Anaesthesiology has given essential impulses to emergency medicine during the last decades. Therefore emergency medicine has become the "third column" of this speciality. As a "generalist with special skills" the anaesthetist fulfils the requirements of an emergency physician to a high degree. The scientific field of emergency medicine is subjected to a considerable amount of changes and requires qualified training and further education; in this context the guidelines for cardiopulmonary resuscitation are of outstanding importance. In the governmental-controlled emergency care system, the emergency physician and the chief emergency physician are responsible for both the individual treatment of patients and the management of major incidents and catastrophes. Moreover, the interhospital transfer is gaining increasing importance. Even though a high quality standard of the German emergency medicine system can be stated, there are still clear deficits such as the lack of integrated dispatch centers and the lack of the position of a medical physician as emergency care leader in each area. A leading structure for the management of major incidents and disasters is established to a great extent, nevertheless personal and material deficits exist in this field especially considering a rising terroristic threat. In the in-hospital emergency medicine anaesthetists are of essential importance for the interdisciplinary teamwork in the resuscitation room, medical treatment of in-hospital emergencies on the wards and outside on the hospital ground, and for internal as well as external major incidents and disasters. This is not always recognized in public opinion, so that the interdisciplinary integration must be secured and reinforced.
In conclusion: A major goal is to preserve emergency medicine as the third column of anaesthesiology and to protect achieved standards, to reinforce research in preclinical and clinical emergency medicine, and to take up new challenges in the future.