Zusammenfassung
In den letzten Jahren hat eine Wandlung in den Einsatzindikationen für Notärzte stattgefunden. Die ursprüngliche Idee des organisierten Rettungswesens in Deutschland, primär Verkehrsunfallpatienten zu versorgen, lässt sich schon lange nicht mehr bestätigen. Vielmehr werden durch den Rettungsdienst Patienten mit internistischen bzw. neurologischen Krankheiten betreut. Die demografische Veränderung der Bevölkerungsstruktur bedingt zusätzlich die vermehrte Versorgung älterer und z. T. multimorbider Patienten. Weiterhin gewinnt die häusliche Betreuung von Patienten mit inkurablen Erkrankungen bis zum Lebensende eine erhöhte Bedeutung, da u. a. seitens des Gesetzgebers seit dem Jahr 2007 ein Anspruch auf eine entsprechende palliativmedizinische Unterstützung gegeben ist (gemäß §§ 37b und 132d SGB [Sozialgesetzbuch] V). Somit werden auch Notärzte stärker mit Palliativpatienten, Patienten am Lebensende konfrontiert (aktuell ca. 3 % aller Notarzteinsätze in Deutschland). Im Folgenden sollen daher diese sog. „palliativen Notfälle“ (Def.: Notfallsituationen, bei Patienten mit inkurablen Erkrankungen im palliativen Krankheitsstadium), deren mögliche Besonderheiten sowie notfallmedizinische therapeutische Entscheidungsfindungen dargestellt, erläutert und diskutiert werden.
Abstract
The scope of different emergency situations for prehospital emergency physicians has changed over the last years. The original intention of the German emergency medicine system was to treat patients injured in traffic accidents. This has switched to a care of patients with mostly medical and / or neurological problems. The demographic change in the population has led to an increased number of elderly and multimorbidly patients. Additionally the home-care of patients with incurable diseases is gaining in importance. Since 2007 patients can demand a palliative-care support at home by German law. These patients are likely to get in contact with prehospital emergency physicians during their illness (3 % of all prehospital emergency physician patient contacts are with palliative patients). In this article the so-called „palliative emergencies“ (defined as emergency situations in patients with an incurable disease in a palliative stage) with their special features along with emergency treatment will be explained and discussed.
Schlüsselwörter
palliativer Notfall - palliative Notfallmedizin - Symptomkontrolle - Palliativnotfallbogen - Entscheidungen am Lebensende
Keywords
palliative emergency - palliative emergency medicine - symptom control - palliative crisis card - end-of-life decision
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Priv.-Doz. Dr. med. Christoph H. R. Wiese
Klinik für Anästhesiologie, Universitätsklinikum Regensburg
Franz-Josef-Strauß-Allee 11
93053 Regensburg
Email: christoph.wiese@klinik.uni-regensburg.de
