Managing Death in the Field: Prehospital End-of-life Care.

Abstract Context Historically, the focus of prehospital care has been life-saving treatment. Absent a Non-Hospital Do Not Resuscitate (NHDNR) order, prehospital providers have been compelled to begin and continue resuscitation unless or until it was certain that the situation was futile; they have faced conflict when caregivers objected. Objectives The purpose of the study was to explore prehospital providers’ perspectives on how legally binding documents (NHDNR/Medical Orders for Life Sustaining Treatment [MOLST]) informed end-of-life decision-making and care. Methods This exploratory study employed mixed methods in a sequential non-dominant, two-stage convergent QUAN-QUAL design. Phase I involved the collection of survey data. Phase II involved in-person semi-structured interviews. Results Surveys were completed by 239 participants and 50 follow-up interviews were conducted. Survey data suggested that 73.7% felt confident when there was a DNR order and they did not initiate resuscitation and 58.2% felt confident working through family disagreement when CPR was requested but there was a DNR; 66.1% felt confident explaining the dying process when death was imminent and 55.7% felt comfortable telling a family that a patient was dying. Four themes emerged: (1) Changing Standards of Care; (2) Eliminating False Hope; (3) Transitioning Care from Patient to Family; and (4) Transferring Care after Death. Conclusion Prehospital providers provide support and care when they tell families that someone has died. Being able to comfort and be present with acute grief on scene is an important and evolving role for prehospital providers who manage death in the field.