Prehosp Emerg Care. 2019 May-Jun;23(3):356-363. doi: 10.1080/10903127.2018.1518504. Epub 2018 Oct 11.
The primary charge of Emergency Medical Services (EMS) is to save lives. However, EMS personnel are frequently called to scenes where prolonging life may not be the primary goal. When someone is nearing death, family members may feel compelled to call 9-1-1 because they are feeling uncertain about how to manage symptoms at the end of life.
We sought to explore prehospital providers' perspectives on how the awareness of dying and documentation of end-of-life wishes influence decision-making on emergency calls near the end of life.
The study design was exploratory, descriptive, and cross-sectional. Qualitative methods were chosen to explore participants' perspectives in their own words. In-depth in-person interviews were conducted with 43 EMS providers. Interviews were audio recorded and professionally transcribed. Interview transcripts were entered in Atlas.ti for data management and coding. The analysis was deductive and guided by a conceptual model of 4 contexts of end-of-life decision-making that is not setting-specific, but has been applied to prehospital care in this study.
The findings illustrate the relationship between awareness of dying and documentation of wishes in EMS calls. The 4 decisional contexts are: (1) Awareness of Dying-Wishes Documented: Families were prepared but validation and/or support was needed in the moment; (2) Awareness of Dying-Wishes Undocumented: EMS must initiate treatment, medical control guidance was needed; (3) Unaware of Dying-Wishes Documented: Shock, expectation that EMS can stop the dying; and (4) Unaware of Dying-Wishes Undocumented: Families were unprepared, uncertain, frantic. Each context is illustrated by representative quotes from participants. Discordance and conflict was found in each decisional context.
This study illustrates that EMS providers are acutely aware of the impact of their decisions and actions on families at the end of life. How emergency calls near the end of life are handled influences how people die, whether their preferences are honored, and the appropriate use of ambulance transport and ED care. The findings highlight how the intersection of awareness of dying and documentation of wishes influence prehospital decision-making in end-of-life emergencies and demonstrate the key role EMS providers have in this critical period.
紧急医疗服务（EMS）的主要职责是拯救生命。然而，EMS 人员经常被呼叫到可能不是延长生命的首要目标的现场。当某人接近死亡时，家属可能会感到不得不拨打 9-1-1，因为他们对如何管理生命末期的症状感到不确定。
我们旨在探讨院前提供者对临终意识和临终意愿记录如何影响生命末期紧急呼叫决策的看法。
该研究设计为探索性、描述性和横断面研究。选择定性方法来探索参与者用自己的话表达的观点。对 43 名 EMS 提供者进行了深入的面对面访谈。访谈进行了录音，并由专业人员进行了转录。访谈记录输入 Atlas.ti 进行数据管理和编码。分析是演绎式的，并以一个不是特定于特定情况的、但已应用于本研究中的院前护理的四个临终决策背景的概念模型为指导。
研究结果说明了 EMS 呼叫中临终意识和意愿记录之间的关系。四个决策背景分别为：（1）临终意识-记录意愿：家属有准备，但在当下需要验证和/或支持；（2）临终意识-未记录意愿：EMS 必须开始治疗，需要医疗控制指导；（3）未意识到临终-记录意愿：震惊，期望 EMS 可以阻止死亡；（4）未意识到临终-未记录意愿：家属没有准备，不确定，慌乱。每个背景都有参与者的代表性引语来说明。在每个决策背景中都发现了不一致和冲突。
本研究表明，EMS 提供者敏锐地意识到他们在生命末期的决策和行动对家庭的影响。如何处理生命末期的紧急呼叫会影响人们的死亡方式、他们的意愿是否得到尊重，以及救护车运输和急诊护理的合理使用。研究结果突出了临终意识和意愿记录的交叉如何影响生命末期的院前决策，并展示了 EMS 提供者在这一关键时期的关键作用。
