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• POLST CAn Help Paramedics with End-of-Life Dilemmas
  Arthur R. Derse
  Published on: 20 September 2016

• Published on: 20 September 2016

  POLST CAn Help Paramedics with End-of-Life Dilemmas

  • Arthur R. Derse, Director, Center for Bioethics and Medical Humanities
  • Other Contributors:
    • Terri A. Schmidt and Susan W. Tolle

  Murphy-Jones and Timmons described paramedics' experiences of end-of- life decision making with regard to nursing home residents, including the challenges faced by paramedics when patients lacked decision making capacity and the resultant stress from uncertainty about appropriate treatments. [1] Among the solutions suggested, an essential, straightforward and well-tested tool for the perplexed paramedic was not available...

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  Murphy-Jones and Timmons described paramedics' experiences of end-of- life decision making with regard to nursing home residents, including the challenges faced by paramedics when patients lacked decision making capacity and the resultant stress from uncertainty about appropriate treatments. [1] Among the solutions suggested, an essential, straightforward and well-tested tool for the perplexed paramedic was not available to EMTs in London. Emergency medical providers in the United States report that that Physicians Orders for Life-Sustaining Treatment (POLST) Paradigm forms both increase the likelihood that the wishes of patients with advanced illness and frailty will be honored and decrease the family and health professional angst of end-of-life decision-making in moments of crisis. POLST orders have been shown to be effective in providing clear instructions to emergency medical providers and in making sure patient wishes at end-of-life are honored -- whether for comfort care or more intensive treatment. [2] [3] [4] The POLST Paradigm is an approach to end-of-life planning for those with advanced illness through a process of shared decision-making between a patient and his/her health care professional. As a result of these conversations, patient wishes are documented in a POLST form, [5] which translates the shared decisions into actionable medical orders, indicating a patient's wishes regarding treatments that are commonly used in a medical crisis. As a medical order, emergency personnel - such as paramedics, EMTs, and emergency physicians - must follow these orders in the absence of other information. The orders address preferences regarding cardiopulmonary resuscitation (CPR), other medical interventions such as intubation and mechanical ventilation, and artificially administered nutrition. The orders are signed by a physician (and is some jurisdictions a nurse practitioner or physician assistant) with the concurrence of the patient or legally recognized decision maker. The POLST form is distinctive, often brightly colored and can be displayed prominently so that it can be easily identified by the emergency medical personnel. The POLST Paradigm has been successfully implemented in the vast majority of states in the US, and is being adopted in a growing number of countries. We encourage health systems to adopt and emergency medical providers who care for patients at the end-of-life to learn more about the POLST Paradigm and how it can provide medical orders and direction when an emergent situation faces providers, patients and families. [6]

  Arthur R. Derse, MD, JD Terri A. Schmidt, MD Susan W. Tolle, MD

  [1] Murphy-Jones G, Timmons. Paramedics' experiences of end-of-life care decision making with regard to nursing home residents: an exploration of influential issues and factors. ] doi:10.1136/emermed-2015-205405

  [2] Schmidt TA, Zive D, Fromme EK, Cook JNB, Tolle SW. Physician Orders for Life-Sustaining Treatment (POLST): Lessons learned from analysis of the Oregon POLST Registry. Resuscitation. 2014; 85:480-485.

  [3] Richardson DK, Fromme E, Zive D, Fu R, Newgard CD. Concordance of out-of-hospital and emergency department cardiac arrest resuscitation with documented end-of-life choices in Oregon. Ann. Emerg. Med. 2014; 63:375- 383.

  (4) Schmidt TA, Hickman SE, Tolle SW, Brooks HS. The Physician Orders for Life-Sustaining Treatment (POLST) Program: Oregon Emergency Medical Technicians'' Practical Experiences and Attitudes. JAGS. 2004; 52, 1430- 1434.

  [5] Oregon POLST Form http://static1.squarespace.com/static/52dc687be4b032209172e33e/t/56e9951204426272fccd1067/1458148629767/Printing+POLST+instructions+3 -16-2016.pdf Accessed June 17, 2016.

  [6] National POLST Paradigm, http://www.polst.org/ Accessed June 16, 2016.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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