[Emergency physician expertise in the emergency medical services of tomorrow: requirements in the context of an evolving emergency care system].

The prehospital emergency care system in Germany is undergoing profound structural change, driven by demographic shifts, increasing emergency service responses and the expanding competencies of paramedics as the most highly qualified non-physician Emergency Medical Services (EMS) professionals. Within standardized pre-delegation frameworks, they perform clearly defined physician-prescribed interventions and, in emergency situations, independently carry out medical procedures in accordance with Section 2a of the German Federal Act on the Profession of Emergency Paramedics (Notfallsanitätergesetz), allowing a substantial proportion of emergency situations to be managed autonomously by paramedics and enabling physician resources to be increasingly focused on critically ill patients. In this context, the competency profile of prehospital emergency physicians is shifting towards highly specialized skills required in rare, life-threatening high-acuity, low-occurrence (HALO) situations, in which complex invasive procedures, nuanced clinical decision-making and structured team leadership are essential. As reliable maintenance of these skills cannot be ensured solely within the EMS setting due to low case numbers, the growing discrepancy between dynamically expanding paramedic competencies and largely static qualification requirements for emergency physicians underscores the need for a structured, mandatory and more specialized framework for prehospital emergency physician training and continuing education.