This is from the prospective of an American who has spent a few years in Germany and made observations.
In the US, when you got a bad life situation going on in terms of an emergency.....you will call 911 and wait for the local ambulance crew to arrive (usually ten to twenty minutes).
Ervin and Willy will be emergency technicians with a certification or two each. They will do their best to stabilize your problem....resuscitate you if necessary....strap you on a gurney....and at least ensure your bleeding is hindered or stopped. On a list of problems.....there's probably just enough training to ensure your survival and hopefully get you to an emergency room within twenty-five minutes.
You can generally depend on Ervin and Willy....in ninety-percent of cases....to keep you alive, and give you a decent chance with the emergency room staff.
In Germany after you dial 112.....there's two vehicles which will be sent out. In vehicle one is Karl and Huns. They are basically there to lift, carry and transport you from the scene to the nearest hospital. They have some basic first aid certifications and might be either as good as the US team or one step less than the US team.
The second vehicle? This will come from the nearest hospital and be an emergency-qualified doctor. Yep, a full-up doctor who will arrive at the scene and give you a bigger chance of survival. He's usually got a station-wagon and it's loaded with just about every type of gadget required. He might not be able to handle snakebites or a dozen broken bones.....but he can handle 99-percent of what you might encounter.
The doctor has one single job.....to ensure you are stabilized at the scene and give you a slightly better chance of making it. Once he gives the signal.....Karl and Huns will strap you down and off you go. The doctor will tail them in his car and arrive at the emergency room to provide notes and info on what happened at the accident or scene. All of this helps the emergency room a little bit more than you'd think.
A slightly better chance in Germany than the US surviving a bad problem? Maybe.
Cost factor? No one says much about that. Somewhere in the billing process, there has to be some extra thousand Euro to cover the doctor and his equipment on top of the ambulance itself, but you never hear much about the cost factor. If you think about it.....spending an extra thousand to get a doctor on the scene.....most folks would readily spend the money and never question this way of doing business.