Palliative medicine in emergency medical services

Abstract

The scope of emergency calls for emergency medical services staffed by an emergency physician (EMS-EP) includes calls to patients with life-limiting diseases. Symptom exacerbation as well as psychosocial overburdening of caring relatives are the most frequent reasons for activation of an EMS-EP. Pain crises, acute dyspnea, massive bleeding and/or an impending or overt cardiac arrest are the most frequent symptom exacerbations. Under the conditions of aprehospital emergency physician mission, particular challenges are the evaluation of the overall situation, the prognosis and the presumed will of the patient. Is the goal of treatment still rehabilitative or is the patient in apre-terminal, terminal or even final condition? Is the goal of treatment the same for the patient, the relatives and the physician? Is it necessary to make the goal of treatment asubject of discussion? It is not unusual that the task of the EMS-EP is to deliver bad news to the relatives, such as the impending death of the patient or even that death has already occurred. Even though it may no longer be required to save alife, the EMS-EP can significantly influence the bereavement of the relatives. Saving life might not be paramount for the EMS when responding to emergency calls from palliative care patients. Nevertheless, it is an important field of activity for the EMS-EP since the burden of symptoms can be relieved and dying with dignity can be made possible.