Ethische Kompetenz im Rettungsdienst

Lindner, Katharina; Ummenhofer, Wolfgang; Reiter-Theil, Stella

doi:10.1007/s10049-007-0896-5

Cited by 8 publications

(4 citation statements)

References 10 publications

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“…Es erscheint trotzdem wün-schenswert, wenn sich Rettungsdienstpersonal (sowohl Rettungsassistenten als auch Notärzte) bei palliativmedizinisch motivierten Einsätzen von den Grundgedanken der Palliativmedizin und der medizinischen Ethik leiten lassen. Gerade letzteres ist aber nicht immer der Fall [16]. Positive Aspekte ethischer Überlegungen ergeben sich aus der Auseinandersetzung mit ethischen Fragen im Notfallteam nach entsprechenden Einsätzen.…”

Section: Patientenverfügung Und Vorsorgevollmachtunclassified

Betreuung von Palliativpatienten in Akutsituationen durch Rettungsassistenten

Wiese

Bartels

Ruppert

et al. 2008

Wien Klin Wochenschr

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The emergency treatment of palliative patients can present a particular challenge to paramedics. Most of the interviewed paramedics felt insecure both about the social care and the assessment of legal issues in dealing with advance directives and decisions at the end of life. Therefore emergency medical training apparently needs to be improved in these fields. Further information and training are necessary to guarantee adequate patient-oriented care of palliative patients und their relatives also in emergency situations.

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Section: Patientenverfügung Und Vorsorgevollmachtunclassified

Betreuung von Palliativpatienten in Akutsituationen durch Rettungsassistenten

Wiese

Bartels

Ruppert

et al. 2008

Wien Klin Wochenschr

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“…Neither the training curricula for emergency physicians in the individual German states [22] nor the training and examination regulations for German paramedics [23] offer for the acquisition of skills in the care of advanced incurably ill patients, although both professional groups are regularly confronted with such rescue operations. Thus, as in this survey and elsewhere, further education in legal and medical-ethical aspects was considered both desirable [17,19,24,25] and necessary, especially for the lawful handling of advance directives and ethically and legally re ected decision making in emergencies.…”

Section: Comparison Of Criteria-driven Decisions Of Emergency Physici...mentioning

confidence: 87%

The minutes until the emergency physician arrives at the scene – Do paramedics face an ethical dilemma when caring for advanced incurably ill and cardiac arrest patients? – a prospective questionnaire - based study

Mühe,

Nauck,

Alt-Epping

2023

Preprint

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Backgound: In Germany, prehospital emergency medicine implies a “rendezvous” system where paramedics and an emergency physician arrive at the scene separately. If paramedics arrive first, they are obliged to perform all possible actions in order to save the patient´s life. But due to a legally contradictory situation, this may lead to moral distress and an ethical dilemma, so far hardly considered scientifically, when comfort care might be more appropriate than aggressive life-saving measures for patients with an advanced incurable disease and cardiac arrest. Methods: A mixed method approach was used to explore the experiences and attitudes of German paramedics by using a newly designed, piloted questionnaire which is based on the limited existing literature and exploratory expert interviews. Results: 295 paramedics participated and 283 questionnaires could be included for analysis. Nearly 80% of the paramedics experienced moral distress when performing cardiopulmonary resuscitation (CPR) or providing medical care to patients with an advanced incurable disease. In approximately one-third of such first-at-scene situations, the respondents decided to refrain from CPR on their own responsibility or not to intervene with extended medical measures. In these first-at-scene situation most of the participating respondents also felt that they were acting outside their prescribed legal competence. The respondents listed the patient´s (actual or presumed) will, previous involvement of palliative home care, estimated overall prognosis, a suggested dying process, and the relatives´ perception and wishes as criteria for refraining from emergency measures. 71.4% of the respondents claimed to have sufficient expertise for making a CPR decision on their own responsibility, 64.0% supported a concept that extends the legal responsibility of paramedics in case of CPR. 50.9% of paramedics felt sufficiently competent in independently administering care to advanced incurably patients, 57.6% of respondents advocated a transfer of (legal) competence. Conclusion: Despite legal uncertainties, aggressive measures were foregone in one third of first-at-scene situations, based on criteria-driven decisions. Extending legal competencies to paramedics while at the same time optimizing training and providing further conceptual and structural support (such as palliative home care, crisis intervention teams and implementation of advance care planning) could help solve these dilemmas.

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“…Somit soll der alsbaldige Todeseintritt durch eine plötzliche vitale Bedrohung des Menschen möglichst ef fektiv verhindert werden. Dies entspricht den in der heutigen Zeit immer größer werdenden Ansprüchen der Gesellschaft auf ein Recht, schnellstmögliche medizi nische Hilfe unabhängig von der Ursache der das Leben bedrohenden Situation zu erhalten [17,18,22,24,25,28,29]. Durch diese Erwartungshaltungen und den da durch entstehenden Druck auf den Not fallmediziner kann das Berücksichtigen spezieller ethischer und juristischer Be sonderheiten während der notfallmedizi nischen Therapie beeinträchtigt werden.…”

Section: Juristische Beurteilung Notfallmedizi Nischer Handlungsweiseunclassified

Notfallmedizinische Betreuung von Palliativpatienten am Lebensende

et al. 2009

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Every EP and paramedic may be involved in the care of palliative care patients who are at the end of their lives. EPs and paramedics do not always adapt their treatment to the will or supposed will of the patient (especially in accordance with the new German law concerning advance directives). The reasons for this usually concern legal uncertainties. Therefore, EPs and paramedics should know that different legal meanings could be important in emergency medical care therapy of palliative care patients. A written "do not resuscitate" order as an advance directive must be evaluated as a desired therapeutic limitation.

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Ethische Kompetenz im Rettungsdienst

Cited by 8 publications

References 10 publications

Betreuung von Palliativpatienten in Akutsituationen durch Rettungsassistenten

Betreuung von Palliativpatienten in Akutsituationen durch Rettungsassistenten

The minutes until the emergency physician arrives at the scene – Do paramedics face an ethical dilemma when caring for advanced incurably ill and cardiac arrest patients? – a prospective questionnaire - based study

Notfallmedizinische Betreuung von Palliativpatienten am Lebensende

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