[Emergency outpatient palliative care in acute situations by paramedics].
BACKGROUND
In recent years outpatient palliative care, even for patients in an advanced state of their disease, has gained importance. Therefore, also paramedics are more often confronted with palliative emergencies, advance directives, and ethical end-of-life issues. Presently in emergency medicine there is undoubtedly a lack of education on palliative medicine and ethical questions for paramedics.


METHODS
In a period of six months we questioned 250 paramedics from two German regions (Göttingen and Braunschweig) about their experiences in palliative medicine, palliative emergencies and about their knowledge of advance directives. For these key questions we drew up a specific questionnaire.


RESULTS
The response rate in the set period of time amounted to 64.8% (n = 162). Most of the interviewed paramedics (91.4%, n = 148) had been confronted with palliative emergency situations on duty. 47.6% felt uncertain about the correct psychosocial care of the patients. 84% of the paramedics were insecure concerning their knowledge about advance directives. 72.8% had already taken care of patients with advance directives. These advance directives had influenced their therapy decision in 42.8%.


CONCLUSIONS
The emergency treatment of palliative patients can present a particular challenge to paramedics. Most of the interviewed paramedics felt insecure both about the social care and the assessment of legal issues in dealing with advance directives and decisions at the end of life. Therefore emergency medical training apparently needs to be improved in these fields. Further information and training are necessary to guarantee adequate patient-oriented care of palliative patients und their relatives also in emergency situations.
Wiese
Christoph H R
CH
Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin der Georg-August-Universität Göttingen, Germany. cwiese@zari.de
Bartels
Utz
U
Ruppert
David
D
Marung
Hartwig
H
Graf
Bernhard M
BM
Hanekop
Gerd G
GG
D016223:Advance Directives / Q000706:statistics & numerical data*; D001317:Austria; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004634:Emergency Medical Technicians / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010166:Palliative Care / Q000706:statistics & numerical data*; D019452:Terminally Ill / Q000706:statistics & numerical data*