Ethical Challenges in Emergency Medical Services: Controversies and Recommendations

Abstract

Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Although provider judgment plays a large role in the resolution of conflicts at the scene, it is important to establish protocols and policies, when possible, to address these high-risk and complex situations. This article describes some of the common situations with ethical underpinnings encountered by EMS personnel and managers including denying or delaying transport of patients with non-emergency conditions, use of lights and sirens for patient transport, determination of medical futility in the field, termination of resuscitation, restriction of EMS provider duty hours to prevent fatigue, substance abuse by EMS providers, disaster triage and difficulty in switching from individual care to mass-casualty care, and the challenges of child maltreatment recognition and reporting. A series of ethical questions are proposed, followed by a review of the literature and, when possible, recommendations for management.

Kurzdarstellung

“…Die Entscheidung, eine Wiederbelebung zu beginnen oder abzubrechen, ist außer-halb des Krankenhauses wegen des Mangels an ausreichenden Informationen über den Willen und die Wertvorstellungen eines Patienten, über Komorbiditäten sowie die gesundheitliche Ausgangslage meist bedeutend schwieriger [992,993]. …”

Safety Events in High Risk Prehospital Neonatal Calls

“…[26][27][28] Lights and sirens priority has been shown to have a modest reduction in transport times, which may not be clinically significant. [29][30][31][32] In some cases with low survival, such as infant cardiac arrest, the risks and benefits of lights and sirens should be carefully considered by the EMS agency.…”

Family Centered Practice During Pediatric Death in an Out of Hospital Setting

“…The pressures exerted by family members to keep trying to revive a patient who is likely to already be dead or who is surely dying showed a need for an ethical and caring ability by providers to care for bereaved family members as well as additional training for EMS providers to care for themselves. 18 Thus, there is a need for training and other tools to help EMS providers move along the continuum of PFCC to reach high levels of competence.…”

“…22 Another professional group called for EMS providers to grapple with ethical dilemmas common in their field, in order to sharpen ethical reasoning and enhance ethical practice with patients, including situations involving child abuse. 18 …”