While ED staffers are well-versed in life-saving techniques, they are not as expert in making dying patients feel comfortable, asserts Tammie E. Quest, MD, assistant professor in the department of emergency medicine at Emory University in Atlanta.

Emergency providers are not typically trained in palliative techniques, Quest says. How do you palliate shortness of breath, nausea or vomiting, pain? How do you manage terminal moments? "That's where I feel much of the gap lies: how we can help people achieve a comfortable death," Quest says.

Just because a patient has a do-not-resuscitate (DNR) order does not mean he or she wants to be in pain, she says. "DNR does not mean 'do not treat,'" she emphasizes.

But "treatment," she insists, should be viewed holistically. "You are treating the whole patient and family: the physical, spiritual, and psychosocial distress," says Quest, who is developing a training model for ED physicians on how to care for patients at the end of life.

To help ensure holistic care, says Quest, ED managers should encourage their staff to enlist the help of palliative care consulting services. Such services are now available in 1,100 hospitals in the United States, according to the Washington, DC-based Center to Advance Palliative Care (CAPC). "You should use them freely, like you would a cardiology consultation," Quest says. (Editor's note: You can contact the CAPC on their web site: http://www.capc.org.)

This story was adapted from one originally published by Thomson American Health Consultants (800-688-2421).

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