TY - JOUR
T1 - Advising and limiting medical treatment during phone consultation
T2 - a prospective multicentre study in HEMS settings
AU - Kangasniemi, Heidi
AU - Setälä, Piritta
AU - Huhtala, Heini
AU - Olkinuora, Anna
AU - Kämäräinen, Antti
AU - Virkkunen, Ilkka
AU - Tirkkonen, Joonas
AU - Yli-Hankala, Arvi
AU - Jämsen, Esa
AU - Hoppu, Sanna
N1 - Funding Information:
This research was supported by scientific research grants from the FinnHEMS Research and Development Unit, the Competitive Research Funding of the Tampere University Hospital (Grant 9U008) and the Competitive Research Funding of the Helsinki University Hospital (Grant TYH2018317). The funding organisations did not have any role in planning the design of the study, collecting, analysing or interpretating the data or writing the manuscript.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/3
Y1 - 2022/3
N2 - 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.
AB - 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.
KW - Anaesthesiology
KW - Decision-making
KW - DNACPR
KW - Emergency medical services
KW - Ethics
KW - HEMS
KW - Limitation of medical treatment
KW - Nursing home
KW - Prehospital physicians
KW - Treatment limitations
U2 - 10.1186/s13049-022-01002-8
DO - 10.1186/s13049-022-01002-8
M3 - Article
C2 - 35264211
AN - SCOPUS:85126080556
SN - 1757-7241
VL - 30
JO - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
JF - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
M1 - 16
ER -