The Judicial Legitimacy of an Analgesic-Based Sedation in EMS Without Supervision of a Physician Part 2: Analgesic-Based Sedation by Morphine in Case of an Acute Coronary Syndrome

摘要

An analgesic-based sedation by morphine administrated by paramedics after an acute coronary syndrome can be legally allowed as far as those are particular trained, i. e. are able to control efficacy and adverse reactions as well as possible complications and judge if compared to the analgesic-based sedation with morphine less risky alternative measures come into question, and act in each individual case in accordance to a precise, also telephonic instruction of an emergency physician. In either case the administration of morphine necessarily must be offered before the arrival of the emergency physician in the interests of the patient. The authorising emergency physician always has to be called in disguise to the place of action to control the accuracy of indication and administration. The judicial responsibility remains at the emergency physician who underlies in this case elevated needs of diligence. The conditions set by the BtMW have to be obeyed principally. The analgesic-based sedation by morphine on the basis of an autonomic decision by paramedics is illegal. In this case they may commit a criminal offence according to ?9 Abs.l Nr.6b) of German Anaesthetic Act, even though an acceptance of the patient is available. From a judicial point of view it has to be recommended not to make the administration of morphine by paramedics in case of an acute coronary syndrome to be a Standard Operating Procedure, but to treat it only as an exception that needs a special medical justification in every single case.