Preclinical patient transport at the end of life

Abstract

Although most people would like to die at home, many die in hospitals. The study shows physicians' and paramedics' experiences with prehospital care of patients at the end of life. Using an anonymous online questionnaire, primary care physicians and ambulance personnel in the Frankfurt am Main metropolitan area were surveyed about their experiences with end of life care. A total of 63primary care physicians (PCP) and 62emergency medical service staff (EMS) answered the questionnaire (female 31.2%, male 68.8%). Of the respondents 65.8% reported that patients are often still transported to hospital at the end of life. Of the participants 17.9% felt confident in their assessment of apatient at the end of life, 33.3% of PCP and 8.5% of EMS felt confident about subsequent treatment and 91.9% of PCP and 96.2% of EMS reported that they always/often ask about an advance healthcare directive. Of the participants 98.3% felt that EMS rarely/never ask about advance care planning, 78.7% of all participants would rarely/never ask about it and 90.4% of EMS would like to have alegally secure emergency document to guide their actions. Transporting patients at the end of life is part of everyday prehospital practice. There are uncertainties in the assessment and care of these patients. In the future, rescue service and medical training should include specific palliative care strategies. Advance healthcare directive and advance care planning must be more widely recognized by the medical community, so that in emergency situations the desired corridors of action in the best interests of the patient are quickly made known.