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Terminal Extubation: The Role of EMS

Recognizing a patient who needs ventilatory support, correctly placing an endotracheal tube, and transporting the patient to the hospital is classic prehospital care.  In this article, we present a case of exactly the opposite: transporting a patient home and removing an endotracheal tube to allow them to die. EMS providers and an EMS physician worked to ensure a patient’s last wishes were upheld. This is an unusual but important opportunity for EMS to impact a patient and a family.

Objectives

  • Articulate the benefits of allowing eligible patients to die at home
  • Identify the other caregivers and providers who should be included in the decision-making, transport, and extubation processes
  • Describe the transport process and contingency plans if something goes wrong
  • Understand what interventions are allowed and available after extubation

Resources

Clemency BM, Grimm KT, Lauer SL, et al. Transport home and terminal extubation by emergency medical services. J Pain Symptom Manage, 2019 Mar 21, epub ahead of print. 

Ghabeljoo J. End of Life Care Practices for Patients Who Die in Intensive Care Units (ICU). SJSU ScholarWorks, https://scholarworks.sjsu.edu/etd_doctoral/66/. 

Emanuel EJ, Onwuteaka-Philipsen BD, Urwin JW, Cohen J. Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe. JAMA, 2016 Jul 5; 316(1): 79–90. 

Masman AD, van Dijk M, Tibboel D, Baar FP, Mathot RA. Medication use during end-of-life care in a palliative care centre. Int J Clin Pharm, 2015 Oct; 37(5): 767–75.  

  • Format
    Article
  • Duration
    0.5 hours
  • Credits
    0.5 CE
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