“Saving lives until the physician arrives?”: Conflicts and perceived burden of paramedics when caring for patients with advanced, incurable diseases

Abstract

Background: Rescue scenarios with patients suffering from severe, incurable illnesses are associated with a high level of distress for the emergency medical team. Since in most instances, nonphysician emergency personnel (paramedics) in Germany arrive on scene first and are legally obliged to perform all possible actions to maintain a patients’ life, their level of distress deserves special attention. The aims of this study were to explore perceived conflicts and their impact on paramedics and to discuss an expansion of the legal therapeutic competencies as an option to lessen the burden. Materials and methods: An online questionnaire (mixed methods design) was used to explore conflicts and perceived distress of paramedics. The free-text comments were analysed by using qualitative content analysis (Mayring method). Perceived intensity and frequency of stress were assessed with a descriptive statistical analysis. Results: Paramedics experience stressful and burdensome conflicts with respect to the making and implementation of therapeutic decisions when being first on the scene. These conflicts can be categorised into four different dimensions: (a) patient-related, (b) structural, (c) personal and (d) conflicts concerning interprofessional relationships. Expanding the legal therapeutic competencies for paramedics was viewed critically. Conclusion: The perceived conflicts described by paramedics when having to decide about interventions for patients who are suffering from severe, incurable illnesses require multifaceted solutions, such as educational efforts or the development of regional and structural advance care planning concepts.