Peran David, Uhlir Marek, Pekara Jaroslav, Kolouch Petr, Loucka Martin
Prague Emergency Medical Services, Prague, Czech Republic; Divisions of Public Health, 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; Medical College, Prague, Czech Republic.
Prague Emergency Medical Services, Prague, Czech Republic; Centre for Palliative Care, Prague, Czech Republic.
J Pain Symptom Manage. 2021 Dec;62(6):1308-1318. doi: 10.1016/j.jpainsymman.2021.04.023. Epub 2021 May 11.
Emergency medical services (EMS) are frequently responding to calls involving patients in advanced stages of incurable diseases. Despite the competencies and potential of EMS in supporting patients and their families facing symptoms of advanced progressive illnesses, the role of EMS in providing palliative care remains unclear.
The following research question was formulated: What is the role of ambulance EMS, EMS dispatch centres, paramedics and emergency medical physicians in the provision of palliative care to terminally ill patients?
Following PRISMA-ScR guidelines, online bibliographic databases CINAHL Complete, MEDLINE Complete (EBSCO), PubMed and MEDLINE (Ovid) were searched from the initial year of database to September 2019. No language restrictions were applied.
31 articles were included in the qualitative synthesis and 3 main roles and one contextual factor were identified: (1) Providing complex care; (2) Adjusting patient's trajectory; (3) Being able to make decisions in a time and information limited environment; (4) Health care professionals are insufficiently supported in palliative care.
There are limited data on the incidence of EMS calls to the patients at the end-of-life and no data focusing on the EMS dispatch centres. Both paramedics and emergency physicians are aware of their role in the end-of-life care. EMS personnel are lacking special training and education in the palliative care. Cooperation between palliative care providers, the EMS providers and other out-of-hours services might improve the responsiveness of the health care system to needs and expectations of patients and their families, and possibly improve the overall health care system efficiency.
紧急医疗服务（EMS）经常接到涉及患有不治之症晚期患者的呼叫。尽管EMS在支持面临晚期进行性疾病症状的患者及其家人方面具备能力和潜力，但EMS在提供姑息治疗方面的作用仍不明确。
提出了以下研究问题：救护车EMS、EMS调度中心、护理人员和急诊医生在为绝症患者提供姑息治疗中扮演什么角色？
遵循PRISMA-ScR指南，从数据库起始年份到2019年9月，对在线书目数据库CINAHL Complete、MEDLINE Complete（EBSCO）、PubMed和MEDLINE（Ovid）进行了检索。未设语言限制。
31篇文章纳入定性综合分析，确定了3个主要角色和1个背景因素：（1）提供综合护理；（2）调整患者病程；（3）能够在时间和信息有限的环境中做出决策；（4）医护人员在姑息治疗方面缺乏足够支持。
关于EMS接到的临终患者呼叫发生率的数据有限，且没有聚焦于EMS调度中心的数据。护理人员和急诊医生都意识到自己在临终护理中的作用。EMS人员在姑息治疗方面缺乏特殊培训和教育。姑息治疗提供者、EMS提供者和其他非工作时间服务之间的合作可能会提高医疗系统对患者及其家人需求和期望的响应能力，并可能提高整体医疗系统效率。
