Prehospital emergency physicians are confronted with emergencies in palliative care patients every day. In the treatment of these emergencies there are potentially serious conflicts due to the different therapeutic concepts of palliative medical care and emergency medical services. This study demonstrates that there is a need for regulated criteria for the therapy of palliative patients and patients at the end of life in emergency situations. Overall, more clinical investigations concerning end-of-life care and unresponsive palliative care patients in emergency medical situations are necessary.

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Journalists have the power to enhance the visibility of certain aspects of campaign issues and, thus, are relevant mediators between political actors and citizens. To serve the public interest, news media coverage should include the views of different political camps and should enable citizens to build opinions in an enlightened way. The authors analyze journalists' framing of the coverage of a 2008 campaign on the naturalization of immigrants. Content analysis was conducted of all campaign coverage by TV stations and major newspaper outlets over a period of 14 weeks. To identify dominant frames, the authors coded all campaign arguments made in news media coverage (N = 3,570). The results show that media coverage focused on three substantive frames-rule of law, mass naturalization, and people's final say. The findings reveal that coverage was not balanced but was clearly in favor of the rule of law frame. This framing bias applies to different types of media, including public service TV and elite newspapers. Furthermore, the authors found a striking bias toward institutional actors, who were covered much more often than civil society actors. AbstractJournalists have the power to enhance the visibility of certain aspects of campaign issues and, thus, are relevant mediators between political actors and citizens. To serve the public interest, news media coverage should include the views of different political camps and should enable citizens to build opinions in an enlightened way. The authors analyze journalists' framing of the coverage of a 2008 campaign on the naturalization of immigrants. Content analysis was conducted of all campaign coverage by TV stations and major newspaper outlets over a period of 14 weeks. To identify dominant frames, the authors coded all campaign arguments made in news media coverage (N = 3,570). The results show that media coverage focused on three substantive frames-rule of law, mass naturalization, and people's final say. The findings reveal that coverage was not balanced but was clearly in favor of the rule of law frame. This framing bias applies to different types of media, including public service TV and elite newspapers. Furthermore, the authors found a striking bias toward institutional actors, who were covered much more often than civil society actors.

Patientenverfügungen (PV) werden auch in der präklinischen Notfallmedizin angetroffen. Ausge− hend von den besonderen Erfordernissen eines Notfalleinsatzes wurde eine neue, speziell für den präklinischen Notfall vorgesehene Patienten− verfügung entworfen. In einer Pilotbefragung von Notärzten sollten die allgemeinen Erfahrungen mit Verfügungen in Notfallsituationen analysiert sowie die neue Notfall−Patientenverfügung (¹PALMA" ± Patienten−Anweisungen für lebens− erhaltende Maßnahmen) aus der Sicht der Not− ärzte bewertet werden. Im Rahmen einer be− grenzten Stichprobenanalyse wurde an 14 Not− arztstandorten mit insgesamt 220 Notärzten eine postalische Befragung durchgeführt. 60 Be− fragungsbögen (Rücklaufquote 27 %) konnten ausgewertet werden. Als wesentliche Hindernis− se für die Berücksichtigung von Verfügungen in einer Notfallsituation wurden neben Mängeln der bestehenden Formulare die schlechte Auf− findbarkeit (41 %) sowie die Unsicherheit hin− sichtlich der Rechtslage (38 %) genannt. 75 % der Befragten befürworteten eine spezielle Notfall− PV, 70 % eine verbindliche Beratung beim Abfas− sen. Das neue ¹PALMA"−Formular wurde von 93 % der Befragten positiv bewertet. Die Thematik ¹Patientenverfügung" ist auch für Notärzte aktu− ell. Die Mehrheit der Teilnehmer dieser Befra− gung mit begrenztem Stichprobenumfang hielt das neue Formular für grundsätzlich geeignet, die Berücksichtigung einer PV beim Notfallein− satz zu verbessern. Die genannten Schwierigkei− ten bei der Umsetzung einer PV unter Notfallbe− dingungen sollten durch das vorgestellte ¹PAL− MA"−Formular größtenteils ausgeräumt werden. Eine umfassende Befragung von Notärzten zu diesem Vordruck sowie eine Patientenbefragung werden derzeit durchgeführt.Abstract ! Emergency physicians acting under prehospital conditions might be confronted with advance directives (AD) at the emergency site. According to the specific characteristics of emergency situa− tions, the authors created a new special emer− gency advance directive. A multi question−survey was used to evaluate emergency physicians' gen− eral experience with advance directives in the prehospital setting and to assess their attitudes towards the newly presented special emergency directive called ¹PALMA" (Patienten−Anweisun− gen für lebenserhaltende Maßnahmen). A questi− onnaire was mailed to 14 local emergency medi− cal services with about 220 emergency physici− ans. 60 emergency physicians (27 %) filled in the questionnaire completely. Main problems with regard to handling of advance directives in the field were lack of content, problems with identi− fying the directive (41 %) as well as legal uncer− tainty (38 %) about the status of these directives. 75 % favoured a special emergency advance di− rective and 70 % supported patient's obligation for consultation when writing a directive. 93 % thought the newly presented emergency advance directive to be helpful in a prehospital emergen− cy situation. The topic ¹advance directives" is of relevance for emergency physicians. Most of the incompatibilities of ...

The high number of returned questionnaires shows the importance of the topic "advance directives" for emergency physicians. Despite some practical and legal problems, a big majority of the experienced emergency physicians in this survey thought the advance directives in the prehospital setting to be helpful. A clear statement on resuscitation as well as simplification of the many existing types of directives are the most essential requirements demanded by the emergency physicians. A solution could be the creation of an extra "emergency advance directive".