Advance directives in the prehospital setting - Emergency physicians' attitudes

Objective: The German physician based emergency medical system (EMS) might confront physicians with advance directives in the field. A multi-question survey was used to evaluate emergency physicians' experience with advance directives in the prehospital setting and to assess their attitudes towards forms and statements of advance directives. Methods: A questionnaire was mailed to the members of the Association of Emergency Physicians of Northern Germany (,,AGNN"), an interest group of emergency physicians, in 2001. Results: 511 emergency physicians (50,4% of the AGNN members) filled in the questionnaire completely and sent it back for evaluation. 75% of the participants were working as emergency physicians at present, 72% had emergency experiences of more than 5 years. One third had previously dealt with advance directives in the prehospital setting. 77% of these physicians thought advance directives generally helpful. Nevertheless 88% based their management on the context of the individual circumstances (e. g. emergency conditions, underlying diseases, expected prognosis), only 7% said they would always exactly follow the statements of the directive. In the view of the emergency physicians the advance directive should contain information on cardiopulmonary resuscitation (CPR: 88%), intensive care-treatment (75%) and preclinical emergency treatment (55%). Information on underlying diseases (87%) and a legal substitute (84%) should be contained as well. As formal requirements, 47% of the physicians wanted the family doctor to be involved, 49% desired a notary authenticity confirmation, additionally or solely. Pragmatically, the advance directive should be kept with the personal documents (84%). A regular reconfirmation was deemed necessary (twice to once a year: 64%). The current legal situation was regarded as unclear by 81% of the emergency physicians, 85% favored a unique, officially authorised type of directive. Conclusion: The high number of returned questionnaires shows the importance of the topic,advance directives" for emergency physicians. Despite some practical and legal problems, a big majority of the experienced emergency physicians in this survey thought the advance directives in the prehospital setting to be helpful. A clear statement on resuscitation as well as simplification of the many existing types of directives are the most essential requirements demanded by the emergency physicians. A solution could be the creation of an extra,emergency advance directive".