Yaegashi Mizunori, Otsuka Koki, Nitta Kasumi, Tono Chihiro, Minagawa Yukihiro, Yoshida Toru, Kawamura Hidenobu
Department of Surgery, School of Medicine, Iwate Medical University, Shiwa, Iwate, Japan.
Department of Surgery, Iwate Prefectural Kuji Hospital, Kuji, Iwate, Japan.
Palliat Med Rep. 2021 Feb 26;2(1):40-47. doi: 10.1089/pmr.2020.0113. eCollection 2021.
There are some restrictions in Japan regarding end-of-life care. For example, only physicians can legally issue death certificates. By law, ambulance staff members perform cardiopulmonary resuscitation (CPR) for all patients with cardiopulmonary arrest (CPA). Therefore, it is difficult to transport patients to hospitals without CPR, even in cases of terminal patients with do-not-attempt-resuscitation (DNAR) order. Furthermore, there is no 24-hour home care nursing system in our area. Therefore, terminal patients are unable to spend their last moments at their home in the Kuji area. To design a system in which terminal patients who wish to spend their final moments at their home can be transported to the hospital without CPR after at-home CPA and a system to avoid confusion between ambulance staff and family members using instructions provided by the physician. The subjects were terminal patients with DNAR order who wanted to stay at home. The instruction to not perform CPR after CPA was created as a document by physicians. Patient information was shared with the fire department; patients were transported to our hospital without CPR after at-home CPA. In total, 26 patients died during the study period; eight received emergency transport to the hospital without CPR after CPA. CPR was not performed for any patient. A system transporting terminal patients without CPR after CPA was necessary in our area. This instruction allows terminal patients to spend their last moments where they wish and avoids unwanted CPR and troubles after CPA.
在日本，临终关怀存在一些限制。例如，只有医生才能合法开具死亡证明。根据法律，救护人员要对所有心脏骤停（CPA）患者进行心肺复苏（CPR）。因此，即使是有不要尝试复苏（DNAR）医嘱的晚期患者，不进行心肺复苏就很难将其送往医院。此外，我们所在地区没有24小时居家护理系统。所以，晚期患者无法在久慈地区的家中度过最后的时光。为设计一种系统，让希望在家中度过最后时光的晚期患者在发生居家心脏骤停后能不进行心肺复苏就被送往医院，以及设计一种系统，利用医生提供的指示避免救护人员和家庭成员之间产生混乱。研究对象是有DNAR医嘱且想留在家中的晚期患者。医生将心脏骤停后不进行心肺复苏的指示写成文件。患者信息与消防部门共享；患者在发生居家心脏骤停后不进行心肺复苏就被送往我们医院。在研究期间共有26名患者死亡；其中8名患者在心脏骤停后未进行心肺复苏就被紧急送往医院。没有对任何患者进行心肺复苏。在我们地区，建立一种在心脏骤停后不进行心肺复苏就运送晚期患者的系统很有必要。这一指示能让晚期患者在他们希望的地方度过最后时光，避免不必要的心肺复苏以及心脏骤停后的麻烦。
