Purpose of the study: Advice given to paramedics by Helicopter Emergency Medical Service (HEMS) anaesthesiologists was investigated, focusing on limitation of medical treatment (LOMT). Our hypothesis was that telephone consultations resulting in LOMTs are frequently related to patients located in health care facilities (HCFs) and nursing homes (NHs).
Materials and methods: A prospective study conducted on four physician-staffed HEMS bases in Finland 6.9.2017–6.3.2018.
Results: Of 6,115 (mean 8.4/day) paramedic initiated calls, 833 (14%) were from HCF/NH. Among all consultations, 452 (7.4%) calls included 191 (3.1%) new or 301 (4.9%) existing LOMT. A new LOMT was more often made during a call if the patient was located in a HCF/NH n=100/833 (12%) rather than elsewhere n=91/5,282 (1.7%) (p<0.001).
The most common limitations were a do-not-attempt-resuscitation (DNAR)-order (n=114, 60%) and/or “not eligible for intensive care (NEIC)” (n=89, 47%). Both “DNAR” (n=69/100, 69% vs. n=45/91, 50%, p=0.006) and NEIC (n=55/100, 55% vs. n=34/91, 37%, p=0.015) were more common new LOMT for patients in HCF/NH. Withdrawing from an initiated resuscitation attempt was a new LOMT in 46 (24%) of all new LOMT consultations. The most frequently recorded reasons for LOMT were; futility of the overall situation (72%), poor baseline functional status (59%), multiple/severe comorbidities (58%) and old age (49%).
In 68% of the calls where an LOMT was made on a patient without any existing LOMT the anaesthesiologist estimated that some LOMT should have already existed. This occurred more often with patients in HCF/NH compared to other locations (n=59/67, 88% vs. n=43/84, 51%, p<0.001).
Conclusions: Prehospital anaesthesiologists frequently made LOMTs on the phone and more often in consultations concerning patients in HCF/NHs. They often had to make LOMTs for patients who probably should have had some LOMT.