Advance directives in the prehospital setting do we need a special emergency advance directive? [Brauchen wir eine spezielle notfall-patientenverfügung? ergebnisse einer pilotbefragung]

摘要

Emergency physicians acting under prehospital conditions might be confronted with advance directives (AD) at the emergency site. According to the specific characteristics of emergency situations, the authors created a new special emergency advance directive. A multi question-survey was used to evaluate emergency physicians' general experience with advance directives in the prehospital setting and to assess their attitudes towards the newly presented special emergency directive called PALMA (Patienten-Anweisungen für lebenserhaltende Ma?nahmen). A questionnaire was mailed to 14 local emergency medical services with about 220 emergency physicians. 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 identifying the directive (41%) as well as legal uncertainty (38%) about the status of these directives. 75% favoured a special emergency advance directive 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 emergency situation. The topic advance directives is of relevance for emergency physicians. Most of the incompatibilities of existing advance directives might be excluded with the new PALMA-directive focussing on the emergency situation and its special characteristics. Further investigation among emergency physicians and patients is in progress.