Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
S Afr Med J. 2023 Nov 6;113(11):41-46. doi: 10.7196/SAMJ.2023.v113i11.1136.
An estimated 56.8 million people require palliative care annually, while only 14% receive such care. This imbalance is particularly acute in low-to middle-income countries (LMICs), where up to 80% of patients requiring palliative care reside. To correct this imbalance, integration between palliative services and other disciplines has been recommended. While improved palliative care integration is a priority in the South African (SA) LMIC context, emergency medical services (EMS) and palliative care remain non-integrated. This has resulted in poor palliative situation management by EMS and a lack of research concerning their intersection.
To examine EMS use for palliative situations in the Western Cape (WC) Province of SA by describing frequency of intersection, patient characteristics and outcomes.
An observational, descriptive, retrospective patient record review was employed at two hospitals with palliative care services in the WC. All patient records of those who arrived at the hospitals between 1 January 2020 and 31 December 2020 via EMS conveyance leading to palliative care provision were included in the study.
In total, 1 207 unique patients received palliative care services at both hospitals during the study period. Of these, 395 (33%) made use of EMS for hospital conveyance on 494 occasions. The median (range) patient age was 60 (20 - 93) years, and most transports involved male patients (54%, n=265). Family members were the primary caregivers in most instances (89%, n=440), dyspnoea was the chief complaint (36%, n=178) and cancer was the most frequent diagnosis (32%, n=159). The median length of hospital stay was 6 days, with most patients discharged home (60%, n=295).
EMS in SA frequently encounter palliative situations for symptoms that may be managed within their scope of practice. Consequently, it appears that EMS have an important role to fulfil in the care of patients with palliative needs. Integrating EMS and palliative care may result in improved palliative care provision and, therefore, EMS and palliative care integration would be beneficial in SA.
每年估计有 5680 万人需要姑息治疗，但只有 14%的人得到这种治疗。这种不平衡在中低收入国家（LMICs）尤为严重，高达 80%的需要姑息治疗的患者居住在这些国家。为了纠正这种不平衡，姑息治疗服务与其他学科之间的整合已被推荐。虽然在南非（SA）中低收入国家背景下，改善姑息治疗的整合是当务之急，但紧急医疗服务（EMS）和姑息治疗仍然没有整合。这导致 EMS 在姑息治疗方面的管理不善，也缺乏对它们交叉点的研究。
通过描述频率、患者特征和结果，检查西开普省（WC）的 EMS 在姑息治疗中的应用。
在 WC 有姑息治疗服务的两家医院进行了一项观察性、描述性、回顾性的患者病历回顾研究。在这项研究中，包括了在 2020 年 1 月 1 日至 2020 年 12 月 31 日期间通过 EMS 运送至医院并接受姑息治疗的所有患者的病历。
在研究期间，共有 1207 名患者在这两家医院接受了姑息治疗服务。其中，395 名（33%）患者在 494 次就诊中使用 EMS 进行医院转运。患者的中位（范围）年龄为 60 岁（20-93 岁），大多数转运涉及男性患者（54%，n=265）。在大多数情况下，家属是主要照顾者（89%，n=440），呼吸困难是主要投诉（36%，n=178），癌症是最常见的诊断（32%，n=159）。医院的中位住院时间为 6 天，大多数患者出院回家（60%，n=295）。
南非的 EMS 经常遇到可能在其管辖范围内管理的姑息治疗症状。因此，EMS 在满足姑息治疗需求的患者的护理中似乎发挥着重要作用。整合 EMS 和姑息治疗可能会改善姑息治疗的提供，因此，在南非，EMS 和姑息治疗的整合将是有益的。
