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Limiting treatment in pre‐hospital care: A prospective, observational multicentre study
Author(s) -
Kangasniemi Heidi,
Setälä Piritta,
Olkinuora Anna,
Huhtala Heini,
Tirkkonen Joonas,
Kämäräinen Antti,
Virkkunen Ilkka,
YliHankala Arvi,
Jämsen Esa,
Hoppu Sanna
Publication year - 2020
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13649
Subject(s) - medicine , observational study , liquid crystal on silicon , medical emergency , emergency medicine , emergency medical services , cardiopulmonary resuscitation , resuscitation , physics , liquid crystal , optics
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 pre‐hospital care. Methods A prospective, nationwide, multicentre study including all Finnish physician‐staffed HEMS bases during a 6‐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 = 5895). 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.