• Deborah P Waldrop, Brian Clemency, Eugene Maguin, and Heather Lindstrom.
• 1 University at Buffalo School of Social Work , Buffalo, New York.
• J Palliat Med. 2014 Mar 1;17(3):338-41.

BackgroundPrehospital emergency providers (emergency medical technicians [EMTs] and paramedics) who respond to emergency calls for patients near the end of life (EOL) make critical decisions in the field about initiating care and transport to an emergency department.ObjectiveTo identify how a sample of prehospital providers learned about EOL care, their perceived confidence with and perspectives on improved preparation for such calls.DesignThis descriptive study used a cross-sectional survey design with mixed methods.Setting/ParticipantsOne hundred seventy-eight prehospital providers (76 EMT-basics and 102 paramedics) from an emergency medical services agency participated.MeasurementsMultiple choice and open-ended survey questions addressed how they learned about EOL calls, their confidence with advance directives, and perspectives on improving care in the field.ResultsThe response rate was 86%. Education about do-not-resuscitate (DNR) orders was formal (92%), experiential (77%), and self-directed (38%). Education about medical orders for life-sustaining treatment (MOLST) was formal (72%), experiential (67%), and self-directed (25%). Ninety-three percent were confident in upholding a DNR order, 87% were confident interpreting MOLST, and 87% were confident sorting out conflict between differing patient and family wishes. Qualitative data analysis yielded six themes on improving preparation of prehospital providers for EOL calls: (1) prehospital provider education; (2) public education; (3) educating health care providers on scope of practice; (4) conflict resolution skills; (5) handling emotional families; and (6) clarification of transfer protocols.ConclusionThese study results suggest the need for addressing the potential interrelationship between prehospital and EOL care through improved education and protocols for care in the field.

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