Betreuung von Palliativpatienten in Akutsituationen durch Rettungsassistenten

Wiese, C.H.R.; Bartels, U.; Ruppert, D; Marung, H.; Graf, Bernhard M.; Hanekop, G. G.

doi:10.1007/s00508-008-1018-1

Cited by 17 publications

(8 citation statements)

References 28 publications

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“…The characteristics of emergency medical care callouts in our study and confirmed in other investigations suggest that palliative medical therapeutic approaches (for instance, good control of symptoms preceding unconditional prolongation of the dying process) are also important for EPs and paramedics [8, 14, 17]. Every EP and paramedic may be confronted with such acute situations in an out-of-hospital palliative home-care setting.…”

Section: Discussionsupporting

confidence: 81%

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Quality of out-of-hospital palliative emergency care depends on the expertise of the emergency medical team—a prospective multi-centre analysis

Wiese

Bartels

Marczynska

et al. 2009

Support Care Cancer

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BackgroundThe number of palliative care patients who live at home and have non-curable life-threatening diseases is increasing. This is largely a result of modern palliative care techniques (e.g. specialised out-of-hospital palliative medical care services), changes in healthcare policy and the availability of home care services. Accordingly, pre-hospital emergency physicians today are more likely to be involved in out-of-hospital emergency treatment of palliative care patients with advanced disease.MethodsIn a prospective multi-centre study, we analysed all palliative emergency care calls during a 24-month period across four emergency services in Germany. Participating pre-hospital emergency physicians were rated according to their expertise in emergency and palliative care as follows—group 1: pre-hospital emergency physicians with high experience in emergency and palliative medical care, group 2: pre-hospital emergency physicians with high experience in emergency medical care but less experience in palliative medical care and group 3: pre-hospital emergency physicians with low experience in palliative and emergency medical care.ResultsDuring the period of interest, the centres received 361 emergency calls requiring a response to palliative care patients (2.8% of all 12,996 emergency calls). Ten percent of all patients were treated by group 1; 42% were treated by group 2 and 47% were treated by group 3. There was a statistically significant difference in the treatment of palliative care patients (e.g. transfer to hospital, symptom control, end-of-life decision) as a result of the level of expertise of the investigated pre-hospital emergency physicians (p< 0.01).ConclusionsIn Germany, out-of-hospital emergency medical treatment of palliative care patients depends on the expertise in palliative medical care of the pre-hospital emergency physicians who respond to the call. In our investigation, best out-of-hospital palliative medical care was given by pre-hospital emergency physicians who had significant expertise in palliative and emergency medical care. Our results suggest that it may be necessary to take the core principles of palliative care into consideration when conducting out-of-hospital emergency medical treatment of palliative care patients.

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Section: Discussionsupporting

confidence: 81%

“…This frequently leads to emergency services being called by patients or by their care-giving relatives [4–8, 14]. The incidence of palliative medical care motivated emergency medical requests was 2.8% of all callouts in the present investigation.…”

Section: Discussionmentioning

confidence: 74%

Quality of out-of-hospital palliative emergency care depends on the expertise of the emergency medical team—a prospective multi-centre analysis

Wiese

Bartels

Marczynska

et al. 2009

Support Care Cancer

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“…Understanding the phenomenon of EMS responses to patients enrolled in hospice programs could support patient-and family-centered end-of-life care, improve the working interface between EMS systems and hospice programs, and optimize utilization of EMS resources. Numerous studies using individual interviews, focus groups, and surveys have explored the recollections and perceptions of hospice staff, 12 family members, 13 and EMS providers [14][15][16][17][18][19][20][21][22][23] of the role of EMS and hospitalization in palliative care. (It should be noted that terms like "palliative care" are sometimes used loosely in the literature, and it may not be limited to patients formally enrolled in a hospice program.)…”

