Paliative care and end-of-life patients in emergency situations : Recommendations on optimization of out-patient care.
Summary of "Paliative care and end-of-life patients in emergency situations : Recommendations on optimization of out-patient care."
BACKGROUND:
At the end of life acute exacerbations of medical symptoms (e.g. dyspnea) in palliative care patients often result in emergency medical services being alerted. The goals of this study were to discuss cooperation between emergency medical and palliative care structures to optimize the quality of care in emergencies involving palliative care patients.
METHODS:
For data collection an open discussion of the main topics by experts in palliative and emergency medical care was employed. Main outcome measures and recommendations included responses regarding current practices related to expert opinions and international literature sources.
RESULTS:
As the essential points of consensus the following recommendations for optimization of care were named: (1) integration of palliative care in the emergency medicine curricula for pre-hospital emergency physicians and paramedics, (2) development of outpatient palliative care, (3) integration of palliative care teams into emergency medical structures, (4) cooperation between palliative and emergency medical care, (5) integration of crisis intervention into outpatient palliative emergency medical care, (6) provision of emergency plans and emergency medical boxes, (7) provision of palliative crisis cards and do not attempt resuscitation (DNAR) orders, (8) psychosocial aspects concerning palliative emergencies and (9) definition of palliative patients and their special situation by the physician responsible for prior treatment.
CONCLUSIONS:
Prehospital emergency physicians are confronted with emergencies in palliative care patients every day. In the treatment of these emergencies there are potentially serious conflicts due to the different therapeutic concepts of palliative medical care and emergency medical services. This study demonstrates that there is a need for regulated criteria for the therapy of palliative patients and patients at the end of life in emergency situations. Overall, more clinical investigations concerning end-of-life care and unresponsive palliative care patients in emergency medical situations are necessary.
Affiliation
Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland, christoph.wiese@klinik.uni-regensburg.de.
Journal Details
This article was published in the following journal.
Name: Der Anaesthesist
ISSN: 1432-055X
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21184035
- DOI: http://dx.doi.org/10.1007/s00101-010-1831-6
Medical and Biotech [MESH] Definitions
Emergency Medical Technicians
Paramedical personnel trained to provide basic emergency care and life support under the supervision of physicians and/or nurses. These services may be carried out at the site of the emergency, in the ambulance, or in a health care institution.
Emergency Medical Services
Services specifically designed, staffed, and equipped for the emergency care of patients.
Emergency Nursing
The specialty or practice of nursing in the care of patients admitted to the emergency department.
Life Support Care
Care provided patients requiring extraordinary therapeutic measures in order to sustain and prolong life.
Ambulances
A vehicle equipped for transporting patients in need of emergency care.
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