Managing Death in the Field: Prehospital End-of-Life Care

Area of Science:

• Emergency Medicine
• Palliative Care
• Medical Ethics

Background:

• Prehospital care traditionally prioritizes life-saving interventions.
• Providers often faced ethical dilemmas without clear end-of-life directives, leading to conflicts with families.

Purpose of the Study:

• To investigate prehospital providers' views on how nonhospital do-not-resuscitate (DNR) orders and medical orders for life-sustaining treatment influence end-of-life care decisions.
• To understand the impact of these legal documents on managing patient death in the field.

Main Methods:

• An exploratory mixed-methods study using a sequential, nondominant two-stage convergent design.
• Phase I: Quantitative survey data collection from 239 prehospital providers.
• Phase II: Qualitative in-depth, semistructured interviews with 50 participants.

Main Results:

• A significant majority (73.7%) reported increased confidence when a DNR order allowed them to forgo resuscitation.
• Many felt better equipped to handle family disagreements (58.2%) and discuss dying (66.1%) with a DNR in place.
• Key themes included evolving standards of care, managing patient and family expectations, and post-death care transitions.

Conclusions:

• Nonhospital DNR orders enhance prehospital provider confidence in managing end-of-life care.
• Providers play a crucial role in supporting grieving families, an evolving aspect of prehospital services.
• Improved clarity on patient wishes facilitates smoother transitions of care and respects patient autonomy.