Section: Introductionmentioning

confidence: 99%

EMS responses to hospice patients: a qualitative study

Kukol

Ryan

2022

Preprint

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In the palliative care community, multiple emergency department visits and hospitalizations are considered an indicator of poor-quality end of life care. There is substantial research on the events surrounding ED visits, and subsequent hospitalizatons, by hospice patients. It is important however to understand that these hospital arrivals often begin with an ambulance response to the home. Emergency medical services (EMS) responses to hospice patients have been less well-studied. We conducted a retrospective study of 170 consecutive electronic patient care reports produced contemporaneously by EMS providers in several US counties during the normal course of their responses to hospice patients. We summarized descriptive epidemiology of the patients and of the incidents, and we explored the provider narratives for recurring themes. To our knowledge this is the first study to explore the contemporaneously-documented on-scene circumstances of pre-hospital care for patients enrolled in a hospice program. The median patient age was 76. Cancer, chronic lung disease, and heart failure were the most common hospice-qualifying diagnoses. Transportation of the patient from the scene occurred in 111 cases (65.3\%). Consistent with previous studies based on interviews of EMS providers, the most common chief complaints included pain, dyspnea, and altered mental status. EMS was frequently called for confirmation of death, a finding not previously reported. Transitions of care, such as from curative medical care to hospice care, and from hospital to home, were a recurring theme. Gaps in care around these transitions were often evident, with EMS being called upon to fill them. Care transitions around weekends were prominent. Also emerging from the narratives was the concept that hospice enrollment is not a single event but rather a step-wise process; we developed a preliminary coding taxonomy to classify those enrollment stages. The hospice-EMS interface can be complex. Although all care by EMS providers is with the literal or implied consent of the patient, the arrival of an ambulance to a scene where emotions are running high carries a certain momentum and could lead to a cascade of interventions that, in retrospect and given other options, the patient may not have wanted. A better understanding of the hospice-EMS interface might illuminate changes that could be made to improve it, with a goal of ensuring that hospice patients and their families receive emergency medical services when they need and can benefit from them but receive other, non-EMS, services when those are more suitable to their needs. It might also improve the efficiency of an already overburdened EMS system.

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“…Nicht jeder aktive Notarzt hat in seiner Ausbildung und durch seine Fachdisziplin Erfahrung mit der Versorgung von Palliativpatienten erwerben können. Die Situation, bei einem unbekannten Patienten von den üblichen lebensrettenden Maßnahmen abzusehen, ist eine Herausforderung sowohl in juristischer als auch in medizinischer Hinsichtfür das gesamte Team [2,3]…”

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Der Notarzt beim Palliativpatienten: Evaluation eines neuen Kurskonzepts

Marung

Harding

Callies

et al. 2013

Notarzt

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Zusammenfassung Notfalleins?tze bei Patienten mit weit fortgeschrittenen Leiden haben in den letzten Jahren zugenommen. Ziel der Untersuchung war es, die entsprechenden Einsatzindikationen aus Sicht deutscher Not?rzte zu evaluieren. Teilnehmer eines Pilotseminars erhielten zu Beginn und am Ende der Veranstaltung einen Erhebungsbogen, der demografische Daten, Vorkenntnisse, Einstellungen und den Seminarerfolg abfragte. Der R?cklauf betrug 96,4?% (n?=?27). Der Nutzen des Kurses f?r die Zusatzbezeichnung Notfallmedizin wurde bezogen auf diese Patientengruppe im Mittel mit ??3,1 (Skala ??5 bis +?5) eingesch?tzt. Die Frage, ob der Einsatz bei Palliativpatienten eine Kernaufgabe sei, wurde zu Beginn mit +?0,7 und am Schluss mit +?2,7 bewertet. Das untersuchte Kollektiv bewertete im Verlauf seine kritische Einsch?tzung rettungsdienstlicher Einbindung teilweise neu. Der Notarztkurs scheint gegenw?rtig nicht geeignet, um Wissen zur Bew?ltigung dieser Notfallsituationen zu erwerben.

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Betreuung von Palliativpatienten in Akutsituationen durch Rettungsassistenten

Cited by 17 publications

References 28 publications

Quality of out-of-hospital palliative emergency care depends on the expertise of the emergency medical team—a prospective multi-centre analysis

Quality of out-of-hospital palliative emergency care depends on the expertise of the emergency medical team—a prospective multi-centre analysis

EMS responses to hospice patients: a qualitative study

Der Notarzt beim Palliativpatienten: Evaluation eines neuen Kurskonzepts

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