The dead and the dying - a difficult part of EMS transport: A Swiss cross-sectional study

Hasler, Rebecca Maria; Stucky, Sandra; Bähler, Heinz; Exadaktylos, Aristomenis; Neff, Frank (2018). The dead and the dying - a difficult part of EMS transport: A Swiss cross-sectional study. PLoS ONE, 13(2), e0191879. Public Library of Science 10.1371/journal.pone.0191879

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Objective Most deaths occur in the pre-hospital setting, whereas mortality in the emergency department (ED) is low (<1%). However, our clinical impression is that some patients are being transported to hospital in devastating conditions with no likelihood of survival, but demanding extensive hospital resources. The decision on whether to transport a dying person to hospital or not is a difficult task for emergency medical services (EMS) personnel. As there is little epidemiological data about these patients, this paper aims to describe this special population. Methods Retrospective cross-sectional study on adult patients transported by ground ambulance to the ED of a Swiss university hospital, who died during their stay in the ED between January 2008 and December 2012. Data was collected on the basis of ambulance report forms and discharge summaries of the ED. Results One hundred and sixty-one patients were analysed. Most deaths were due to cardiovascular diseases (43%). Only 9% of patients died of trauma. The median age was 70 years (IQR 56–81 years) and 70% (n = 112) were men. Trauma patients were significantly younger (median age 55 years, p<0.001). The overall mortality rate was 0.9% for all patients transported by EMS to the ED. About one third of all patients received cardiopulmonary resuscitation (CPR) from bystanders (n = 53). The most common electrocardiogram (ECG) findings were asystole (n = 57) and pulseless electrical activity (n = 91). Fifty percent (n = 64) of the resuscitated patients were defibrillated. Three quarters (n = 115, 72%) of all patients were intubated on site. The mechanical chest compression device Lucas™2 was mainly used in cases of cardiovascular or uncertain cause of death and did not reduce the operating time on site. Conclusion The low ED mortality rate of 0.9% shows that only a few dying patients are transported to hospital. However, transport to hospital has to be carefully evaluated, especially for elderly patients with asystole or PEA due to medical conditions. The low CPR rate from bystanders demonstrates that public CPR training should be promoted further. The use of Lucas™2 did not reduce the operating time on site. For further investigations, comparison with survivors would be needed.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center

UniBE Contributor:

Hasler, Rebecca Maria; Exadaktylos, Aristomenis and Neff, Frank

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1932-6203

Publisher:

Public Library of Science

Language:

English

Submitter:

Romana Saredi

Date Deposited:

06 Feb 2019 09:10

Last Modified:

10 Feb 2019 02:40

Publisher DOI:

10.1371/journal.pone.0191879

PubMed ID:

29485991

BORIS DOI:

10.7892/boris.124987

URI:

https://boris.unibe.ch/id/eprint/124987

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