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- Title
Paramedics' 'end-of-life' decision making in palliative emergencies.
- Authors
Wiese, Christoph H. R.; Taghavi, Mahmoud; Meyer, Nicole; Lassen, Christoph; Graf, Bernhard
- 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.
- Subjects
GERMANY; ANALYSIS of variance; CHI-squared test; DECISION making; DO-not-resuscitate orders; EMERGENCY medical services; EMERGENCY medical technicians; EMERGENCY medicine; EMPLOYEES; EXPERIENCE; LEGAL liability; PALLIATIVE treatment; PATIENTS; PROBABILITY theory; QUESTIONNAIRES; RESUSCITATION; SCALE analysis (Psychology); SCALES (Weighing instruments); STATISTICS; SURVEYS; T-test (Statistics); TERMINALLY ill; DECISION making in clinical medicine; PROFESSIONAL practice; DATA analysis; JOB performance; DATA analysis software; DESCRIPTIVE statistics
- Publication
Journal of Paramedic Practice, 2012, Vol 4, Issue 7, p413
- ISSN
1759-1376
- Publication type
Article
- DOI
10.12968/jpar.2012.4.7.413