On July 27, 2023, several amendments to the BtMG entered into force [1]. The following (abbreviated) statement is authoritative: “Narcotics may be administered by emergency medical technicians without a prior physician’s order if they are acting according to standardized medical instructions, a physician’s arrival cannot be waited for, and the administration is necessary to prevent danger to health or to eliminate or relieve significant discomfort.” Now it is up to the medical directors of the rescue services to define standardized procedural instructions and to create organizational prerequisites that meet a guarantee of safety aspects and the documentation obligation.

Fundamentally, this is an opportunity for more rapid, adequate pain management and thus significant improvement in patient care. The text of the law contains no statement on the age of patients or whether children – and if so, at what age – should also benefit from this change in the law.

Caution for child emergencies
From the perspective of pediatric medicine, special caution and the involvement of experts with pediatric pharmacological knowledge in the planning of concepts are imperative. Significant aspects in this regard are also addressed in the S2K guideline “Medication Safety in Pediatric Emergencies” [2]. For example, it also refers to children with a highly elevated risk profile, reviews the relevant literature, and provides specific recommendations.

The table from the guideline:

Children at greatly increased risk for respiratory depression from opioids and/or sedatives.

• • Muscle weakness, muscular or neurological in origin
  • Upper airway obstruction, obstructive sleep apnea syndrome
  • Neurodevelopmental delays or limitations.
  • Neurodegenerative diseases
  • Various syndromal diseases
  • Difficult anatomical conditions of the airway
  • Renal function impairment