Needs of Patients in the Triage Category “Expectant” in Prehospital Disaster Settings: A Survey Among German Medical Incident Commanders and Palliative Care Physicians

Abstract

Introduction:

The treatment of patients in the triage category “expectant” is not in the focus of the prehospital disaster medicine. The aim is to save as many lives as possible in situations with very limited resources. It is necessary to allocate the life-saving interventions to those who have the chance to survive, but there is a human right of best assistance even for those who are expected to die.

Aim:

In Germany, it is possible to use the triage category “expectant” in overwhelming disasters, so there should be preparedness for those patients, who receive this categorization. A survey was conducted to find out what the needs are of those patients.

Methods:

An online-survey was submitted to German medical incident commanders and palliative care physician in function of expert groups via their national associations.

Results:

219 physicians participated. The majority confirmed a necessity to treat those patients and to be prepared. Currently, in most of the areas, there is no preparation. The main needs are the treatment of pain, dyspnoea, fear, and loneliness. Following the “Dying person’s bill of rights” (1), the most relevant rights are:

• To be treated as living human being until I die

• To be free from pain

• To express the feelings and emotions

• To die in peace and dignity

Discussion:

Palliative care should be part of disaster medicine planning. It is not too difficult to prepare a special group of helper for the care of dying patients. Medical incident commanders and palliative care physicians agree in the majority about the necessity, so SOPs can be implemented to teach non-medics. The medics will be needed for the first aim of disaster medicine.