The Yomiuri Shimbun In at least 54 cases over the three years through the end of 2017, ambulance crews began resuscitative measures (see below) on elderly people in the last days of their life but stopped because the patients or their families did not want life-sustaining measures, according to a survey conducted by The Yomiuri Shimbun.
The 54 cases were handled by 20 major firefighting services nationwide. Ambulance crews rushed to the sites because elderly people had suffered cardiopulmonary arrest.
There are no government-set rules on whether to discontinue resuscitative measures, so the actions taken differ among firefighting authorities depending on the region. Ambulance crew members have expressed a desire for uniform rules to be established in this area.
Due to the increased popularity of at-home medical treatment, a growing number of people have spent their final days at home or at facilities for the elderly. As a result, the family members of dying people have sometimes asked for resuscitative measures to be discontinued, causing concern among ambulance staff.
The survey was conducted through questionnaires on 52 firefighting headquarters and departments in November and December 2017. The surveyed firefighting authorities were the Tokyo Fire Department, those in major cities designated by a government ordinance, and those in prefectural capitals. All of the authorities responded.
Regarding the discontinuation of resuscitative measures in the past, 20 of the authorities, or about 40 percent, said they had experienced such cases.
In all the cases, family members of the dying people or employees of nursing homes for the elderly who took care of the dying people asked ambulance crews to stop performing resuscitative measures, and the crews stopped upon instructions from doctors.
In one case, a patient had prepared a written will stating their wish that resuscitative measures be stopped.
In contrast, 25 of the authorities said they had not dealt with cases in which such measures were stopped.
A firefighting department in the Kyushu region said, “As long as ambulances are dispatched after receiving 119 emergency calls, ambulance crews must persuade such family members and transport the patients to hospitals.”
Other authorities among the 25 also said that their ambulance crews continued measures to try to save people’s lives.
The remaining seven authorities said they did not know whether such cases had occurred.
The Fire Service Law and other related laws stipulate that ambulance crews must provide first-aid treatment to ill or injured persons and transport them to hospitals, except in cases in which it is clear that the patients are already dead.
The laws do not mention discontinuing resuscitative measures. An official of the Fire and Disaster Management Agency of the Internal Affairs and Communications Ministry said, “If ambulance crews discontinue resuscitative measures, the action does not constitute a violation of the law.”
But one of the authorities that had not discontinued resuscitative measures, in the Kinki region, voiced the concern that “the risk of being sued in civil lawsuits is not zero.”
Of the surveyed authorities, 44, or more than 80 percent, said it was necessary to establish uniform rules about discontinuing resuscitative measures.
One said, “It’s not desirable that there can be differences among regions over how people die.”
The discontinuation of resuscitative measures has been discussed in academic societies and other entities. In spring last year, the Japanese Society for Emergency Medicine made public its manual for discontinuing resuscitative measures for the first time.
In the wake of this, some of the firefighting authorities instructed ambulance crew members to conform to procedures stipulated in the manual when they are in the field.
Toru Aruga, director of the Japan Organization of Occupational Health and Safety and an expert in emergency medicine, said: “The situation indicates that working-level operations of emergency medicine have failed to catch up with changes in society, as the officials in the field have made it a precondition that their job is to save lives. The time has come for reexamining the proper nature of ambulance transportation.”
The Health, Labor and Welfare Ministry is working to revise a guideline for the treatment of terminal-stage patients, and aims to announce the updated version in March. The guideline was made in 2007 for doctors and nurses. A ministry official said, “In line with the directions in the guideline after the revision, we want relevant people in different regions to debate the issue.”
■ Resuscitative measures
Efforts to save the lives of patients in cardiopulmonary arrest, by performing such procedures as heart massage, artificial respiration, and administering electric shocks. Emergency medical technicians are allowed to conduct higher-level treatments under doctors’ instructions, such as inserting tubes into the trachea and administering drugs.Speech