Advising and limiting medical treatment during phone consultation: a prospective multicentre study in HEMS settings

Heidi Kangasniemi, Piritta Setälä, Heini Huhtala, Anna Olkinuora, Antti Kämäräinen, Ilkka Virkkunen, Joonas Tirkkonen, Arvi Yli-Hankala, Esa Jämsen, Sanna Hoppu

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background: We investigated paramedic-initiated consultation calls and advice given via telephone by Helicopter Emergency Medical Service (HEMS) physicians focusing on limitations of medical treatment (LOMT). Methods: A prospective multicentre study was conducted on four physician-staffed HEMS bases in Finland during a 6-month period. Results: Of all 6115 (mean 8.4/base/day) paramedic-initiated consultation calls, 478 (7.8%) consultation calls involving LOMTs were included: 268 (4.4%) cases with a pre-existing LOMT, 165 (2.7%) cases where the HEMS physician issued a new LOMT and 45 (0.7%) cases where the patient already had an LOMT and the physician further issued another LOMT. The most common new limitation was a do-not-attempt cardiopulmonary resuscitation (DNACPR) order (n = 122/210, 58%) and/or ‘not eligible for intensive care’ (n = 96/210, 46%). In 49 (23%) calls involving a new LOMT, termination of an initiated resuscitation attempt was the only newly issued LOMT. The most frequent reasons for issuing an LOMT during consultations were futility of the overall situation (71%), poor baseline functional status (56%), multiple/severe comorbidities (56%) and old age (49%). In the majority of cases (65%) in which the HEMS physician issued a new LOMT for a patient without any pre-existing LOMT, the physician felt that the patient should have already had an LOMT. The patient was in a health care facility or a nursing home in half (49%) of the calls that involved issuing a new LOMT. Access to medical records was reported in 29% of the calls in which a new LOMT was issued by an HEMS physician. Conclusion: Consultation calls with HEMS physicians involving patients with LOMT decisions were common. HEMS physicians considered end-of-life questions on the phone and issued a new LOMT in 3.4% of consultations calls. These decisions mainly concerned termination of resuscitation, DNACPR, intubation and initiation of intensive care.

Original languageEnglish
Article number16
Number of pages11
JournalScandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Volume30
DOIs
Publication statusPublished - Mar 2022
Publication typeA1 Journal article-refereed

Keywords

  • Anaesthesiology
  • Decision-making
  • DNACPR
  • Emergency medical services
  • Ethics
  • HEMS
  • Limitation of medical treatment
  • Nursing home
  • Prehospital physicians
  • Treatment limitations

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

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