International recommendations for outpatient palliative care and 1 prehospital “ Palliative Emergencies ” – a

26 Aim: To determine current practice among experts in palliative care and a qualitative 27 exploration of their recommendations regarding outpatient palliative emergencies. The main 28 goal of the study was to get the experts ́ opinions on their nationally practised concepts. 29 Methods: A standardised questionnaire was mailed to experts in palliative and emergency 30 care. In the search for experts those with published articles were considered as relevant. 31 Results: Survey response rate was 61% from 35 countries. Following standards in palliative 32 emergency care were recommended: (1) early integration of PCTs and basic outpatient 33 palliative care systems, (2) end-of-life discussions, (3) defined emergency medical 34 documents, drug boxes, and “Do not attempt resuscitation” orders (4) emergency medical 35 training (physicians and paramedics). Conclusions: The study detected structurally and 36 nationally different outpatient palliative care attempts regarding to the treatment of palliative 37 emergencies. These should be discussed accordingly and be adapted to the respective 38 specificities of the single countries. Single established outpatient palliative emergency 39 medical care concepts may build the basis for an overall out-of-hospital palliative care 40 concept. 41 42