An emergency call comes in. Shortly afterwards an air ambulance helicopter lifts off from Berlin Accident Hospital (ukb) in Marzahn. On board are a pilot, an emergency doctor and an emergency paramedic – a well-practised team for missions where routine, precision and time can be decisive.
The destination is the small town of Lübben in Brandenburg. There a patient with severe burns is waiting. He needs to be transferred quickly to the ukb’s specialised burns centre. For the crew this is a familiar routine.
“When an emergency call comes in, every moment counts,” says emergency doctor Jan Martin. “In particular with heart attack or stroke patients, 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 that the crew can take off immediately. From the alarm being raised to take-off usually takes no more than two minutes.
Where air rescue becomes especially important
Air rescue does not replace the ground-based emergency services; it complements them. It becomes particularly important where distances are long, hospitals are far apart or specialised treatments are available only at a few sites. In such cases the time gained by using a helicopter can be crucial – both for initial treatment and for transfers.
DRF Luftrettung operates 34 helicopter bases at 32 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.
RelatedClassical emergency call-outs and inter-hospital transfers
The special feature of this base is that the “Christoph Berlin” intensive care transport helicopter at Berlin Accident Hospital carries out two types of mission. Primary missions are classical emergency deployments directly at the scene – for example after road traffic accidents or in acute internal medical emergencies. Here it is above all about getting medical help to the patient quickly.
In addition, there are secondary missions, meaning transfers between hospitals. In these cases patients are taken to another hospital because a specific treatment is available there.
On standby 13 hours a day
The day shift starts early. At 6:30 a.m. the crew members check the technology, equipment and operational readiness. This includes the medical kit, checks on the helicopter itself and the weather situation. During breakfast they hold a joint briefing.
Pilot Sebastian Nothbaum describes how many factors have to be considered even before take-off: the weather, restricted airspace, exercises, requirements for flight paths. Air rescue therefore means not only flying fast, but also precise planning under time pressure.
The crews work 13-hour shifts. That demands concentration over many hours – even when they are waiting a long time for the next call-out. As soon as the alarm comes, everything has to work quickly. On top of that there are night flights, changing weather conditions and the emotional strain. The crew sums it up soberly: “You have to really want to do this job.”
Highly specialised help on board
Modern medical technology is carried on board. In Berlin-Marzahn, blood and plasma units have also been part of the equipment since November 2024. In cases of severe injury 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 a helicopter. Many also work in anaesthesiology or intensive care medicine to maintain close links to clinical practice. The emergency doctors are not always employed directly by DRF Luftrettung, but come from partner hospitals.
There are also special requirements for pilots and emergency paramedics (HEMS-TC). They have to master both medical and aviation procedures and function as a team under time pressure. This interaction is crucial, especially when landing away from hospital sites.
Once they reach the scene, the crew carries out what is known as a “high reconnaissance”: they assess from the air where it is safe to land and how best to reach the patient. It is not always possible to land right next to the scene, which is why the exact mode of onward transport is often decided only on site.
Limits of air rescue
Low cloud, thunderstorms, high winds or ground fog can mean a flight is not possible or only 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 has to walk some distance to the patient after landing. Public cooperation is also needed. If safety distances are not observed or instructions are not understood, this can cause problems when landing.
RelatedWhat lies behind every mission
Providing air rescue around the clock requires a complex infrastructure. Helicopters, technology, maintenance, fuel and highly qualified staff all have to be kept available at all times. According to DRF Luftrettung, a helicopter including its equipment costs several million euros, and around 280 litres of kerosene are burned 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 scheduled maintenance. What is financed is therefore not just a single flight, but a permanent standby system.
DRF managing director Dr Krystian Pracz says: “We bill by flying minute; that is what we have agreed with the health insurance funds. That covers all services.” In his view, the debate about costs often falls short. Faster rescue, he argues, can also help reduce later treatment costs – for example when patients receive earlier care and their recovery time is shortened.
Why the Act to limit health insurance costs is alarming the sector
With the planned GKV Contribution Rate Stabilisation Act (source in German), the federal government wants to stabilise the finances of the statutory health insurance system and curb further contribution increases. The idea is to cap increases in reimbursement in many areas of the health system. The cap is to be based on the basic wage rate, which reflects the average annual percentage change in the contribution-relevant income of all members of the statutory health insurance scheme. Alternatively, actual cost increases can serve as the basis, depending on which figure is lower.
From the operators’ point of view this is problematic for air rescue because the 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 farther apart, specialist clinics are not close by and road journeys take longer, air rescue can play a decisive role – both in emergencies and in inter-hospital transfers.
Emergency paramedic and Helicopter Emergency Medical Service Technical Crew Member (HEMS-TC) Mathias Buchholz illustrates the advantage from day-to-day practice: “If this patient had been transported by road, an emergency doctor would have been tied up outside the response area for three to four hours. This way, it is much quicker.” A long road transfer ties up staff and reduces capacity elsewhere. For the seriously injured man from Lübben, what ultimately matters most is the fast route to the specialised burns centre.
Back at Berlin-Marzahn Accident Hospital things quieten down again. The patient has been handed over, the rotors are at a standstill. 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, what will ultimately matter is not how expensive a flying minute is – but that they are flown in time.
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