References
Paramedics' ‘end-of-life’ decision making in palliative emergencies
Abstract
Background:
Paramedics in Germany routinely treat palliative care patients at the end-of-life (EoL). For this, they play a legally significant role in EoL decision making in the outpatient emergency setting. This study was undertaken to determine paramedics’ understanding of their role in withholding or withdrawing resuscitation/EoL-treatment of palliative care patients when an advance directive is present.
Methods:
Using a self-administered survey, participants/paramedics were asked about (1) ‘their occupational experience’ (less/more than 10 years, (2) ‘emergency responses’ (less/more than 100/month), (3) ‘their experiences in palliative emergencies’ (less/more than 10 palliative emergencies/year), (4) ‘palliative emergency sheets concerning end-of-life decisions’, and (5) ‘their treatment options during resuscitation’. Participants were paramedics from two cities in Germany.
Results:
Overall, 728 questionnaires were returned (response rate: 81%). Seventy-three percent of respondents were older than 20 years, 98.5% were male. Most paramedics dealt with palliative emergencies and terminally ill patients during their work (71%). Work experience and training in palliative care shows statistically significant differences concerning our dependent variables.
Conclusions:
Our results underline the necessity for more training in EoL. Paramedics stated that improved guidelines regarding EoL decisions/advance directives and the possibility to withdrawing resuscitation for appropriative cases are necessary. The treatment of terminally ill patients by paramedics may present an ethical problem: if paramedics honour patients' wishes, they will violate juridical regulations. In future, a change concerning current regulations seems to be necessary as well.
Emergency Medical Services (EMS) are often frequented to treat outpatient palliative care patients at the end-of-life (EoL). Therefore, paramedics must have knowledge in legal aspects, communication with palliative care patients and their care, and the special aspect of withholding or withdrawing outpatient resuscitation in terminally ill patients (Stone, 2009).
Overall, palliative care patients and patients at the EoL define a major mission for EMS and paramedics (Mengual, 2007). About 3–5% of all pre-hospital emergencies deal with palliative care (Wiese, 2007; 2010). Especially cardio-pulmonary-resuscitation in unresponsiveness palliative care patients offers only a short term success and often limits patients’ self-defined quality of life (Eló, 2005). Mostly, resuscitation is performed reflexly but there is a need to prevent cardio-pulmonary resuscitation in the terminally ill patient (Iserson, 1991).
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