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Anästhesiol Intensivmed Notfallmed Schmerzther 2025; 60(06): 329-344
DOI: 10.1055/a-2351-8020
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Palliativmedizinische Patienten – was sollten Notärzte wissen?

Palliative Patients and Prehospital Emergency Medicine – Which Aspects Should the Prehospital Emergency Physician Know?
Christoph H. R. Wiese
,
Vera Peuckmann-Post
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Notfallmedizinische Einsätze sind häufig durch lebensbedrohliche Situationen verursacht. Ein Notfall tritt stets plötzlich und unerwartet auf und erfordert ein umgehendes Handeln des notfallmedizinischen Teams. Palliativmedizinische Notfälle treten oft ebenfalls unerwartet auf, können jedoch durch vorausschauende Planung, Respektieren des Patientenwillens und Nutzen spezialisierter ambulanter Strukturen angemessen adressiert oder sogar vermieden werden.

Abstract

Emergency medical care indications have changed in Germany in recent years. Emergency interventions in elder people and nursing homes, which used to be an exceptional indication, have now become a standard intervention and one of the main tasks of emergency medical care in Germany. Emergency care for the elderly and people with life-threatening illnesses has increasingly become the focus of modern emergency medicine. Emergency care is increasingly confronted with patients in the palliative stage of illness, with special treatment needs and with end-of-life decisions. The rapidity of these changes in emergency care has not yet been adequately addressed through appropriate training and the expansion of emergency medical and legal knowledge. In palliative care, too, developments and their implementation in practice need to be optimized. Since 2007, for example, there has been a legal entitlement to specialized outpatient palliative care for patients and their families, but is not yet sufficiently available and applicable on a broad basis (according to §§ 37b and 132d of the German Social Code, Book V). For this reason, decisions that needed to be made in anticipation of palliative care continue to be shifted to preclinical emergency care and subsequently to hospitals. The aim of this article is to explain the special features of “palliative emergencies” and to give recommendations for emergency physicians in order to provide excellent therapeutic care for people with life-limiting illnesses.

Kernaussagen

  • Während der Notfalleinsatz im Alten- und Pflegeheim in der Vergangenheit für den Rettungsdienst eine Ausnahmeindikation darstellte, ist er mittlerweile zu einem Standardeinsatz und zu einer Hauptaufgabe für die Notfallversorgung in Deutschland geworden.

  • Die notfallmedizinische Versorgung älterer Menschen sowie von solchen mit lebenslimitierenden Grunderkrankungen ist verstärkt in den Fokus der modernen Notfallmedizin gerückt.

  • Das notfallmedizinische Personal wird vermehrt mit Patienten im palliativen Erkrankungsstadium, mit besonderen Therapiebedürfnissen und Entscheidungen am Lebensende konfrontiert.

  • Die Geschwindigkeit dieser Änderungen in der Notfallversorgung ist sowohl für Notärzte als auch für Notfallsanitäter bisher durch geeignete Schulungsmaßnahmen und Erweiterung der notfallmedizinischen, aber auch rechtlichen Kenntnisse nicht ausreichend berücksichtigt worden.

  • Auch in der Palliativmedizin sind die Entwicklung und die Umsetzung in der vorausschauenden Planung und Therapie akuter Notfallsituationen zu optimieren.

  • Seit 2007 besteht ein gesetzlicher Anspruch auf eine spezialisierte ambulante palliativmedizinische Unterstützung betroffener Menschen und deren Angehöriger, doch ist diese noch nicht ausreichend flächendeckend vorhanden und nutzbar (gemäß §§ 37b und 132d SGB V).

  • Aus diesem Grund werden Entscheidungen, die palliativmedizinisch antizipierend getroffen werden müssten, weiterhin in die präklinische Notfallversorgung und nachfolgend in die Kliniken verlagert.

  • Dieser Beitrag soll die Besonderheiten „palliativer Notfallsituationen“ erläutern und Handlungsempfehlungen für Notärzte geben, um eine exzellente therapeutische Versorgung auch bei Menschen mit lebenslimitierenden Erkrankungen zu ermöglichen.

Schlüsselwörter

Entscheidungen am Lebensende - Palliativpatient - Notfallversorgung

Keywords

end-of-life decision - palliative care - emergency medical care


Publication History

Article published online:
13 June 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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