Purpose: The autonomous practice of medicine in emergencies is an essential part of the professional profile of emergency paramedics. To date, there is no consensual specific catalogue of activities for autonomous actions according to § 2a NotSanG, which can be used as a guideline for training and further education as well as for the practice of emergency paramedics.Methods: In an informal group process, a modular competence matrix was created along the legal requirements for the autonomous practice of medicine by paramedics, and common medical measures and pharmaceuticals were assigned to the categories of the matrix. This was subsequently consented by the emergency medical services providers and the Medical Directors of Emergency Medical Services Bavaria.Results: The competence matrix for the autonomous practice of medicine distinguishes three categories: the standard competence is expected of every paramedic after professional training and comprises 23 medicines and 18 curative measures. Through professional experience and defined additional educational measures, an extended level of competence can be achieved (up to 10 medicines and 2 measures). The scope of application of § 2a NotSanG does not include 20 listed medicines and all other possible invasive measures.Conclusion: The present consented concept defines for the state of Bavaria the specific contents of emergency paramedic training according to § 4 (2) 1c NotSanG as well as the scope of the paramedics’ guarantor position, and offers a professional development opportunity. A concretization of the requirements for the extended level of competence is planned for the future.