Psychological impact of end of life situations in pre-hospital emergency medicine on nurses and doctors of the fire brigade of Paris

JOUFFROY R, JOST D, MAURIN O, BIGNAND M, LAVILLUNIÈRE N, BON O et al. Psychological impact of end of life situations in prehospital emergency medicine on nurses and doctors of the Fire Brigade of Paris. Med Emergency, MJEM 2015; 22:13-20.
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Correspondent author: Romain JOUFFROY, MD

Emergency Medical Service, Fire Brigade of Paris Scientific section of Emergency Medical Services

1 place Jules Renard 75017 Paris

Jouffroy R, MD1,2, Jost D, MD2, Maurin O, MD2, Bignand M, MD2, Lavillunière N, MD2, Bon O, MD2, Domanski L, MD2, Tourtier JP, MD2

1. Intensive care department and SAMU 75, 149 rue de Sèvres 75015 Paris, France

2. Emergency Medical Service, Fire Brigade of Paris, 1 place Jules Renard 75017 Paris, France

Category: Original article

Received: Nov. 12, 2014

Revised: Dec. 10, 2014

Accepted: Jan. 8, 2015

The authors declare no conflict of interest


Introduction: The Leonetti law draws the legislative framework for the medical handling of end of life cases. The aim of this work was to assess the knowledge of the various notions pertaining to this law and to measure the rate of exposure to such cases and their impact on nurses and doctors of Fire Brigade of Paris (Brigade de sapeurs-pompiers de Paris – BSPP) operating in pre-hospital emergency medicine.

Materials and Methods: An anonymous questionnaire was designed and shared with medical and paramedical staff of a pre-hospital emergency medicine department in order to explore the exposure of the staff to end of life situations, their impact on them and the training received or desired to handle such cases. Results: From 01/01/2009 to 01/04/2009, 36 questionnaires (72% exhaustiveness) were collected and analyzed. The mean age of the respondents was 36 ± 6 years and 86% of them were men. The mean duration of practice at the pre-hospital emergency medicine departments was 8 ± 6 years. Results have shown that during their clinical practice, 94% of subjects had already been exposed to violent death and 97% to end of life care. Eighty-six percent of subjects reported discouragement due to end of life care and only 18% due to violent death. Twenty-five percent reported a professional impact and/or extraprofessional impact. Seventy-five percent declared the need to talk about these situations and 88% were able to do so with members of the pre hospital medical team who were present during the intervention or other medical colleagues. Seventy-five percent declared to know the concept of “trusted person” whilst 47% only declared to know the concept of “advance directives”. Eighty three percent thought that the concept of Trusted Person should be taken into consideration in pre-hospital Emergency medicine versus 69% who thought that “advance directives” should be taken into consideration in pre-hospital Emergency medicine. Seventy-two percent declared not having received any training and wished to be better prepared for the management of such situations. An initial and/or continuous training was viewed as necessary in the form of “seminars” or “Education from personal experiences”.

Discussion: “End of Life” situations are inevitable in pre hospital emergency medicine and bear a significant psychological impact. A good knowledge of the “trusted person” and “advance directives” concepts could facilitate the handling of such situations. The training that is most preferred ought to be integrated in every pre-hospital emergency medicine institution. This topic warrants a larger survey of a larger number of staff.