Background Little is known about why people call 9-1-1 in cases where death is expected or when resuscitation attempts are withheld by EMS personnel due to a patient's do-not-resuscitate (DNR) order indicating that a resuscitation attempt is not desired. A better understanding of why 9-1-1 is used in end-of-life circumstances may provide insights that could preserve individuals' autonomy at the end of life and make appropriate use of EMS resources as well as other public and private health services.
Study Design and Methods This was a 3-month prospective pilot study investigating the reasons for 9-1-1 use in cases where resuscitation was withheld by EMS personnel from June 2005 through August 2005. To obtain a complete picture of the event and gather evidence of an expected death and/or a DNR, we obtained data from four sources: the Medical Incident Report Form (MIRF), the dispatch tape of the event, an interview with the EMS provider who was on the scene of the event, and an interview with the patient's family member (if present) and/or the person who called 9-1-1 for the event.
Results A total of 37 cases were reported over the 3-month span, 11 of which were determined to be expected deaths. Of these 11 expected deaths, there were six patients with DNR orders, four with terminal illnesses and two who were enrolled in a hospice. For the bystanders of these 11 expected deaths, 63% reported the need for cognitive/procedural assistance while 27% reported the need for emotional assistance. Although each bystander/family member reported that they did not know what to do or who else to call at the time of death of the patient, both family members and EMTs responded positively to the support that was given.
Conclusion These results suggest that there is inadequate preparation and information for family members in end-of-life circumstances. This lack of information for end-of-life events extends well into the health care system, including EMTs and personal physicians. In addition, the study suggests that the role of giving both cognitive and emotional support to family members and/or bystanders is welcomed by EMTs.
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