Henry Dunant, the founder of the International Red Cross and Red Crescent Movement, stood by the dying on the battlefield of Solferino. There he provided first aid as well as last aid. In a report on the work of Henry Dunant after the Battle of Solferino in 1859 it says: “Dunant tried to help to the best of his ability. He knelt beside severely wounded people who begged him to stay by their side until their last breath so that they would not die alone.”
(Buk-Swienty: Slagtebænk Dybbøl, Gyldendal; translated from Danish by G. Bollig)
WHAT IS LAST AID?
Designed in 2008 by Dr. Georg Bollig as an emergency care physician and consultant in Palliative Medicine he recognised that there was training in First Aid, but no comparable training for those who are at the end of their life. This led to an idea, Dr. Georg Bollig defined First Aid and Last Aid as follows:
Measures to help with acute injury and illness with the primary goal of ensuring the survival of those affected.
Measures to help in the case of life-threatening diseases with the primary goal of alleviating suffering and maintaining quality of life.
Within these definitions Dr. Georg Bollig explored what they mean within a wider social context.
First aid encourages humane attitudes and promotes a willingness to help other people in need. First Aid can be done in an active sense for example, by dressing wounds and resuscitating heart and lungs in first aid; or a passive sense providing companionship while awaiting medical services. Dr. Georg Bollig compared this to his understanding of Last Aid and suggested that there were active elements such as personal care, oral hygiene and use of medication and also passive elements such as through mere presence by accompanying and facing the difficult situation together with a dying person. From this Dr. Georg Bollig went onto create the Last Aid course.
LAST AID, THE COURSE
The aim of Last Aid is to provide basic knowledge and encourage people not to turn away from the dying, and care for them in the place of their choosing with increased confidence. Competent kindness and compassion is what we all need most at the end of life. We offer practical guidance and teach basic skills. Caring for the dying is not a science and within this teaching we provide skills to be translated into real world situations.
In the future, experienced GP´s or community nurses, hospice and palliative staff will offer Last Aid courses for the community they serve. The courses can be completed in one afternoon or evening. The participants learn Last Aid, i.e. accompanying the seriously ill and dying at the end of their lives.
There are four educational sessions (each 45 minutes) that form the course:
1. Dying is a part of life
2. Making provisions and decisions
3. Physical, psychological, social and existential needs
4. Saying goodbye to life
In the course we talk about the normality of dying as part of life. We will also add a brief discussion about living wills and patient decrees/authorization. We address possible distress and discomfort during the dying process and how we can help alleviate it. We will also share ideas about how to deal with the heavier, but also the lighter hours. Finally, we consider together how to say goodbye and discuss our possibilities and limits.
As with First Aid, Last Aid is intended to impart knowledge about humane help and compassion in difficult situations.
In 2015 the first Last Aid courses took place in Schleswig-Holstein, Norway and Denmark.
One of our first participants says:
“Last Aid” is a provocative title that arouses curiosity. That’s a good thing, because in view of the current debate on euthanasia, the issue needs more attention so that the majority, which knows nothing about the possibilities of palliative medicine, does not set the tone. The course content succeeded on the one hand in providing information and on the other, in dealing with the issue of personal attitudes, which guide our actions more than all our knowledge.
My advice: be sure to attend!”
Lecturer for Nursing Ethics and Dying Accompaniment, author of specialist books
The courses were evaluated for the first time in spring 2015. The first training for course leaders took place on 10.10.2015 in Schleswig, Germany. Further trainings for future trainers are planned and we hope that as soon as possible many hospice associations, adult education centres and other local organisations will be able to offer last aid courses.
If you already have questions about dying and death, please contact a hospice near you which can advise you already in case of problems in the care of your loved ones.
The first scientific article on the experiences of the pilot courses in Germany was awarded the German sponsorship prize for outpatient palliative care of the German Society for Palliative Medicine (donated by the Grünenthal company) in 2015.
Bollig G, Kuklau N. The Last Aid Course – an offer to improve general outpatient palliative care through information and empowerment of citizens. Z Palliativemed 2015; 16:210-216.
Dr. med. Georg Bollig, PhD, MAS Palliative Care, DEAA
Clin. Ace. Professor of Palliative Care at the University of Southern Denmark
is a palliative care physician, emergency physician and researcher. He works as chief physician of the palliative team and the palliative ward of the regional hospital in South Denmark (Sygehus Sønderjylland) and the hospice in Haderslev.
In addition to his clinical work in palliative care, he is Clinical Associate Professor and heads the Palliative Care Research Group of the Medical Department of the Regional Hospital in Southern Denmark / University of Southern Denmark. His current research focuses on ethical challenges and decisions, telemedicine and last aid courses.
Georg leads the international working group on last aid. He created the idea of the Last Aid Courses.
Dr. med. Ingmar Hornke, DEAA
iis a palliative physician, anesthesiologist and emergency physician. He works as managing director in the PalliativTeam Frankfurt gGmbH, which operates a PalliativTeam for adults in Frankfurt/Main, as well as the KinderPalliativTeam Südhessen.
In addition to his activities in this area, he founded the gUG Dignity Centre in 2016. As an active palliative care provider, he realized very early on that it is not only sufficient to organise good palliative care in the last phase of life, but also to actively develop innovative, sustainable projects in the health care system that contribute to the experience of dignity. Last aid courses are an essential part of this.
Is a nurse, palliative care specialist, hospice specialist and systemic and psycho-oncology consultant. She works as senior coordinator of two hospice services in Hamburg.
Improving the situation of seriously ill and dying people in our society and in health care institutions, as well as supporting their families, is a matter close to her heart.
“The struggle in society with the finiteness of life and concern for each other in the last phase is still associated with many fears and uncertainties. The last aid courses help to (re)integrate illness, old age and death as a natural part of life into our culture”.
is a specialist nurse for anaesthesia and intensive care, palliative care specialist and health networker. He also works as managing team leader in the PalliativTeam Frankfurt gGmbH and founded the gUG dignity centre together with Ingmar.
“The Last Aid courses are very important to me, because we can make citizens more aware of the issue of death and dying. The knowledge about it belongs back into society. It helps eliminate fear and encourages us to deal with what we can’t hide from, death!”
Unsere Kurse sind anerkannt durch:
Letzte Hilfe Deutschland gemeinnützige UG (hb)
Dr. Georg Bollig, Marina Schmidt, Dr. Ingmar Hornke
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