Emergency airway management is a complex task for emergency physicians. This viewpoint by the EUSEM states the most important aspects and discusses the recently published practice guidelines for emergency airway management of the Society of Critical Care Medicine.

Purpose: Emergency departments are frequently confronted with traumatic dental injuries (TDIs). The prognosis of the injured tooth is related to early dental trauma management. For this reason, physicians must be familiar with the appropriate management of TDI. This study aimed to investigate the knowledge and skills of German emergency physicians regarding TDI. Methods: An electronic questionnaire was sent to 438 emergency departments throughout Germany. Four hundred and twenty seven questionnaires were evaluated and included in the analysis. The survey contained questions about physician characteristics and assessed their knowledge and skills of managing dental trauma. For statistical analysis, the Kruskal–Wallis, Mann–Whitney U test or ANOVA test was used as appropriate. Rank correlations were performed with the Spearman’s rank correlation. Results: Out of 427 participants, 256 (59.95%) stated they had no or insufficient knowledge, and 266 (71.12%) stated they had no skills in dental trauma management. Almost 76% of the participants had no previous knowledge of dentistry. Only 7.28% knew the right procedure for replanting an avulsed tooth. Just 26.06% would choose the right medium for temporary tooth storage. Having a dentist in the family (p = 0.0074) or clinical exposure to patients with dental trauma (p = 0.0384) influenced the results of the knowledge score. Conclusion: The knowledge and skills in dental trauma management among German emergency physicians are generally inadequate. Targeted training courses are necessary to ensure early and adequate TDI treatment to reduce the resulting medical and societal costs as much as possible.

(1) Background: Endotracheal intubation in the prehospital setting is an important skill for emergency physicians, paramedics, and other members of the EMS providing airway management. Its success determines complications and patient mortality. The aim of this study was to find predictors for first-pass intubation success in the prehospital emergency setting. (2) The study was based on a retrospective analysis of a population-based registry of prehospital advanced airway management in Germany. Cases of endotracheal intubation by the emergency medical services in the cities of Tübingen and Jena between 2016 and 2019 were included. The outcome of interest was first-pass intubation success. Univariate and multivariable regression analysis were used to analyse the influence of predefined predictors, including the characteristics of patients, the intubating staff, and the clinical situation. (3) Results: A total of 308 patients were analysed. After adjustment for multiple confounders, the direct vocal cord view, a less favourable Cormack–Lehane classification, the general practitioner as medical specialty, and location and type of EMS were independent predictors for first-pass intubation success. (4) Conclusions: In physician-led emergency medical services, the laryngoscopic view, medical specialty, type of EMS, and career level are associated with FPS. The latter points towards the importance of experience and regular training in endotracheal intubation.

Background: Medication administration is a fundamental component of paramedic-provided prehospital emergency care within a physician-based EMS-System. In Germany, the Emergency Paramedic Act expanded pharmacological competencies and authorization pathways, yet real-world utilization of medications in routine EMS practice remains insufficiently described. This study aimed to quantify medication use, characterize medication categories and administration routes, and assess temporal and regional variation across three German EMS districts. Methods: We conducted a retrospective multicenter observational study of all paramedic-led EMS missions without on-scene physician involvement between 1 January 2019 and 31 December 2024. Electronic patient care records from three mixed urban–rural EMS districts were analyzed. Outcomes included the proportion of missions with medication administration, distribution of medication classes, administration routes, six-year temporal trends, and interregional differences. Statistical analyses included descriptive measures, chi-square tests, and Cochran–Armitage trend testing. Results: Among 197,432 eligible missions, 22,340 involved medication administration (11.3%). Crystalloids (4.1%) and analgesics (3.2%) were the most frequently administered medications, followed by bronchodilators (1.4%), glucose (1.2%), and antiemetics (0.5%). Advanced medications were used in 0.9% of missions. Medication administration increased significantly from 9.4% in 2019 to 12.1% in 2024 ( p = 0.02). Intravenous administration was predominant (76.3%). Districts with telemedical physician support demonstrated higher overall medication use compared to the district without tele-EMS (12.7% vs. 9.1%; p < 0.001). Conclusions: Medication use in German paramedic-led prehospital care remains concentrated on a narrow spectrum of frequently used medication categories despite expanded legal competencies and a comprehensive pharmacology curriculum. A system supervised by the EMS medical director (ÄLRD) is essential to ensure patient safety and to support the maintenance of pharmacological competencies.