Legally Binding Documents at the End of Life: EMS Providers’ Perspectives

end of life.

When asked, most people express the wish to dieat home rather than being transported to a hospital at the end of life (Bell,Somogyi-Zalud, & Masaki, 2010; Gruneir et al., 2007), yet 77 percent of people over age 65 die in a hospital (National Vital Statistics System, 2012). Emergency 911 calls are often made when the end stage of an advanced illness is accompanied by alarming symptoms and substantial anxiety for family caregivers, particularly when an approaching death is not anticipated. How prehospital providers (Paramedics and Emergency Medical Technicians [EMTs]) manage emergency calls near death influences how and where people will die, if their end-of-life choices are upheld and how appropriately healthcare resources areutilized. Legally binding documents (e.g. Non-hospital Do Not Resuscitate [NHDNR] and Medical Orders for Life Sustaining Treatment [MOLST]) can provideguidance but can also be a source of conflict on end-of-life emergency calls.

The purpose of the study is to explore the decision-making process that occurs when EMS teams are called to the home of someone who is imminently dying from a terminal illness—rather than an acute event such as a cardiac arrest. Specifically, the study objectives are to investigate emergency medical providers’ perspectiveson (1) the frequency with which they encounter medical orders to forego resuscitationin non-acute events, and (2) how medical orders (of Non Hospital Do NotResuscitate [NHDNR] orders and Medical Orders for Life Sustaining Treatment [MOLST]) inform decision-making on end-of-life calls and (3) their opinionsabout NHDNR and MOLST orders in EMS care. The results will provide data that will be used to develop interventions for emergency calls at the end of life.

Principal Investigator: Deborah P. Waldrop
Funding Source: Les Brun Research Endowment Fund Pilot Program
Funding Period: January 1, 2015 - December 31, 2015
Funding Amount: $10,000

For more information on this project, contact Deborah P. Waldrop at or 716-645-1231.