Waldrop Deborah P, Clemency Brian, Lindstrom Heather A, Clemency Cordes Colleen
University at Buffalo School of Social Work, Buffalo, New York, USA.
Department of Emergency Medicine, University at Buffalo School of Medicine, Buffalo, New York, USA; Department of Emergency Medicine, Erie County Medical Center, Buffalo, New York, USA.
J Pain Symptom Manage. 2015 Sep;50(3):328-34. doi: 10.1016/j.jpainsymman.2015.03.001. Epub 2015 Mar 28.
Emergency 911 calls are often made when the end stage of an advanced illness is accompanied by alarming symptoms and substantial anxiety for family caregivers, particularly when an approaching death is not anticipated. How prehospital providers (paramedics and emergency medical technicians) manage emergency calls near death influences how and where people will die, if their end-of-life choices are upheld and how appropriately health care resources are used.
The purpose of this study was to explore and describe how prehospital providers assess and manage end-of-life emergency calls.
In-depth and in-person interviews were conducted with 43 prehospital providers. Interviews were audiotaped, transcribed, and entered into ATLAS.ti for data management and coding. Qualitative data analysis involved systematic and axial coding to identify and describe emergent themes.
Four themes illustrate the nature and dynamics of emergency end-of-life calls: 1) multifocal assessment (e.g., of the patient, family, and environment), 2) family responses (e.g., emotional, behavioral), 3) conflicts (e.g., missing do-not-resuscitate order, patient-family conflicts), and 4) management of the dying process (e.g., family witnessed resuscitation or asking family to leave, decisions about hospital transport). After a rapid comprehensive multifocal assessment, family responses and the existence of conflicts mediate decision making about possible interventions.
The importance of managing symptom crises and stress responses that accompany the dying process is particularly germane to quality care at life's end. The results suggest the importance of increasing prehospital providers' abilities to uphold advance directives and patients' end-of-life wishes while managing family emotions near death.
当晚期疾病的终末期伴有令人担忧的症状且家庭护理人员极度焦虑时，尤其是在未预料到临近死亡的情况下，往往会拨打911急救电话。院前急救人员（护理人员和急救医疗技术员）对濒死急救电话的处理方式会影响人们的死亡方式和地点、临终选择是否得到尊重以及医疗资源的使用是否合理。
本研究旨在探索和描述院前急救人员如何评估和处理临终急救电话。
对43名院前急救人员进行了深入的面对面访谈。访谈进行了录音、转录，并录入ATLAS.ti软件进行数据管理和编码。定性数据分析采用系统编码和轴心编码，以识别和描述浮现的主题。
四个主题阐明了临终急救电话的性质和动态：1）多焦点评估（如对患者、家庭和环境的评估），2）家庭反应（如情绪、行为方面），3）冲突（如缺失的不要复苏医嘱、患者与家庭的冲突），4）临终过程的管理（如让家人目睹复苏或要求家人离开、关于送往医院的决定）。在进行快速全面的多焦点评估后，家庭反应和冲突的存在会介导关于可能干预措施的决策。
处理临终过程中伴随的症状危机和应激反应对于临终时的优质护理尤为重要。结果表明，提高院前急救人员在尊重预先指示和患者临终意愿的同时管理濒死家庭情绪的能力具有重要意义。
