 The level is not well defined (varies from state to state or organization to organization), but mostly includes the 160 hours theoretical course and 80 hours of the EMS internship, but no state exam.Depending on the state in which they work, those in the "Rettungshelfer" role are usually the drivers of non-emergency patient transports, with a "Rettungssanitäter" acting as crew chief for the vehicle.In most German states, for emergency ambulance service, those in the "Rettungssanitäter" role are often the drivers of emergency ambulances and act as an assistant to the "Rettungsassistent" and "Notfallsanitäter".