title: [Save life--allow death. Collation of emergency missions for terminally ill patients].
abstract: BACKGROUND
  Emergency missions can also be necessary for patients in the terminal phase of a progressive incurable disease. The emergency physician, accustomed to acting under strict procedures and whose training focuses on the restoration and stabilization of acutely threatened vital functions, can face severe difficulties when treating incurably ill patients in the terminal phase. This study investigates the number of such cases, patient symptoms and the events occurring during life-threatening emergencies of terminally ill patients.
  
  
  METHODS
  All cases of emergency events involving terminally ill patients were analyzed prospectively. In addition to the standardized protocol (following DIVI/Mind 2) an enquiry sheet was used, which contained an 8-item checklist specifically for terminally ill patients, to be filled out by the responding physician.
  
  
  RESULTS
  The total number of patients in the terminal phase identified by the emergency physician was 55 (0.72% of total cases) and of these patients 30 (55%) were tumor patients. The most frequent complaint observed was dyspnea (30 patients, 55%), followed by relatives of the patients experiencing the stress of caring for a terminally ill person (19 patients, 35%). The leading symptom of 6 patients (11%) was pain. Only 17 cases (30.9%) required transport of the patient to hospital for further treatment.
  
  
  CONCLUSIONS
  Every emergency physician can be confronted with an emergency involving a patient with a progressive incurable disease. The condition of each patient must be assessed for each medical decision. Not only medical, but also psychosocial, ethical and legal aspects have to be considered.
authors.affiliation: Klinik für Anästhesiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131 Mainz, Deutschland. rita.laufenberg@unimedizin-mainz.de
authors.forename: R
authors.initials: R
authors.lastname: Laufenberg-Feldmann
authors.forename: B
authors.initials: B
authors.lastname: Kappis
authors.forename: M
authors.initials: M
authors.lastname: Weber
authors.forename: C
authors.initials: C
authors.lastname: Werner
mesh_terms: D000328:Adult; D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology; D057189:Checklist; D017281:Cost of Illness; D003657:Decision Making; D004632:Emergency Medical Services / Q000941:ethics* / Q000379:methods*; D004992:Ethics, Medical; D005066:Euthanasia, Passive / Q000941:ethics*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010166:Palliative Care / Q000941:ethics* / Q000379:methods*; D011368:Professional-Family Relations; D011446:Prospective Studies; D012151:Resuscitation / Q000941:ethics* / Q000401:mortality; D016019:Survival Analysis; D013727:Terminal Care / Q000941:ethics* / Q000379:methods*; D014187:Transportation of Patients / Q000941:ethics