If you live in southwestern Schleswig-Holstein and need to dial the 112 emergency number, you’ll be comforted to know your emergency is being handled by one of the best control centers in the business. The West Cooperative Regional Emergency Control Center (KRLS), as it’s known, is based in the town of Elmshorn in a shiny new building that impresses from afar with its vast expanse of glass frontage and calming green surroundings.

It is great place to work, thanks in part to state-of-the-art climate control, air quality, acoustics and daylight control systems – which is a good thing, because every year it coordinates around 135,000 fire and emergency call-outs. Of that number, all the emergency rescue and patient transport call-outs go to RKiSH. And KRLS is only one of three control centers in the whole of Schleswig-Holstein that forward emergency rescue dispatch calls to RKiSH.

Focus on efficiency

RKiSH is a joint venture between several administrative districts (five at last count). The decision to establish it in 2005 was motivated largely by economies of scale – because emergency vehicles and equipment work out cheaper if you pool resources and buy them in bulk.

Another key benefit is efficiency: specialist task areas can be consolidated and handed off to specialized departments. Not that those are the only benefits of having such a large emergency rescue workforce – RKiSH currently has over 1,200 employees – under one roof.

Focus on quality

RKiSH’s mission right from the outset has been to give patients the best possible emergency medical care. Apart from technology, good staff and solid strategies, that calls for a well-honed quality management system. RKiSH systematically checks and audits its service delivery against a harmonized quality standard – no easy task, given that its catchment area is home to around 1.1 million people.

It has also implemented a further layer of quality assurance in the form of a digital documentation system. And to ensure it has the best people, it invests in quality training and professional development.

Focus on training

Since 2009, RKiSH has been operating an academy in the town of Heide that provides training and professional development opportunities. This year it is training 180 new paramedics, and next year it is looking at training 200. The academy also offers numerous professional development courses that employees can use in order to gain new skills for new task areas.

All of its training and professional development offerings make extensive use of simulation so that trainees gain a good understanding of real-life work scenarios. To this end it has three training ambulances equipped with elaborate simulation and video equipment. As well as technical and medical skills, the academy’s programs have a strong focus on effective communication between crew members.

Focus on outdoor festivals

Every rescue-service catchment area has its own unique challenges. For RKiSH, these include two tourist hotspot coastlines and the crowds that flock to the "Wacken Open Air" heavy-metal festival and the "Werner-Rennen" motorsport event. For RKiSH, dealing with those challenges means being flexible – the ability to rapidly scale up its response capability when normally relatively sparsely populated areas receive massive visitor influxes in the summer season or during major music festivals and sporting events.

Admittedly the operation of "Wacken Hospita" – aka the first-aid station set up to look after the Wacken festival’s 120,000 heavy-metal fans, staff and helpers – is in the capable hands of the Kaltenkirchen branch of the German Red Cross and its 500-strong army of volunteers drawn from all over Germany. But the daunting task of coordinating the entire Wacken operation, providing emergency medical treatment and transporting patients to hospitals rests with RKiSH.

This year, RKiSH had 140 personnel at the Wacken Open Air, including 12 ER doctors and 44 trainees. It also had up to 13 vehicles at the ready. The “Werner-Rennen” motorsport event is a slightly smaller affair, so the RKiSH presence there is reduced accordingly. The key point is that in both cases, RKiSH has the flexibility to maintain normal service everywhere else while these events are on.

Focus on the future

Around the world, the number of calls received by emergency control centers is on the rise. The emergencies called in can range from minor ailments all the way to genuinely life-threatening situations, but it’s generally not possible to ascertain where on this spectrum a caller sits and what help he or she needs until the emergency crew is on the scene. To improve this, RKiSH is working on a differentiated emergency response model in which first aid is delivered in a faster, more tailored way. But to be sure: clear emergencies will continue to receive the emergency medical care they warrant.

One part of the new model is a pain-management strategy in which paramedics with special training are authorized to administer pain relief without having to wait for an ER doctor. As a safeguard, the attending paramedics must describe the patient’s symptoms and circumstances to an anesthesiologist via telephone and get his/her go-ahead before administering the medication. Another strategy relates to a plan for pre-clinical case management. The idea here is that every emergency call needs to be met with the appropriate response – for example, specific medical treatment or a recommendation for nursing care, or a referral for further treatment by the general practitioner. In none of these cases does the patient require immediate hospitalization or other stationary medical care. In future it will be possible to determine which patients require immediate hospitalization and which don’t by having the attending paramedics transmit test readings, photos or videos of the patient to a physician at a remote location. RKiSH is pushing ahead with the development of these types of telemetry models.


RKiSH is always looking for quality, highly motivated professionals to join its team. That is why it is exhibiting at INTERSCHUTZ 2020 in Hannover, Germany, and profiling its training activities. At the show, visiting professionals will be able to put their skills to the test on medical simulation dummies in one of RKiSH’s training ambulances. The simulations will be filmed so that participants can review their performance afterwards with a trainer from the RKiSH academy.

Emergency rescue professionals are of no use to anyone if they don’t look after their own health, so RKiSH has put out a special rescue service cookbook, “Retten und Kochen”, to make sure its people are getting the nutrition they need in order to stay effective on the job. Copies of the book will be on display at the RKiSH stand. The book contains recipes, compiled by RKiSH’s health management team, for healthy meals that paramedics can prepare on site at the ambulance station during their normal work breaks.

RKiSH: Facts & figures

Established in 2005, RKiSH is responsible for the provision of ambulance and non-acute transport services in five administrative districts of Schleswig-Holstein. It has a workforce of more than 1,200 and services a population of around 1.1 million spread across 27 cities and 509 municipalities. Its catchment area constitutes about 42 percent of the total land area of Schleswig-Holstein.

In 2018, RKiSH handled 160,000 emergency call-outs, and volumes are continuing to grow. Its vehicle fleet is spread across 44 ambulance stations region-wide and includes 17 non-transporting EMS vehicles for ER doctors, 94 ambulances and 15 non-acute transport vehicles.

RKiSH is a wholly-owned subsidiary of five administrative districts: Dithmarschen, Pinneberg, Rendsburg-Eckernförde, Segeberg and Steinburg. It has been providing training and professional development at its own academy in Heide since 2009.