US Ambulance: what are the Advanced Directives and what is the behavior of rescuers with respect to "end of life"
Advanced directives and “end of life”: the US ambulance rescuer has to deal with different legislation and cultural sphere than his colleague in other areas of the world
USA ambulance, advanced directives, concepts of futility, and the patient’s end of life
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ADVANCED DIRECTIVES:
Defined as a written statement of a person’s wishes regarding medical treatment.
Often including a living will, these statements are made to ensure those wishes are carried out should the person be unable to communicate them to a doctor.
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Do Not Attempt Resuscitation (DNR) Order:
A type of advanced directive that is usually present when a patient has a terminal disease that is associated with medical futility.
DNR’s are hospital, EMS, and facility specific.
It is an order written by a doctor, has a time limit, and does not eliminate non-resuscitative treatment.
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THE USA AMBULANCE AND MEDICAL FUTILITY:
Interventions that are unlikely to produce any significant benefit for the patient and which are categorized into two distinguishable categories:
- QUANTITATIVE FUTILITY: where the likelihood that an intervention benefitting the patient is extremely poor.
- QUALITATIVE FUTILITY: the quality of benefit that an intervention will produce is extremely poor.
Quantitative = benefit of an intervention (example: positive physiologic response from a medication is a benefit)
Qualitative = the quality of benefit an intervention will produce (example: will it improve their condition or worsen it)
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LIVING WILL:
A type of advanced directive indicating a patient’s wishes that may not address the emergency medical response in your state.
Surrogate decision-makers have a durable power of attorney for health care and follow a healthcare proxy or legal document wherein a patient appoints an agent to legally make healthcare decisions on behalf of him/her for when he or she is incapable of doing so.
Oftentimes the next of kin is the surrogate decision-maker.
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