An emergency call comes in. Shortly afterwards, a rescue helicopter lifts off from the Berlin accident hospital in Marzahn (ukb). 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 critical.
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The destination is the small town of Lübben in Brandenburg. There, a patient with severe burns is waiting. He needs to be taken quickly to the UKB’s specialist burns center. For the crew, this is a familiar routine.
“When an emergency call comes in, every second counts,” says emergency doctor Jan Martin. “Especially for heart attack or stroke patients, with every minute that passes without treatment, tissue is lost.” That is why, at the start of a shift, everything has to be prepared so that the crew can take off immediately. From the alarm being raised to lift-off usually takes no more than two minutes.
Where air rescue becomes particularly important
Air rescue does not replace the ground-based ambulance service; it complements it. It becomes particularly important where distances are long, hospitals are further apart or specialized treatments are only possible at a few locations. In such cases, the time gained by using a helicopter can be crucial – both for initial emergency care and for transfers.
DRF Luftrettung operates 33 helicopter bases at 31 locations across Germany, three of them in Berlin. The Berlin base is on standby around the clock. A helicopter can cover around 70 kilometers in about 17 minutes. Especially outside metropolitan areas, that can make a significant difference.
Classic emergency missions and patient transfers
The special feature of this base: the intensive care transport helicopter “Christoph Berlin” at Trauma Hospital Berlin undertakes two types of mission. Primary missions are classic emergency call-outs directly to the scene – for example after road traffic accidents or in acute internal medical emergencies. Here, the key thing is that medical help arrives quickly.
In addition, there are secondary missions, in other words transfers between hospitals. Patients are taken to another hospital because a specific treatment can be carried out there.
On standby 13 hours a day
The day shift starts early. At 6.30 am the crew members check the technology, equipment and operational readiness. That includes the medical equipment, an inspection of the helicopter and the weather situation. The joint briefing takes place over breakfast.
Pilot Sebastian Nothbaum describes how many factors have to be considered even before take-off: the weather, airspace closures, training exercises, prescribed flight routes. Air rescue therefore means not only flying fast but also meticulous planning under time pressure.
The crews work 13-hour shifts. That demands sustained concentration over many hours – even when there is a long wait for the next mission. 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 sum it up in sober terms: “You have to want to do this.”
Highly specialized help on board
Modern medical technology is carried on board. In Berlin-Marzahn, blood and plasma reserves have also been part of the equipment since November 2024. In cases of severe injury or massive blood loss, life-saving measures can therefore begin even before the patient reaches hospital.
The personnel are also highly specialized. Emergency doctors need an additional qualification to work on the helicopter. Many also work in anesthetics or intensive care medicine in order to stay closely connected to clinical practice. The emergency doctors do not always belong directly to DRF Luftrettung, but come from partner hospitals.
Special requirements also apply to pilots and emergency paramedics (HEMS-TC). They must be familiar with both medical and aviation procedures and function as a team under time pressure. This interaction is particularly crucial when landing away from hospital sites.
Once on site, the crew carry out what is known as a high reconnaissance: from the air they check where it is safe to land and how best to reach the patient. Direct access is not possible everywhere, so the onward transport is often only decided once they are there.
Limits of air rescue
In conditions of low cloud, thunderstorms, storms or ground fog, a flight may not be possible or may only be possible with restrictions. Before every take-off, it is therefore checked whether the mission can be carried out safely. Information from the German Weather Service is also taken into account.
Things are not always straightforward at the scene either. Not every location is suitable as a landing site, and sometimes the crew still has to walk some distance to reach the patient after landing. Public cooperation is also needed. If safety distances are not observed or instructions are not understood, this can make landing difficult.
What lies behind every mission
To ensure that air rescue is available at all times, a complex infrastructure is required. Helicopters, technology, maintenance, fuel and highly qualified staff must be kept permanently ready. According to DRF Luftrettung, a helicopter including its equipment costs several million euros, and around 280 liters of kerosene are consumed per flight hour.
On top of that, it is not only successful transports that cost money. False alarms and aborted missions also put a strain on the system. Every take-off brings the helicopter closer to its next maintenance. What is financed, therefore, is not a single flight but a permanent standby system.
DRF managing director Dr Krystian Pracz says: “We bill by minutes of flight time; that is what has been agreed with the health insurance funds. That covers all services.” In his view, the debate about costs often falls short. Rapid rescue can also help to reduce subsequent treatment costs – for example if patients receive care earlier and their recovery time is shortened.
Why the Act to Limit Health Insurance Fund Costs is alarming the sector
With the planned Statutory Health Insurance Contribution Rate Stabilization Act (source in German)the federal government wants to stabilize 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. The cap is to be based on the basic wage rate, which reflects the average annual percentage change in the contribution-liable income of all members of the statutory health insurance scheme. Alternatively, actual cost increases can be used as the benchmark, depending on which figure is lower.
From the operators’ perspective, this is problematic for air rescue, because its funding cannot keep up with these costs. The non-profit air rescue organizations ADAC, DRF and Johanniter therefore Warn of a funding gap (source in German). In their view, this would put pressure on an area that is becoming more important in an increasingly specialized 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 crucial role – for emergencies as well as for transfers.
Emergency paramedic and Helicopter Emergency Medical Service Technical Crew Member (HEMS-TC) Mathias Buchholz 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 their area of operation for three to four hours. This way it is much faster.” A long road transfer ties up personnel and worsens provision elsewhere. For the seriously injured man from Lübben, what ultimately matters is the rapid journey to the specialist burns center.
Back at Berlin-Marzahn Accident Hospital, things calm down again. The patient has been handed over, the rotors have come to a halt. For the crew the mission is over, but their shift is far from finished. They remain on standby for several more hours.
Whether this system will continue to function as reliably in the future now also depends on political decisions. The Bundestag is due to vote on the savings package on July 10. For patients, what is likely to matter in the end is not how expensive a minute of flying is – but that they are flown in time.