted. Overall, legally compliant handling of transport refusal requires a structured approach, precise capacity assessment, risk-adapted counselling, and interdisciplinary cooperation to ensure both patient autonomy and medical safety.
Zusammenfassung Ziel der Studie war es, das affektive Commitment von Mitarbeitenden im Rettungsdienst (RDM) in Deutschland zu untersuchen und zentrale Einflussfaktoren der Mitarbeiterbindung zu identifizieren. Im Jahr 2024 wurde eine offene Online-Querschnittserhebung unter RDM durchgeführt. Erfasst wurden soziodemografische Angaben, affektives Commitment (OCQ-G), individuelle Karriere-Ressourcen und arbeitsbezogene Faktoren. Die Auswertung erfolgte deskriptiv sowie mittels Varianzanalysen und Ein-Stichproben-t-Tests. Freitextantworten wurden inhaltsanalytisch nach Mayring ausgewertet. In die Analyse gingen 1060 vollständige Datensätze ein. Das affektive Commitment war moderat ausgeprägt (M = 3,05; SD = 0,34). Organisationale Entwicklungsmöglichkeiten wurden niedrig eingeschätzt. Als besonders bindungsrelevant erwiesen sich Vergütung, Führung, Arbeitsbedingungen und Karriereperspektiven. Die Ergebnisse zeigen einen deutlichen Handlungsbedarf im Retention-Management des Rettungsdienstes, insbesondere hinsichtlich Vergütung, Karrierepfaden sowie gesundheitsorientierter Arbeitsgestaltung und Führung.
