What Are Ethical Implications of Regionalization of Trauma Care?

Outcomes for severely injured patients are improved when they are treated at trauma centers. However, interfacility transfers can delay time-sensitive treatments not requiring the resources of tertiary institutions. Regionalized trauma systems allow physicians to decrease delays in care, prevent inadequate treatment, and ultimately reduce preventable deaths. Although precise risks and benefits of triage choices are unknowable, estimating them is a process well known to surgeons. Recognizing patient transfers as integral to optimal care delivery systems, rather than as detracting from them, is essential.

Interhospital Transport of Children Undergoing Cardiopulmonary Resuscitation: A Practical and Ethical Dilemma.

OBJECTIVES: To discuss risks and benefits of interhospital transport of children in cardiac arrest undergoing cardiopulmonary resuscitation. DESIGN: Narrative review. RESULTS: Not applicable. CONCLUSIONS: Transporting children in cardiac arrest with ongoing cardiopulmonary resuscitation between hospitals is potentially lifesaving if it enables access to resources such as extracorporeal support, but may risk transport personnel safety. Research is needed to optimize outcomes of patients transported with ongoing cardiopulmonary resuscitation and reduce risks to the staff caring for them.

Ethics surrounding the medical evacuation of catastrophically injured individuals from an operational theatre of war.

Although prolonging life is usually in the best interests of patients, the British Medical Association states that it is not appropriate to prolong life with no regard to its quality. Medical advances both on the battlefield and within the field hospitals have resulted in the unexpected survival of a number of British personnel, and in some cases, soldiers are being repatriated with injuries categorised as 'catastrophic'. This paper considers medical ethics based on the Beauchamp and Childress Four Principles framework with regard to whether catastrophically injured individuals should be repatriated without any prior advanced directive and without evaluation of future quality of life.

Mental health emergency transport: the pot-holed road to care.

Police have, historically, been the first point of contact for people experiencing a mental health crisis in the Australian community. Changes in the NSW Mental Health Act 2007 extended the powers and responsibilities for involuntary transport to paramedics and accredited mental health practitioners. The Mental Health Act also allows for police assistance to other agencies during transport of people living with mental illness if there are serious safety concerns. Involuntary intervention for people living with mental illness is based on risk-of-serious-harm criteria under the Mental Health Act, implying serious deterioration before the Act may be invoked. At the point of risk of serious harm, police involvement may be more frequently required according to the acuity of the situation. If the legal basis of non-consensual treatment under the Mental Health Act was lack of capacity, it would provide a more comprehensive legal and ethical basis for early intervention. Police contact is intensified in rural and remote regions, particularly after hours, where crisis assessments and intervention by health services are further stretched. Further reducing police involvement using strategies that increase access to consensual pathways of care for people living with mental illness, particularly for people in regional and remote areas, is desirable but not likely in the foreseeable future.

Ethical challenges in Emergency Medical Services: controversies and recommendations.

Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Although provider judgment plays a large role in the resolution of conflicts at the scene, it is important to establish protocols and policies, when possible, to address these high-risk and complex situations. This article describes some of the common situations with ethical underpinnings encountered by EMS personnel and managers including denying or delaying transport of patients with non-emergency conditions, use of lights and sirens for patient transport, determination of medical futility in the field, termination of resuscitation, restriction of EMS provider duty hours to prevent fatigue, substance abuse by EMS providers, disaster triage and difficulty in switching from individual care to mass-casualty care, and the challenges of child maltreatment recognition and reporting. A series of ethical questions are proposed, followed by a review of the literature and, when possible, recommendations for management.

[Save life--allow death. Collation of emergency missions for terminally ill patients]. / Leben retten--sterben zulassen. Erfassung notärztlicher Einsätze bei Patienten in der Terminalphase.

BACKGROUND: Emergency missions can also be necessary for patients in the terminal phase of a progressive incurable disease. The emergency physician, accustomed to acting under strict procedures and whose training focuses on the restoration and stabilization of acutely threatened vital functions, can face severe difficulties when treating incurably ill patients in the terminal phase. This study investigates the number of such cases, patient symptoms and the events occurring during life-threatening emergencies of terminally ill patients. METHOD: All cases of emergency events involving terminally ill patients were analyzed prospectively. In addition to the standardized protocol (following DIVI/Mind 2) an enquiry sheet was used, which contained an 8-item checklist specifically for terminally ill patients, to be filled out by the responding physician. RESULTS: The total number of patients in the terminal phase identified by the emergency physician was 55 (0.72% of total cases) and of these patients 30 (55%) were tumor patients. The most frequent complaint observed was dyspnea (30 patients, 55%), followed by relatives of the patients experiencing the stress of caring for a terminally ill person (19 patients, 35%). The leading symptom of 6 patients (11%) was pain. Only 17 cases (30.9%) required transport of the patient to hospital for further treatment. CONCLUSION: Every emergency physician can be confronted with an emergency involving a patient with a progressive incurable disease. The condition of each patient must be assessed for each medical decision. Not only medical, but also psychosocial, ethical and legal aspects have to be considered.