Becker Linda J, Yeargin Kimberlee, Rea Thomas D, Owens Merrili, Eisenberg Mickey S
Emergency Medical Services Division, Public Health of Seattle and King County, Seattle, Washington 98104, USA.
Prehosp Emerg Care. 2003 Jul-Sep;7(3):303-6. doi: 10.1080/10903120390936464.
A considerable number of emergency medical services (EMS) responses for cardiac arrest occur in long-term care facilities. In some instances, these responses are for residents who have expressed wishes not to be resuscitated by signing a do not resuscitate (DNR) order.
To assess the magnitude of EMS use for cardiac arrest in long-term care facilities for residents with DNR orders and to determine reasons why EMS is called.
A retrospective study was conducted using data collected from medical incident reports between July 1999 and December 2000 for all persons experiencing cardiac arrest in long-term care facilities defined as nursing homes, adult family homes, and assisted-living centers in King County, Washington, excluding Seattle. The authors also surveyed facilities to determine their policies for calling 9-1-1 in the event of cardiac arrest. Results. Of the 392 cardiac arrests in long-term care facilities to which EMS responded, 139 (35%) of the residents had DNR orders. Of these 139, 29 (21%) received attempted resuscitation by EMS. The problem appeared to be greater among nursing homes and adult family homes than in assisted-living centers. Among nursing homes, the primary reason for an EMS call was concern for validity of the DNR order, whereas among adult family homes, the primary concern was appropriate medical authority to declare death.
Efforts to clarify existing regulations, streamline the DNR transfer process, and improve communication between EMS and long-term care facilities may result in better fulfillment of residents' end-of-life wishes and a saving of EMS resources.
相当数量的心脏骤停紧急医疗服务（EMS）响应发生在长期护理机构。在某些情况下，这些响应针对的是那些已签署“不要复苏”（DNR）医嘱表达了不希望被复苏意愿的居民。
评估长期护理机构中针对有DNR医嘱的居民心脏骤停时使用EMS的规模，并确定呼叫EMS的原因。
进行了一项回顾性研究，使用从1999年7月至2000年12月期间华盛顿州金县（不包括西雅图）定义为养老院、成人家庭护理院和辅助生活中心的长期护理机构中所有经历心脏骤停的人员的医疗事件报告收集的数据。作者还对各机构进行了调查，以确定其在心脏骤停情况下拨打911的政策。结果。在EMS响应的长期护理机构的392例心脏骤停事件中，139名（35%）居民有DNR医嘱。在这139名居民中，29名（21%）接受了EMS的复苏尝试。这个问题在养老院和成人家庭护理院中似乎比在辅助生活中心更严重。在养老院中，呼叫EMS的主要原因是对DNR医嘱有效性的担忧，而在成人家庭护理院中，主要担忧是宣布死亡的适当医疗权威。
努力澄清现有法规、简化DNR转移程序以及改善EMS与长期护理机构之间的沟通，可能会更好地实现居民的临终愿望并节省EMS资源。
