Withholding and withdrawing life-support in adults in emergency care: joint position paper from the French Intensive Care Society and French Society of Emergency Medicine
Abstract For many patients, notably among elderly nursing home residents, no plans about end-of-life decisions and palliative care are made. Consequently, when these patients experience life-threatening events, decisions to withhold or withdraw life-support raise major challenges for emergency healt...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2019-09-01
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| Series: | Annals of Intensive Care |
| Online Access: | http://link.springer.com/article/10.1186/s13613-019-0579-7 |
| _version_ | 1818506194769149952 |
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| author | Jean Reignier Anne-Laure Feral-Pierssens Thierry Boulain Françoise Carpentier Pierrick Le Borgne Denis Del Nista Gilles Potel Sandrine Dray Delphine Hugenschmitt Alexandra Laurent Agnès Ricard-Hibon Thierry Vanderlinden Tahar Chouihed For the French Society of Emergency Medicine (Société Française de Médecine d’Urgence, SFMU) and French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) |
| author_facet | Jean Reignier Anne-Laure Feral-Pierssens Thierry Boulain Françoise Carpentier Pierrick Le Borgne Denis Del Nista Gilles Potel Sandrine Dray Delphine Hugenschmitt Alexandra Laurent Agnès Ricard-Hibon Thierry Vanderlinden Tahar Chouihed For the French Society of Emergency Medicine (Société Française de Médecine d’Urgence, SFMU) and French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) |
| author_sort | Jean Reignier |
| collection | DOAJ |
| description | Abstract For many patients, notably among elderly nursing home residents, no plans about end-of-life decisions and palliative care are made. Consequently, when these patients experience life-threatening events, decisions to withhold or withdraw life-support raise major challenges for emergency healthcare professionals. Emergency department premises are not designed for providing the psychological and technical components of end-of-life care. The continuous inflow of large numbers of patients leaves little time for detailed assessments, and emergency department staff often lack training in end-of-life issues. For prehospital medical teams (in France, the physician-staffed mobile emergency and intensive care units known as SMURs), implementing treatment withholding and withdrawal decisions that may have been made before the acute event is not the main focus. The challenge lies in circumventing the apparent contradiction between the need to make immediate decisions and the requirement to set up a complex treatment project that may lead to treatment withholding and/or withdrawal. Laws and recommendations are of little assistance for making treatment withholding and withdrawal decisions in the emergency setting. The French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) and French Society of Emergency Medicine (Société Française de Médecine d’Urgence, SFMU) tasked a panel of emergency physicians and intensivists with developing a document to serve both as a position paper on life-support withholding and withdrawal in the emergency setting and as a guide for professionals providing emergency care. The task force based its work on the available legislation and recommendations and on a review of published studies. |
| first_indexed | 2024-12-10T22:01:13Z |
| format | Article |
| id | doaj.art-3d42e968e98f4c4ead4fee200d77a117 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-10T22:01:13Z |
| publishDate | 2019-09-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-3d42e968e98f4c4ead4fee200d77a1172022-12-22T01:31:53ZengSpringerOpenAnnals of Intensive Care2110-58202019-09-01911710.1186/s13613-019-0579-7Withholding and withdrawing life-support in adults in emergency care: joint position paper from the French Intensive Care Society and French Society of Emergency MedicineJean Reignier0Anne-Laure Feral-Pierssens1Thierry Boulain2Françoise Carpentier3Pierrick Le Borgne4Denis Del Nista5Gilles Potel6Sandrine Dray7Delphine Hugenschmitt8Alexandra Laurent9Agnès Ricard-Hibon10Thierry Vanderlinden11Tahar Chouihed12For the French Society of Emergency Medicine (Société Française de Médecine d’Urgence, SFMU) and French Intensive Care Society (Société de Réanimation de Langue Française, SRLF)Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hotel-DieuAssistance Publique Hôpitaux de Paris, Service des Urgences, Hôpital Européen Georges Pompidou ParisService de Réanimation Médicale Polyvalente, Centre Hospitalier Régional OrléansPôle Urgences Médecine Aigüe, Hôpital Universitaire des AlpesService d’Accueil des Urgences, Hôpital de Hautepierre, CHRU StrasbourgService des Urgences, CH de RochefortUniversité de NantesService de Réanimation Médicale, Hôpital Nord, CHU de MarseilleSAMU-SMUR de Lyon, Hospices Civils de LyonLaboratoire Psy-DREPI, Université de Bourgogne Franche-ComtéSAMU-SMUR 95- Service des Urgences, Centre Hospitalier René DubosService de Réanimation Polyvalente, Groupe Hospitalier Institut Catholique de Lille/Faculté Libre de Médecine/Université Lille Nord de FranceSAMU-SMUR-Service d’Urgences, Hôpital Central, CHRU NancyAbstract For many patients, notably among elderly nursing home residents, no plans about end-of-life decisions and palliative care are made. Consequently, when these patients experience life-threatening events, decisions to withhold or withdraw life-support raise major challenges for emergency healthcare professionals. Emergency department premises are not designed for providing the psychological and technical components of end-of-life care. The continuous inflow of large numbers of patients leaves little time for detailed assessments, and emergency department staff often lack training in end-of-life issues. For prehospital medical teams (in France, the physician-staffed mobile emergency and intensive care units known as SMURs), implementing treatment withholding and withdrawal decisions that may have been made before the acute event is not the main focus. The challenge lies in circumventing the apparent contradiction between the need to make immediate decisions and the requirement to set up a complex treatment project that may lead to treatment withholding and/or withdrawal. Laws and recommendations are of little assistance for making treatment withholding and withdrawal decisions in the emergency setting. The French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) and French Society of Emergency Medicine (Société Française de Médecine d’Urgence, SFMU) tasked a panel of emergency physicians and intensivists with developing a document to serve both as a position paper on life-support withholding and withdrawal in the emergency setting and as a guide for professionals providing emergency care. The task force based its work on the available legislation and recommendations and on a review of published studies.http://link.springer.com/article/10.1186/s13613-019-0579-7 |
| spellingShingle | Jean Reignier Anne-Laure Feral-Pierssens Thierry Boulain Françoise Carpentier Pierrick Le Borgne Denis Del Nista Gilles Potel Sandrine Dray Delphine Hugenschmitt Alexandra Laurent Agnès Ricard-Hibon Thierry Vanderlinden Tahar Chouihed For the French Society of Emergency Medicine (Société Française de Médecine d’Urgence, SFMU) and French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) Withholding and withdrawing life-support in adults in emergency care: joint position paper from the French Intensive Care Society and French Society of Emergency Medicine Annals of Intensive Care |
| title | Withholding and withdrawing life-support in adults in emergency care: joint position paper from the French Intensive Care Society and French Society of Emergency Medicine |
| title_full | Withholding and withdrawing life-support in adults in emergency care: joint position paper from the French Intensive Care Society and French Society of Emergency Medicine |
| title_fullStr | Withholding and withdrawing life-support in adults in emergency care: joint position paper from the French Intensive Care Society and French Society of Emergency Medicine |
| title_full_unstemmed | Withholding and withdrawing life-support in adults in emergency care: joint position paper from the French Intensive Care Society and French Society of Emergency Medicine |
| title_short | Withholding and withdrawing life-support in adults in emergency care: joint position paper from the French Intensive Care Society and French Society of Emergency Medicine |
| title_sort | withholding and withdrawing life support in adults in emergency care joint position paper from the french intensive care society and french society of emergency medicine |
| url | http://link.springer.com/article/10.1186/s13613-019-0579-7 |
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