We investigated paramedic-initiated consultation calls and advice given via telephone by Helicopter Emergency Medical Service (HEMS) physicians focusing on limitations of medical treatment (LOMT). A prospective multicentre study was conducted on four physician-staffed HEMS bases in Finland during a 6-month period. Of all 6115 (mean 8.4/base/day) paramedic-initiated consultation calls, 478 (7.8%) consultation calls involving LOMTs were included: 268 (4.4%) cases with a pre-existing LOMT, 165 (2.7%) cases where the HEMS physician issued a new LOMT and 45 (0.7%) cases where the patient already had an LOMT and the physician further issued another LOMT. The most common new limitation was a do-not-attempt cardiopulmonary resuscitation (DNACPR) order (n = 122/210, 58%) and/or ‘not eligible for intensive care’ (n = 96/210, 46%). In 49 (23%) calls involving a new LOMT, termination of an initiated resuscitation attempt was the only newly issued LOMT. The most frequent reasons for issuing an LOMT during consultations were futility of the overall situation (71%), poor baseline functional status (56%), multiple/severe comorbidities (56%) and old age (49%). In the majority of cases (65%) in which the HEMS physician issued a new LOMT for a patient without any pre-existing LOMT, the physician felt that the patient should have already had an LOMT. The patient was in a health care facility or a nursing home in half (49%) of the calls that involved issuing a new LOMT. Access to medical records was reported in 29% of the calls in which a new LOMT was issued by an HEMS physician. Consultation calls with HEMS physicians involving patients with LOMT decisions were common. HEMS physicians considered end-of-life questions on the phone and issued a new LOMT in 3.4% of consultations calls. These decisions mainly concerned termination of resuscitation, DNACPR, intubation and initiation of intensive care.

中文翻译：

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在电话咨询期间建议和限制医疗：在 HEMS 设置中的前瞻性多中心研究

我们调查了由直升机紧急医疗服务 (HEMS) 医生通过电话提供的护理人员发起的咨询电话和建议，重点关注医疗限制 (LOMT)。在为期 6 个月的时间内，对芬兰的四个配备医生的 HEMS 基地进行了一项前瞻性多中心研究。在所有 6115 次（平均 8.4 次/基地/天）护理人员发起的咨询电话中，包括 478 次（7.8%）涉及 LOMT 的咨询电话：268 例（4.4%）病例具有预先存在的 LOMT，165 例（2.7%）病例HEMS 医生发布了新的 LOMT 和 45 (0.7%) 例患者已经有 LOMT 并且医生进一步发布了另一个 LOMT。最常见的新限制是不尝试心肺复苏 (DNACPR) 命令 (n = 122/210, 58%) 和/或“不符合重症监护条件” (n = 96/210, 46%)。在涉及新 LOMT 的 49 次 (23%) 呼叫中，终止启动的复苏尝试是唯一新发布的 LOMT。在咨询期间发布 LOMT 的最常见原因是总体情况无效 (71%)、基线功能状态差 (56%)、多种/严重合并症 (56%) 和年老 (49%)。在大多数情况下（65%），HEMS 医生为没有任何预先存在的 LOMT 的患者发布了新的 LOMT，医生认为患者应该已经有 LOMT。在涉及发布新 LOMT 的呼叫中，有一半 (49%) 患者在医疗机构或疗养院。在 HEMS 医生发出新的 LOMT 的电话中，有 29% 的电话报告了对医疗记录的访问。与有 LOMT 决定的患者的 HEMS 医生的咨询电话很常见。HEMS 医生在电话中考虑了临终问题，并在 3.4% 的咨询电话中发布了新的 LOMT。这些决定主要涉及终止复苏、DNACPR、插管和开始重症监护。