title: [Emergency medical treatment of palliative care patients at the end of life: regulatory emergency medical care framework--a case control investigation of medical intervention and advance directives].
abstract: BACKGROUND
  The treatment of out-of-hospital palliative emergency care situations during cardiac arrest is a special situation. The prehospital emergency physician (EP) and the paramedic must be informed about the medical, legal, and ethical specifics of these situations, but this knowledge is not integrated within emergency medical curricula at all. We present a case study to discuss such legal and ethical specifics.
  
  
  METHODS
  We retrospectively analysed six emergency cases with palliative care patients in the final stages of their illnesses. On the basis of these case studies, we present six different emergency cases with different regulatory frameworks for each EP and paramedic. In accordance with the Declaration of Helsinki, data were collected pseudonymously.
  
  
  RESULTS
  The six case studies show therapeutic concepts concerning the emergency medical care of palliative care patients during cardiac arrest. The differences are apparent in the treatment given by EPs and by paramedics (such as whether to start or stop resuscitation). EPs and paramedics differ in their therapeutic approach to these specific situations (e.g. paramedics more often start resuscitation during cardiac arrest even though patients would refuse this according to their advance directives). These differences may be important for the patient and his or her caregivers.
  
  
  CONCLUSIONS
  Every EP and paramedic may be involved in the care of palliative care patients who are at the end of their lives. EPs and paramedics do not always adapt their treatment to the will or supposed will of the patient (especially in accordance with the new German law concerning advance directives). The reasons for this usually concern legal uncertainties. Therefore, EPs and paramedics should know that different legal meanings could be important in emergency medical care therapy of palliative care patients. A written "do not resuscitate" order as an advance directive must be evaluated as a desired therapeutic limitation.
authors.affiliation: Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland. christoph.wiese@klinik.uni-regensburg.de
authors.forename: C H R
authors.initials: CH
authors.lastname: Wiese
authors.forename: G
authors.initials: G
authors.lastname: Duttge
authors.forename: A K
authors.initials: AK
authors.lastname: Weber
authors.forename: Y A
authors.initials: YA
authors.lastname: Zausig
authors.forename: D
authors.initials: D
authors.lastname: Ruppert
authors.forename: G G
authors.initials: GG
authors.lastname: Hanekop
authors.forename: B M
authors.initials: BM
authors.lastname: Graf
mesh_terms: D000488:Allied Health Personnel; D001919:Bradycardia / Q000628:therapy; D016887:Cardiopulmonary Resuscitation; D016022:Case-Control Studies; D003657:Decision Making; D004417:Dyspnea / Q000628:therapy; D004632:Emergency Medical Services / Q000331:legislation & jurisprudence; D005858:Germany; D006323:Heart Arrest; D006801:Humans; D007883:Legislation, Medical; D010166:Palliative Care / Q000331:legislation & jurisprudence; D010820:Physicians; D016414:Resuscitation Orders; D012189:Retrospective Studies