When every minute counts: German air rescue between emergency calls and cost pressures
When an emergency call comes in, every minute counts: air rescue can reach the scene within minutes. But a planned cap on health insurance costs could endanger this rapid help from the air.
An emergency call comes in. Shortly afterwards, an air ambulance takes off from the Unfallkrankenhaus Berlin (ukb) in Marzahn. On board are the pilot, an emergency doctor and an emergency paramedic – a well-rehearsed team for missions where routine, precision and time can all be crucial.
Their destination is the small town of Lübben in Brandenburg. A patient with severe burns is waiting there. He needs to be taken quickly to the ukb’s specialist burns centre. For the crew, this is a familiar routine.
"When an emergency call comes in, every moment counts," says emergency doctor Jan Martin. "With heart attack or stroke patients in particular, tissue is lost with every minute that passes without treatment." That is why everything has to be prepared at the start of the shift so the crew can take off immediately. From the alarm to lift-off, it usually takes no more than two minutes.
Where air rescue is especially vital
Air rescue does not replace the ambulance service on the ground; it complements it. It becomes particularly important where distances are long, hospitals are far apart or specialised treatments are only available at a few locations. In those cases the time saved by using a helicopter can be decisive – both for initial care and for transfers.
DRF Luftrettung operates 34 helicopter bases at 32 locations nationwide, three of them in Berlin. The Berlin base is on call around the clock. A helicopter can cover around 70 kilometres in about 17 minutes. Especially outside densely populated areas, that can make a substantial difference.
Classic emergency missions and hospital transfers
What is special about this site is that the "Christoph Berlin" intensive care transport helicopter at the Unfallkrankenhaus Berlin carries out two types of missions. Primary missions are classic emergency call-outs directly to the scene – for example after road accidents or in acute internal medical emergencies. Here the crucial factor is that medical help arrives quickly.
In addition there are secondary missions, that is transfers between hospitals. Patients are taken to another hospital because a specific treatment is available there.
Ready for emergencies 13 hours a day
The day shift starts early. At 6:30 a.m. the crew members check the technology, equipment and readiness for deployment. That includes the medical kit, inspection of the helicopter and the weather situation. They then hold a joint briefing over breakfast.
Pilot Sebastian Nothbaum describes how many factors have to be taken into account even before take-off: the weather, airspace restrictions, exercises, and prescribed flight routes. Air rescue therefore means not only flying fast, but also precise planning under time pressure.
The crews work 13-hour shifts. That requires sustained concentration over many hours – even when they are waiting a long time for the next call-out. As soon as the alarm comes in, everything has to work quickly. On top of that come night flights, changing weather conditions and the emotional strain. The crew sums it up soberly: "You have to really want to do this."
Highly specialised help on board
Modern medical technology is carried on board. In Berlin-Marzahn, blood and plasma supplies have also been part of the equipment since November 2024. In cases of severe injuries or massive blood loss, life-saving measures can thus begin even before the patient reaches hospital.
The air rescue service is also highly specialised in terms of personnel. Emergency doctors need an additional qualification to work on the helicopter. Many also work in anaesthesia or intensive care medicine to maintain close links with clinical practice. The emergency doctors do not always belong directly to DRF Luftrettung but often come from partner hospitals.
Special requirements also apply to pilots and emergency paramedics (HEMS-TC). They must master both medical and flight procedures and function as a team under time pressure. This interplay is crucial, especially when landing away from hospital sites.
Once on scene they carry out what is known as a high reconnaissance: from the air the crew checks where they can land safely and how best to reach the patient. Direct access is not always possible, so the decision on how to continue the transport is often only taken on site.
Limits to air rescue
In low cloud, thunderstorms, storms or ground fog a flight may not be possible, or only to a limited extent. That is why every take-off is preceded by a check to see whether the mission can be flown safely. The crews also rely on information from the German Weather Service.
Things are not always straightforward at the scene either. Not every location is suitable as a landing site, and sometimes the crew has to walk some distance to reach the patient after landing. Public cooperation is also needed on the ground. If safety distances are not observed or instructions are not understood, this can make landing difficult.
What lies behind every mission
Ensuring that air rescue is available at all times requires a complex infrastructure. Helicopters, technology, maintenance, fuel and highly qualified staff all have to be permanently available. According to DRF Luftrettung, a helicopter including its equipment costs several million euros, and around 280 litres of kerosene are consumed per flight hour.
And it is not only successful missions that cost money. False alarms and aborted missions also place a burden on the system. Every take-off brings the helicopter closer to its next maintenance check. What is financed, therefore, is not a single flight but a permanent standby system.
DRF managing director Dr Krystian Pracz says: "We bill by flight minute, that is what has been agreed with the health insurance funds. That covers all services." From his point of view, the debate about costs often falls short. Fast rescue can also help reduce later treatment costs – for example when patients receive care earlier and their recovery is quicker.
Why the Law to Limit Health Insurance Costs is alarming the sector
With the planned GKV-Beitragssatzstabilisierungsgesetz (source in German), the federal government wants to stabilise the finances of statutory health insurance and limit further contribution increases. The idea is to cap increases in remuneration in many areas of the healthcare system. These are to be aligned with the basic wage rate, which reflects the average annual percentage change in the contribution-liable income of all members of statutory health insurance. Alternatively, actual cost increases can be used as the basis, depending on which figure is lower.
From the operators’ perspective, this is problematic for air rescue because its funding does not keep pace with these costs. The non-profit air rescue organisations ADAC, DRF and Johanniter therefore warn of a funding gap (source in German). In their view, this would put pressure on a sector that is becoming more, not less, important in an increasingly specialised healthcare system.
Consequences for care in rural areas
This debate carries particular weight for rural regions. Where hospitals are further apart, specialist clinics are not close by and journeys by road take longer, air rescue can play a decisive role – both in emergencies and for transfers.
Mathias Buchholz, emergency paramedic and Helicopter Emergency Medical Service Technical Crew Member (HEMS-TC), describes the advantage from day-to-day operations as follows: "If this had been done by road, an emergency doctor would have been out of the area for three to four hours. This way it is much quicker." Long journeys by road tie up staff and worsen care elsewhere. For the severely injured man from Lübben, what ultimately matters is the quick journey to the specialist burns centre.
Things quieten down again at the Unfallkrankenhaus Berlin-Marzahn. The patient has been handed over, the rotors have stopped. For the crew the mission is over, but their shift is far from finished. They will remain on standby for several more hours.
Whether this system will continue to function as reliably in future now also depends on political decisions. The Bundestag is due to vote on the savings package on 10 July. For patients, the key point in the end is unlikely to be how expensive a minute of flight time is, but that they are flown in time.
