ArticleScandinavian journal of trauma, resuscitation and emergency medicine2017
Termination of prehospital resuscitative efforts: a study of documentation on ethical considerations at the scene.
Article in Scandinavian journal of trauma, resuscitation and emergency medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 3 of them syntheses that pooled it.
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Who cites it
14 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Non-medical factors in prehospital resuscitation decision-making: a mixed-methods systematic review.Scandinavian journal of trauma, resuscitation and emergency medicine · 2022Pooled it
- Cardiopulmonary resuscitation (CPR) during spaceflight - a guideline for CPR in microgravity from the German Society of Aerospace Medicine (DGLRM) and the European Society of Aerospace Medicine Space Medicine Group (ESAM-SMG).Scandinavian journal of trauma, resuscitation and emergency medicine · 2020Guideline
- Clinical reasoning in the emergency medical services: an integrative review.Scandinavian journal of trauma, resuscitation and emergency medicine · 2019Pooled it
- Special care services delivery at disaster scenes: a systematic review.International journal of emergency medicine · 2025Review
- Moral sensitivity and professional quality of life in EMS personnel: a cross-sectional multicenter study.BMC emergency medicine · 2025Article
- Preventing burnout from moral distress among prehospital emergency personnel through action research and targeted clinical ethics support.Scientific reports · 2024Article
- The Use of Prehospital Intensive Care Units in Emergencies-A Scoping Review.Healthcare (Basel, Switzerland) · 2023Article
- Pediatric out-of-hospital cardiac arrest in Denmark.Scandinavian journal of trauma, resuscitation and emergency medicine · 2022Article
- Advising and limiting medical treatment during phone consultation: a prospective multicentre study in HEMS settings.Scandinavian journal of trauma, resuscitation and emergency medicine · 2022Article
- Documentation of ethically relevant information in out-of-hospital resuscitation is rare: a Danish nationwide observational study of 16,495 out-of-hospital cardiac arrests.BMC medical ethics · 2021Observational
- External validation of multimodal termination of resuscitation rules for out-of-hospital cardiac arrest patients in the COVID-19 era.Scandinavian journal of trauma, resuscitation and emergency medicine · 2021Observational
- Provision of ECPR during COVID-19: evidence, equity, and ethical dilemmas.Critical care (London, England) · 2020Article
- Does the "Morning Morality Effect" Apply to Prehospital Anaesthesiologists? An Investigation into Diurnal Changes in Ethical Behaviour.Healthcare (Basel, Switzerland) · 2020Article
- Quantitative pupillometry and neuron-specific enolase independently predict return of spontaneous circulation following cardiogenic out-of-hospital cardiac arrest: a prospective pilot study.Scientific reports · 2018Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDiscussions on ethical aspects of life-and-death decisions within the hospital are often made in plenary. The prehospital physician, however, may be faced with ethical dilemmas in life-and-death decisions when time-critical decisions to initiate or refrain from resuscitative efforts need to be taken without the possibility to discuss matters with colleagues. Little is known whether these considerations regarding ethical issues in crucial life-and-death decisions are documented prehospitally. This is a review of the ethical considerations documented in the prehospital medical records of patients in a Danish prehospital setting for whom the decision to resuscitate or not was made at the scene.
methodsThe study is based on discharge summaries of all patients subjected to crucial life-and-death decisions by the Mobile Emergency Care Unit in Odense in the years 2010 to 2014. The medical records with possible documentation of ethical issues were independently reviewed by two philosophers in order to identify explicit ethical or philosophical considerations pertaining to the decision to resuscitate or not.
resultsIn total, 1275 patients were either declared dead at the scene without exhibiting layman's reliable signs of death or admitted to hospital following resuscitation. In a total of 62 patients, 85 specific ethical issues related to resuscitation were documented. The expressions of the ethical considerations were generally vague or unclear and almost exclusively concerned the interests of the patient and not the relatives. In the vast majority of cases where an ethical content was identified, the ethical considerations led to a decision to terminate treatment.
conclusionsA strengthened practice of documenting ethical considerations in prehospital life-and-death decision-making in the patient's medical records is required. We suggest that a template be implemented in the prehospital medical records describing the basis for any ethical decisions. This template should contain information regarding the persons involved in the deliberations and notes on ethical considerations. The documentation should include considerations concerning the patient's end-of-life wishes, the estimations of the quality of life before and after the incident, and a summary of other ethical concerns taken into account, such as the integrity of the patient and frame of mind of relatives.
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