The German Football League, the DFL, has a protocol for head injuries in the Bundesliga and the 2. Bundesliga. The form has signature lines for the club, the head coach, the person responsible for sport and the team doctor. The examination and treatment of a player on the pitch may take up to three minutes. Die Entscheidung obliegt allein dem/der Mannschaftsarzt/-ärztin. The decision rests with the team doctor alone. Trainer/-in, Schiedsrichter/-in und Spieler dürfen die Beurteilung und Entscheidung des Arztes/der Ärztin nicht beeinflussen. The coach, the referee and the player may not influence the doctor’s assessment and decision. The player may go on only if the doctor expressly confirms that he is able to. If a concussion cannot be ruled out, he takes no further part in the match.
health
After the Blackout in Rio
In the 2014 World Cup final against Argentina, the German midfielder Christoph Kramer collided with Ezequiel Garay and blacked out. He asked the referee: Schiri, ist das das Finale? Ref, is this the final? He stayed on the pitch for about fifteen more minutes with a concussion and was taken off after 30 minutes. He still cannot remember it. In June 2019 the German football association’s medical commission told the clubs that every professional in the first and second Bundesliga must have a neurological baseline screening at the yearly fitness examination. In March 2023 the clubs signed the first common DFL-Protokoll Kopfverletzungen, a protocol for head injuries. Head coaches, sporting directors and team doctors each signed it. It obliges club medical staff to attend emergency training every year. An appendix sets out the return of a player to training and matches after a concussion. The doctor who led the working group, Tim Meyer, said: Kopfverletzungen sind keine Bagatellen. Head injuries are not trifles.
The Food Hygiene Instruction
Anyone in Germany who starts a job with food, such as meat, dairy products, baked goods or ice cream, or who works in the kitchen of a restaurant, canteen or café, first needs a certificate from the public health office. It confirms that the person has been instructed about the legal duties and about which infectious diseases bar them from the work. The certificate must not be older than three months when the job begins. After that, the employer must repeat the instruction once the job has started and then every two years. The certificate and the record of the last instruction stay with the employer. The certificate replaced the old Gesundheitszeugnis, the health certificate under the former federal epidemics law. The old certificates are still valid.
What Paramedics May Do Alone
Germany’s emergency paramedics, the Notfallsanitäter, train for three years. Since 4 March 2021, Section 2a of the Paramedics Act has given them a defined right to act on their own. Until the emergency doctor arrives, or until other medical care begins, including care by a doctor over video, they may carry out medical measures on their own responsibility. These include invasive measures and medication. The law sets two conditions. The paramedics must have learned the measure in their training and must master it, erlernt haben und beherrschen. The measure must also be necessary to avert danger to life or serious lasting harm to the patient. Before the new section, such steps rested on the general rule of necessity in Section 34 of the Criminal Code. During the debate on the law in December 2020, the paramedics’ professional association described the dilemma: a paramedic faces a conflict of conscience over whether to act invasively or to wait for the emergency doctor.
Minimum Numbers for Hospitals
For certain difficult operations, a German hospital must prove its experience in numbers. The Federal Joint Committee, the G-BA, sets Mindestmengen, minimum numbers. A hospital may perform such an operation in the next calendar year only if its case numbers make it likely that it will reach the minimum. In December 2020 the G-BA raised two of them, with effect from 1 January 2021. For operations on the esophagus, the minimum rose from 10 to 26 a year at each hospital site, after a transition period. Hospitals caring for premature and newborn babies under 1,250 grams must now care for at least 25 such children a year instead of 14. For kidney transplants, the minimum of 25 a year stayed in place. The G-BA cited the scientifically demonstrable link between the number of operations and their quality. Particularly difficult planned operations should take place only in hospitals that have enough experience with them. The expected gain was fewer complications and deaths.
The Right to a Second Opinion
A German doctor who recommends certain planned operations must tell the patient about a right. It is the right to a Zweitmeinung, an independent second medical opinion from another qualified doctor. The rule is Section 27b of Book V of the Social Code, introduced in 2015. The doctor must, as a rule, give this information at least ten working days before the planned operation. For some operations the period is fifteen working days. The Federal Joint Committee decides which operations are covered. Its guideline, published at the end of 2018, named two in 2019: tonsil operations and hysterectomies. According to the Deutsches Ärzteblatt, the law responded to a rise in the number of certain elective operations that medicine could hardly explain.
A Pandemic Rehearsed in 2007
LÜKEX is short for Länder- und Ressortübergreifende Krisenmanagementübung, a crisis management exercise across federal states and ministries. The exercises run in a two-year cycle. On Wednesday, 7 November 2007, one of them played through a pandemic. In the scenario, 27 million people in Germany fell ill within eight weeks. 307,000 were treated in hospital, and 102,000 died. Seven federal states and about 3,000 people took part. Afterward, it was said internally that the crisis staff led by the interior and health ministries hat sich strukturell und organisatorisch uneingeschränkt bewährt, had proven itself fully in structure and organization. In fact, the exercise saw severe shortages of medicines, a breakdown of medical care in some districts, staff absences in hospitals and the police, and stalled communication between decision makers.
Thirteen years later, the real pandemic arrived.
Told Before Treatment
Before an operation in Germany, the patient sits down with a doctor for an Aufklärungsgespräch, a talk that explains the procedure. The patient also signs a form and gets a copy. The Civil Code has required this since 2013. The doctor must explain Art, Umfang, Durchführung, zu erwartende Folgen und Risiken der Maßnahme: its nature, scope, performance, expected consequences and risks. The doctor must also cover its necessity, urgency, suitability and chances of success. If several equally suitable methods carry clearly different risks, the doctor must name the alternatives. The talk must be oral. Written papers may only add to it. It must come early enough dass der Patient seine Entscheidung über die Einwilligung wohlüberlegt treffen kann, so that the patient can make a well-considered decision about consent. It must also be für den Patienten verständlich, understandable to the patient.
“It Is Serious”
On 18 March 2020, Chancellor Angela Merkel spoke to the country on television about the coronavirus. She did not soften the message. Es ist ernst. Nehmen Sie es auch ernst. It is serious. Take it seriously too. She also said: Die nächsten Wochen werden noch schwerer. The next weeks will be even harder. The rhetoric department of the University of Tübingen named it the speech of the year 2020. On 9 December 2020, in the Bundestag, she backed a call by the national academy of sciences, the Leopoldina, for a hard lockdown over the holidays. She said that if there were too many contacts before Christmas und es anschließend das letzte Weihnachten mit den Großeltern war, dann werden wir etwas versäumt haben, and it then turned out to be the last Christmas with the grandparents, we will have failed to do something.
The Red Hand Letter
When a drug company learns of a new, important risk in one of its medicines, it sends doctors and pharmacists a Rote-Hand-Brief, a red-hand letter. A red hand is printed on the envelope and on the letter. The duty rests on the German Medicines Act. The company sends the letter on its own responsibility, but the federal drug authority agrees its content and its recipients first. The letter may report a new reason not to use a drug or a new warning. One such letter, in February 2024, concerned the drug valproate. It warned of a possible risk of neurodevelopmental disorders in children whose fathers had taken it. Letters that bring no new risk are called Informationsbriefe. They do not carry the red hand.