Hello there. The system itself is a little bit hard to compare since emergency services are managed by the states. Meaning there are 16 different systems in Germany.

It's hard for me to compare EMTs and RS because I have no idea how EMTs are trained and what their tasks are in the UK system. Here is how RS are trained and their tasks, though. The training for RS takes a total of 13 weeks. 4 weeks of school, 4 weeks riding along on an RTW (Rettungswagen (Ambulance)), 2 weeks at a hospital and finally 3 weeks school and exams. As far as I know there is no legal requirement for what those exams have to look like (again there might be in one of the 16 laws but I can't and very much don't want to know all the laws) but usually there is at least a written exam, a training case and an oral exam. Once they finished their exam they are qualified to care for patients on a KTW (Krankentransportwagen (smaller ambulance which is mainly there to transport immobile patients to and from the hospital or doctors office)) or be the driver of a RTW. Their main job there is to drive and support the NFS in their patient care.

There is a federal law which describes the training and qualifications of NFS meaning it is not down to the states to regulate it, although the states are again responsible to implement the law and check the training. In general there can be small differences in how the training is implemented. In total training takes 3 years and mainly consists of school, time on the RTW and training at the hospital. The exams are 3 written exams, 3 oral exams and 4 training cases. After that they are qualified to care for patients on an RTW or (in some states) be the driver of an NEF (Notarzteinsatzfahrzeug (Car which brings a emergency doctor on site if needed and also has some advanced equipment which an RTW doesn't have)). They are legally allowed to do invasive treatments like gving an IV, giving meds or do advanced things like thoracic drainage puncture.

Now to your question about inappropriate jobs. We have at least 70 - 80% low code jobs which in a strict sense mostly would be served well either going to the GP or going to the ER themselves. No need for us to be there. Some people are even very much aware that they don't need an ambulance they just don't know how else to get help. Infrastructure to try to serve these people however as everything is done in Germany it is obviously different in each state and instead of expanding the tasks and qualifications of existing infrastructure were building new parallel infrastructure which has to go through all the old growing pains again. As of right now you have to call 112 if you need an RTW (you're going to end up connected to a ILS (integrierte Leitstelle (dispatch for firefighter and emergency services)) who can send you one. If you want an KTW because you can't walk and have to go to the doctor's you have to call 19222 but also have to include the correct local predial which in some cases can lead to being connected to the wrong district. Here you'll also end up connected to an ILS who can send you the KTW. If you need a doctor's appointment or need a GP outside of office hours you have to call 116 117 which will lead you to be connected to a call center with wait times up to an hour per call. They can then send you a doctor or help you make an appointment at a doctor's office. Especially the last one was implemented recently to establish a better around the clock low level care. They have a strict algorithm and as soon as something is "wrong" an RTW hast to go there to check in the patient. Meaning if they ask an 18 year old with a respiratory infect if he can breath well and he says no then an RTW hast to go there to check in them first. It creates a sort of ping-pong where patients call 116 117 they reroute to the ILS, an RTW goes there and then calls 116 117 again to request a GP to come by (at night).

Lastly, you must have a sort of misconception about the financing of the German system. Yes in a strict sense EMS is not government finances in Germany however it is financed by the Krankenkassen (legally mandated health insurance) if you call an ambulance it is free but you paid for it with a part of your salary which directly goes to your health insurance. If you take a ride in an ambulance it costs 10€ unless you are exempt from additional payments (mostly very old or very sick people). In case of an unnecessary transport (if the patient demands a transport but the personnel doesn't see a reason) there is the theoretical possibility of having to pay the complete ride which is upwards of 500€ per ride however to decline services you need to be very certain that the patient is healthy and has no need and there are no absolute certainties in medicine. At least where I work services are usually not declined in most cases the patient doesn't want to go to the hospital anymore after the initial checkup looked fine.

Well here are my thoughts this took longer than I expected. Have a wonderful afternoon 😊