Heidi Kangasniemi1,2,3, Piritta Setälä2, Anna Olkinuora1, Heini Huhtala4, Joonas Tirkkonen5,6, Antti Kämäräinen2,7, Ilkka Virkkunen1,2, Arvi Yli-Hankala3,8, Esa Jämsen3,9, Sanna Hoppu2. 1. Research and Development Unit, FinnHEMS Ltd, WTC Helsinki Airport, Lentäjäntie 3, 01530, Vantaa, Finland. 2. Emergency Medical Services, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland. 3. Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland. 4. Faculty of Social Sciences, Tampere University, P.O. Box 100, FI-33014, Tampere, Finland. 5. Department of Intensive Care Medicine and Department of Emergency, Anaesthesia and Pain Medicine, Tampere University Hospital, Tampere, Finland. 6. Intensive Care Unit, Liverpool Hospital, Sydney, Australia, PO Box 2000, FI-33521, Tampere, Finland. 7. Department of Emergency Medicine, Department of Anaesthesia, Hyvinkää District Hospital, Hyvinkää, Finland. 8. Department of Anaesthesia, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland. 9. Centre of Geriatrics, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland.
Abstract
BACKGROUND: Data are scarce on the withdrawal of life-sustaining therapies and limitation of care orders (LCOs) during physician-staffed Helicopter Emergency Medical Service (HEMS) missions. We investigated LCOs and the quality of information available when physicians made treatment decisions in prehospital care. METHODS: A prospective, nationwide, multicentre study including all Finnish physician-staffed HEMS bases during a six-month study period. All HEMS missions where a patient had pre-existing LCOs and/or a new LCO were included. RESULTS: There were 335 missions with LCOs, which represented 5.7% of all HEMS missions (n=5,895). There were 181 missions with pre-existing LCOs, and a total of 170 new LCOs were issued. Usually, the pre-existing LCO was a do not attempt cardiopulmonary resuscitation order only (n=133, 74%). The most frequent new LCO was 'termination of cardiopulmonary resuscitation' only (n=61, 36%), while 'no intensive care' combined with some other LCO was almost as common (n=54, 32%). When issuing a new LCO for patients who did not have any preceding LCOs (n=153), in every other (49%) case the physicians thought that the patient should have already had an LCO. When the physician made treatment decisions, patients' background information from on-scene paramedics was available in 260 (78%) of the LCO missions, while patients' medical records were available in 67 (20%) of the missions. CONCLUSION: Making LCOs or treating patients with pre-existing LCOs is an integral part of HEMS physicians' work, with every twentieth mission involving LCO patients. The new LCOs mostly concerned withholding or withdrawal of cardiopulmonary resuscitation and intensive care. This article is protected by copyright. All rights reserved.
BACKGROUND: Data are scarce on the withdrawal of life-sustaining therapies and limitation of care orders (LCOs) during physician-staffed Helicopter Emergency Medical Service (HEMS) missions. We investigated LCOs and the quality of information available when physicians made treatment decisions in prehospital care. METHODS: A prospective, nationwide, multicentre study including all Finnish physician-staffed HEMS bases during a six-month study period. All HEMS missions where a patient had pre-existing LCOs and/or a new LCO were included. RESULTS: There were 335 missions with LCOs, which represented 5.7% of all HEMS missions (n=5,895). There were 181 missions with pre-existing LCOs, and a total of 170 new LCOs were issued. Usually, the pre-existing LCO was a do not attempt cardiopulmonary resuscitation order only (n=133, 74%). The most frequent new LCO was 'termination of cardiopulmonary resuscitation' only (n=61, 36%), while 'no intensive care' combined with some other LCO was almost as common (n=54, 32%). When issuing a new LCO for patients who did not have any preceding LCOs (n=153), in every other (49%) case the physicians thought that the patient should have already had an LCO. When the physician made treatment decisions, patients' background information from on-scene paramedics was available in 260 (78%) of the LCO missions, while patients' medical records were available in 67 (20%) of the missions. CONCLUSION: Making LCOs or treating patients with pre-existing LCOs is an integral part of HEMS physicians' work, with every twentieth mission involving LCO patients. The new LCOs mostly concerned withholding or withdrawal of cardiopulmonary resuscitation and intensive care. This article is protected by copyright. All rights reserved.