• Christoph H R Wiese, Friedemann Nauck, Bernhard M Graf, and Gerd-Gunnar Hanekop.
• Klinik für Anästhesiologie, Universitätsklinikum Regensburg. christoph.wiese@klinik.uni-regensburg.de
• Z Evid Fortbild Qual Gesundhwes. 2010 Jan 1;104(2):143-9.

BackgroundIn Germany a few specialised palliative care teams (PCTs) enable paediatric palliative care patients to stay at home in the final stage of their life. During this stage patients often experience episodes of acute symptoms requiring rapid medical intervention. In this case care-giving relatives can call emergency medical care services. The present investigation aims to show the meaning of emergency medical care services in treating paediatric palliative care patients in a home-care setting. Moreover, mental strain of emergency medical staff in paediatric medical emergencies and end-of-life care will be discussed.MethodsIn a multi-centre retrospective study we analyse all paediatric emergency medical care cases of four emergency sites over a 24-month period. In particular, all cases of acute palliative care in terminal paediatric cancer patients up to the age of 14 were evaluated.ResultsIn the defined period we analysed 738 paediatric emergency documents (5.7% of all emergency cases); of these we identified two (0.3%) emergency calls by paediatric palliative care patients or their caregiving relatives. In both cases there was no specialised outpatient PCT involved in the treatment of the patients or the assistance to their caregiving relatives.ConclusionsOur data demonstrate that emergency medical treatment is less frequently provided to paediatric than to adult palliative care patients. However, these paediatric patients also need help that is based on the principles of palliative care like adult patients do. In the context of quality standard optimisation, specialised PCTs should get more involved in paediatric palliative home and pre-hospital care, even in cases of medical emergencies in these patients. After end-of-life decisions relating to paediatric patients, psychological support to the emergency medical team seems to be both helpful and reasonable.

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