When should the emergency rescue service not be called?

Before a recommendation not to call the emergency rescue service can be given, a vast variety of situations have to be considered which form the typical background of emergency calls. Clearly abuse just for fun is a major problem which may and should have legal consequences. It is however much more difficult to consider the situation from the viewpoint of the patient or an eyewitness especially if the caller is a relative of the ill person and is also a lay person. For a lay caller it is nearly impossible to decide whether this involves a real emergency or not. Generally emergency calls arise from the subjective feeling of urgency and lack of other acceptable solutions. Social environment plays an additional role: the lower the social status the higher the frequency of not clearly indicated emergency calls and the emergency medical service often plays a last anchor role for people in the lowest social status in society. Even if it seems to be impossible to formulate a general rule there are clear possibilities to avoid unnecessary emergency calls. Nursing homes for example are a source of a large number of unnecessary calls due to insufficient provisions for typical medical problems or problems which can be expected for a given patient. Missing orders for these situations often lead to emergency alarm calls which could have been avoided. Do not attempt resuscitation (DNAR) orders often do not exist because the private physician taking care of the patient at the end of life is afraid of discussing this question with the patient and/or the relatives. An open discussion of the conflict of objectives resulting from rights of autonomy of the patient, the relatives, caregivers, emergency medical services and the cost payer is necessary to clarify the fact that all resources are limited and therefore need restrictions also in making emergency calls.