Survey reveals ambulance crews stopped life-saving measures in 54 cases

TOKYO (The Japan News/ANN) - 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.

■ 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.

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