Open Access Open Badges Research article

International recommendations for outpatient palliative care and prehospital palliative emergencies – a prospective questionnaire-based investigation

Christoph HR Wiese1*, Christoph L Lassen1, Utz E Bartels2, Mahmoud Taghavi1, Saleem Elhabash1, Bernhard M Graf1 and Gerd G Hanekop3

Author Affiliations

1 Department of Anaesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg 93053, Germany

2 Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Ulm, Ulm, Germany

3 Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medical Centre Goettingen, Goettingen, Germany

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BMC Palliative Care 2013, 12:10  doi:10.1186/1472-684X-12-10

Published: 21 February 2013



To determine the international recommendations and current practices for the treatment and prevention of palliative emergencies. The primary goal of the study was to gather information from experts on their nationally practised concepts.


One hundred and fifty self-report surveys were distributed by email to selected leading experts (palliative and emergency medical care) in Europe, North and South America, Africa, Asia, and Australia. An expert in this context was defined as an author of an article that was ranked by three reviewers as relevant to outpatient palliative and emergency medical .


The total response rate was 61% (n = 92 experts). Survey responses were obtained from 35 different countries. The following standards in the treatment of palliative emergencies were recommended: (1) early integration of “Palliative Care Teams” (PCTs) and basic outpatient palliative care systems, (2) end-of-life discussions, (3) defined emergency medical documents, drug boxes, and “Do not attempt resuscitation” orders and (4) emergency medical training (physicians and paramedics).


This study detected structurally and nationally differences in outpatient palliative care regarding the treatment of palliative emergencies. Accordingly, these differences should be discussed and adapted to the respective specifications of individual single countries. A single established outpatient palliative emergency medical care concept may be the basis for an overall out-of-hospital palliative care system.

Specialised palliative care services (SPCS); Emergency medical care; Palliative care; Palliative emergency; End-of-life care