When an emergency call comes in, every minute counts. Air rescue can be on scene in minutes, backing up ground crews – but a planned cap on health insurance costs could put this rapid support at risk.
An emergency call comes in. Moments later, an air ambulance helicopter lifts off from the Unfallkrankenhaus Berlin (ukb) in Marzahn. On board are a pilot, an emergency doctor and an emergency paramedic – a well-rehearsed team for missions where routine, precision and time can all be critical.
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Their destination is the small town of Lübben in Brandenburg, where a patient with severe burns is waiting. 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 second counts," says emergency doctor Jan Martin. "In particular for heart attack or stroke patients, tissue is lost with every minute that passes without treatment." That is why, he says, everything has to be prepared at the start of the shift so the crew can take off immediately. From the alarm to lift-off usually takes no more than two minutes.
Where air rescue is especially vital
Air rescue does not replace the ground ambulance service; it complements it. It becomes particularly important where distances are great, hospitals are far apart or specialised treatments are only available at a few locations. In such cases, the time saved by helicopter can be crucial – both for initial emergency care and for transfers between clinics.
DRF Luftrettung operates 33 helicopter bases at 31 locations across Germany, three of them in Berlin. The Berlin base is on call around the clock. A helicopter can cover roughly 70 kilometres in about 17 minutes. Especially outside metropolitan areas, that can make a significant difference.
Classic emergency call-outs and patient transfers
This base has a particular role: the "Christoph Berlin" intensive care transport helicopter at the Unfallkrankenhaus Berlin carries out two types of mission. Primary missions are classic emergency deployments directly to the scene – after road accidents, for example, or in acute medical emergencies. In these cases, the overriding priority is that medical help reaches the patient quickly.
There are also secondary missions, meaning transfers between hospitals, when patients are flown to another clinic because it can provide a specific treatment.
On standby for emergencies 13 hours a day
The day shift starts early. At 6.30 a.m. the crew check the technology, equipment and operational readiness: medical kit, helicopter inspection and weather conditions. They hold a joint briefing over breakfast.
Pilot Sebastian Nothbaum lists the many factors that have to be taken into account even before take-off: weather, airspace restrictions, training flights, prescribed flight routes. Air rescue therefore means not only flying fast, but also meticulous planning under time pressure.
The crews work 13-hour shifts, which demands sustained concentration – even during long waits for the next call-out. Once the alarm sounds, everything has to run smoothly and fast. On top of that there are night flights, changing weather conditions and the emotional strain. As the crew put it soberly: "You have to really want to do this job."
Highly specialised care on board
State-of-the-art medical technology is on board. Since November 2024, blood and plasma supplies have also formed part of the standard equipment in Berlin-Marzahn. In cases of severe injury or massive blood loss, life-saving treatment can thus begin even before reaching the hospital.
The staffing is highly specialised as well. Emergency doctors need an additional qualification to work on board the helicopter. Many also work in anaesthetics or intensive care medicine to maintain close ties to day-to-day clinical practice. The doctors are not always employed directly by DRF Luftrettung, but often come from partner hospitals.
Pilots and emergency paramedics (HEMS-TC) are also subject to special requirements. They must master both medical and aviation procedures and function as a team under time pressure. This interaction is especially crucial when landing away from hospital sites.
Once at the scene, the crew carry out what is known as a high reconnaissance: from the air they assess where it is safe to land and how best to reach the patient. Direct access is not always possible, so decisions on how to continue the transport are often only made on site.
Limits of air rescue
In low cloud, thunderstorms, high winds or ground fog, flights may be impossible or only possible with restrictions. Before every take-off, it is therefore checked whether the mission can be carried out safely, drawing also on information from the German Weather Service.
Conditions at the scene are not always straightforward either. Not every location is suitable as a landing site, and sometimes the crew have to walk some distance to reach the patient after landing. They also rely on the cooperation of people on the ground. If safety distances are not respected or instructions are not understood, this can create problems for the landing.
What lies behind every mission
Ensuring that air rescue is available at all times requires complex infrastructure. Helicopters, technology, maintenance, fuel and highly qualified staff all have to be kept permanently on standby. According to DRF Luftrettung, a fully equipped helicopter costs several million euros, and around 280 litres of kerosene are burned per flight hour.
Moreover, it is not only successful transports 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 being financed is therefore not a single flight, but a permanent readiness system.
DRF managing director Dr Krystian Pracz explains: "We bill by flight minute; that is what has been agreed with the health insurers. That covers all services." In his view, the debate about costs often falls short, because rapid rescue can also help reduce subsequent treatment costs – for example if patients receive care earlier and their recovery time is shortened.
Why the Act to limit health insurance costs is alarming the sector
With the planned GKV-Beitragssatzstabilisierungsgesetz (source in German) (Statutory Health Insurance Contribution Rate Stabilisation Act), the federal government aims to stabilise the finances of statutory health insurance and curb further premium increases. The bill provides for limits on fee increases in many areas of the health system. These are to be based on the basic wage rate, which reflects the annual average percentage change in the contribution-liable income of all members of statutory health insurance. Alternatively, actual cost increases can be used as the benchmark, depending on which figure is lower.
From the operators’ point of view, 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 warn of a looming funding gap (source in German). In their view, this would put pressure on a sector that is actually becoming more important in an increasingly specialised healthcare system.
Consequences for healthcare provision in rural areas
This debate carries particular weight for rural regions. Where hospitals are far apart, specialist clinics are not close by and journeys by road take longer, air rescue can play a decisive role – in emergencies as well as for transfers.
Emergency paramedic and Helicopter Emergency Medical Service Technical Crew Member (HEMS-TC) Mathias Buchholz illustrates the advantage from day-to-day operations: "If this had been done by road, an emergency doctor would have been tied up and out of the area for three to four hours. This way it is much quicker." A long journey by road ties up staff and undermines care elsewhere. For the seriously injured man from Lübben, what ultimately matters most is the fast route to the specialist burns centre.
Back at the Unfallkrankenhaus Berlin-Marzahn things quieten down again. The patient has been handed over, the rotors have come to a stop. The mission is over for the crew, but their shift is far from finished; they will remain on standby for several more hours.
Whether this system will remain just as reliable in future now also depends on political decisions. The Bundestag is due to vote on the savings package on 10 July. For patients, what ultimately matters is unlikely to be the cost of a flight minute – but that they are flown in time.
