On July 27, 2023, several amendments to the BtMG entered into force [1]. The following (abbreviated) statement is decisive: “Narcotics may be administered by emergency paramedics without a prior doctor’s order if they act in accordance with standardized medical instructions, the arrival of a doctor cannot be awaited and the administration is necessary to avert danger to health or to eliminate or alleviate significant discomfort.” It is now up to the medical directors of the emergency services to define standardized procedural instructions and to create organizational conditions that guarantee safety aspects and the documentation obligation. In principle, this is an opportunity for faster, adequate pain therapy and thus a significant improvement in patient care. The legal text 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 in pediatric emergencies From the point of view of pediatric medicine, particular caution and the involvement of experts with pediatric pharmacological knowledge are imperative when planning concepts. 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