The Yomiuri ShimbunWhat should ambulance crews do if they are racing to take a terminally ill elderly person or another patient to hospital, only to be asked to halt cardiopulmonary resuscitation? Crews across the nation have found themselves grappling with this serious issue.
According to a survey by the Fire and Disaster Management Agency, a body under the Internal Affairs and Communications Ministry, about 80 percent of the nation’s approximately 700 fire departments have experienced such a situation.
There have been a noticeable number of cases in which an elderly or other person who previously indicated their wish not to be resuscitated has fallen into a state of cardiopulmonary arrest at home or at a facility, and a distressed family member or other person has called 119 to notify emergency services, but the ambulance crew is asked — after arriving at the scene — not to provide treatment.
Fire departments are divided over how to respond in such a situation. About 300 departments have already drawn up their own guidelines stipulating how they will deal with such cases, with about 30 percent of them saying resuscitation can be halted based on a doctor’s decision or under other circumstances. By contrast, 60 percent say they would transport the patient to a hospital while performing CPR.
This highlights the confusion felt on the front lines by rescue crews whose duty has been to save lives.
There have been calls from rescue crews for the central government to compile a unified policy on this issue. However, a study panel of the agency put off establishing such guidelines in July. The panel argued that, at the present time, it had an insufficient grasp on the actual situation.
The circumstances of each case vary, and there also are times when a request for emergency treatment is necessary. The agency should collect and examine more specific cases, and then consider standard procedures that could form the basis for rescue crews to make a decision at the scene.
Prepare for final days
This problem comes against a backdrop of the nation’s increasingly elderly population and the arrival of a high-mortality society.
In 2017, a record-high 5.73 million people were taken to hospitals by ambulance. Of the 120,000 people who were in cardiopulmonary arrest, more than 70 percent were aged 70 or older. One factor behind this is the increased number of people who wish to see out their final days in their own homes or somewhere other than a hospital, which has become possible due to the spread of at-home medical care.
To ensure the person’s wishes are respected and prevent confusion from erupting when an ambulance crew arrives on the scene, it is essential to create an environment in which that person can peacefully face the final stage of their life.
Firstly, it is important to bolster the medical care provided at home. A person’s regular doctor will regularly gauge their condition in familiar surroundings and decide on details including the necessity of providing CPR if their health suddenly changes. In Hachioji, western Tokyo, doctors involved in providing at-home medical care take turns being on call around the clock.
Local governments, fire departments, local medical associations, hospitals and other entities need to work together and communicate smoothly to deal with such cases.
A patient also needs to routinely discuss with family members and medical care providers the treatment they want to receive in their final days, and ensure these wishes are detailed in a written document. They should tell people around them about their own wishes, while still healthy enough to do so, to prepare for when the worst happens.
A growing number of elderly people live alone, and many have no living relatives. Nursing care and welfare workers must not forget to also properly understand the wishes of these people.