Health care Emergency departments – the port of call for medical emergencies

An emergency department is the first port of call in a medical emergency. It provides 24/7 care to patients with acute medical issues. Many hospitals have emergency departments. They are sometimes also referred to as accident and emergency departments or casualty departments. 

The procedure for patient examination and treatment is similar in all emergency departments.

Doctors from various disciplines work in an emergency department. This can include surgery or internal medicine, for example.

People from other professions are also involved in caring for patients. For example:

• Nurses
• Physician assistants
• Administrative staff and other support staff

Emergency departments employ medical personnel who have been specially trained in emergency medicine. The senior medical staff in an emergency department must have completed special further training in emergency medicine. Other staff can also have additional qualifications in emergency medicine or emergency care.

Emergency departments are there to help people with serious illnesses or injuries. If rapid assistance is required and treatment cannot be provided in a medical practice, call the emergency services on 112. Examples of cases in which this is necessary include the following:

• Severe shortness of breath
• Severe chest pain or pressure on the chest
• Severe abdominal pain
• Loss of consciousness
• Sudden speech or visual disturbances
• Sudden paralysis
• Acute injuries such as broken bones, heavily bleeding wounds or severe burns
• Poisoning
• Allergic shock (anaphylaxis) with shortness of breath and circulatory weakness

In the event of other medical issues, people should contact an out-of-hours medical service or, during consultation hours, a family doctor practice. This generally also applies to medical issues that have existed for a while.

How do you get to an emergency department?

In the event of a risk to life or serious medical issues, people should always call the emergency services on 112. They will then be taken to the emergency department in an ambulance, where necessary accompanied by an emergency doctor. 

People can also take themselves to an emergency department. Doctors outside the hospital can furthermore refer patients to an emergency department.

People who take themselves to an emergency department must check in (register) on arrival. During this process, they will be asked about their symptoms and their insurance status.

Triage

Emergency department nurses and doctors use a set scale to establish how urgently patients need to be treated. Patients are also asked targeted questions about their symptoms, pre-existing conditions or accident. Emergency services personnel also provide an assessment. Measurements such as a patient’s heart rate or blood pressure are also taken into account.

The information collated is then used to categorize patients by treatment urgency. The highest category means that immediate treatment is required. The lowest category means that treatment is not urgent.

This form of triage occurs regardless of whether patients arrive independently or with the emergency services. 

The categorization can lead to different waiting times for different patients. Some patients may have to wait longer if others are more seriously ill or injured.

Examinations in the emergency department are used to determine or narrow down the cause of symptoms.
Depending on the symptoms, different examinations can be performed. Examples of examinations in the emergency department include:

• Physical examinations: these are based on the symptom or injury type. For example, in the case of severe abdominal pain, medical staff may listen to and palpate the stomach.
• Scans: these include cross-sectional imaging such as computed tomography (CT) scans as well as x‑rays and ultrasound examinations.
• Laboratory tests: these primarily involve blood tests but can also include urine tests, for example.
• Other examinations: there are numerous other examination procedures that can be used in emergency departments. These can include measuring the heart’s electrical activity (ECG) or assessing how well the blood is able to absorb oxygen.

Some illnesses or injuries can be fully treated in the emergency department. For example, if a patient presents with a cut or a simple bone fracture, the wound can be sutured in the emergency department or the fracture can be splinted. In such cases, patients can return home the same day. They are given a short doctors’ letter for the medical practice that will continue their treatment.

Other patients who attend the emergency department have to be admitted to hospital for further treatment or monitoring. 

If patients are admitted to hospital, the initial medical care is provided in the emergency department. For example, they can be given medication to alleviate acute pain. They are then moved to a hospital ward for a certain period for further treatment.

Examination and treatment in the shock room

If severely ill or injured people are brought to the emergency department, medical action must be initiated as quickly as possible. 
In such cases, patients are examined and treated in a special room known as a shock room or trauma room. This is equipped to care for people with life-threatening illnesses or injuries. 

Multiple doctors and nurses jointly care for the patient in the shock room. The examination and initial medical care occur simultaneously. Measures are instantly taken to improve the condition of the ill or injured person. Meanwhile, tests are performed to determine the cause of the life-threatening health condition and adapt the treatment to it. 

In a medical emergency, hospitals are obliged to provide treatment – regardless of whether or not people have health insurance or residence papers. The hospital is also prohibited from passing on information about the residency status to other people or authorities.

Hospitals that treat people without health insurance in an emergency can claim back the costs from the responsible social service providers. However, this involves a great deal of administrative work and legal uncertainties exist in such cases. Patients should clarify who will bear the costs by consulting with the hospital’s social service team and the social welfare office (“Sozialamt”).

They should also determine whether they can take out health insurance retroactively. If this is possible, the treatment costs can be submitted to the insurance company. Otherwise, patients may have to pay the treatment costs themselves.

Further information about rejoining health insurance can be found in our article “Health insurance – security in the event of illness”. 

Clearing houses provide advice on how people without health insurance can become insured again. A list of contact details for clearing houses in Germany is provided by the Office for the Equal Treatment of EU Workers.

In the event of a risk to life or serious illness or injury, people should always call the emergency services on 112. For all other acute medical issues, they should dial 116117 to find out where they can best receive help.

The Bundes-Klinik-Atlas hospital directory also provides information about nearby hospitals and the emergency care they offer.

Individual hospitals furthermore provide information about their emergency departments on their websites, for example how to contact them by telephone or directions for getting there.