title: Palliative care and prehospital emergency medicine: analysis of a case series.
abstract: Palliative care, which is intended to keep patients at home as long as possible, is increasingly proposed for patients who live at home, with their family, or in retirement homes. Although their condition is expected to have a lethal evolution, the patients-or more often their families or entourages-are sometimes confronted with sudden situations of respiratory distress, convulsions, hemorrhage, coma, anxiety, or pain. Prehospital emergency services are therefore often confronted with palliative care situations, situations in which medical teams are not skilled and therefore frequently feel awkward.We conducted a retrospective study about cases of palliative care situations that were managed by prehospital emergency physicians (EPs) over a period of 8 months in 2012, in the urban region of Lausanne in the State of Vaud, Switzerland.The prehospital EPs managed 1586 prehospital emergencies during the study period. We report 4 situations of respiratory distress or neurological disorders in advanced cancer patients, highlighting end-of-life and palliative care situations that may be encountered by prehospital emergency services.The similarity of the cases, the reasons leading to the involvement of prehospital EPs, and the ethical dilemma illustrated by these situations are discussed. These situations highlight the need for more formal education in palliative care for EPs and prehospital emergency teams, and the need to fully communicate the planning and implementation of palliative care with patients and patients' family members.
authors.affiliation: From the Emergency Service (P-NC, FDa, OH); Palliative Care Unit, Lausanne University Hospital, Lausanne (FDi); and Institute of Biomedical Ethics, University of Geneva, Geneva, Switzerland (SH).
authors.forename: Pierre-Nicolas
authors.initials: PN
authors.lastname: Carron
authors.forename: Fabrice
authors.initials: F
authors.lastname: Dami
authors.forename: Fatoumata
authors.initials: F
authors.lastname: Diawara
authors.forename: Samia
authors.initials: S
authors.lastname: Hurst
authors.forename: Olivier
authors.initials: O
authors.lastname: Hugli
mesh_terms: D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000379:methods*; D004635:Emergency Medicine / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies; D013557:Switzerland; D014505:Urban Population