Paramedics' ‘end-of-life’ decision making in palliative emergencies

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.