不要复苏 (DNR) 紧急医疗服务 (EMS) 协议变化在美国
Amelia M Breyre1, E Jane Merkle-Scotland2, David H Yang3
1University of California San Francisco, San Francisco, CA, USA.
The American journal of emergency medicine
|July 27, 2025
概括
紧急医疗服务 (EMS) 协议在识别"不复苏" (DNR) 文档方面显示出显著的差异,影响了患者的护理. 首选的是像POLST这样的便携式医疗订单,而口头DNR的接受程度则有很大差异.
科学领域:
- 紧急医疗 紧急医疗
- 医学伦理 医学伦理
- 公共卫生政策 公共卫生政策
背景情况:
- 不要复苏 (DNR) 命令对于将紧急医疗护理与患者的愿望保持一致至关重要.
- 紧急医疗服务 (EMS) 对DNR文档协议的现有变化造成了护理不一致和道德挑战.
研究的目的:
- 系统地分析和描述美国各地在EMS协议中接受DNR文档的多样性.
主要方法:
- 对全州EMS协议和美国50个人口最多城市的协议进行了结构化审查.
- DNR文件类型 (预先指示,遗嘱,珠宝,便携式订单,口头DNR) 根据EMS协议的接受,排除或对医疗监督的要求进行分类.
主要成果:
- 在63个审查的协议中,86%有特定的DNR协议,但接受程度有很大差异.
- 便携式医疗订单 (76%) 和DNR珠宝 (61.1%) 的接受率高于预先指示 (50%) 和遗嘱 (13%) 的接受率.
- 口头的DNR经常被拒绝 (38.5%) 或需要直接的医疗监督,医疗保健 (18.5%) 和非医疗保健提供者 (26.6%) 的接受度有限.
结论:
- 虽然大多数EMS机构都有DNR协议,但在公认的文档中存在很大差异,这给符合目标的医院外护理带来了挑战.
- 简洁的,便携式的格式,如医生订单维持生命治疗 (POLST) 是有利于EMS使用.
- 建议进行进一步的研究,以评估文档的有效性,并考虑扩大口头DNRs的使用.
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