Some EOL care is not adequate

Shortness of breath in terminally ill patients is often managed poorly, says Mark Rosenberg, DO, MBA, FACEP, chairman of emergency medicine at St. Joseph's Regional Medical Center in Paterson, NJ, and co-creator of its new Life-Sustaining Management and Alternative (LSMA) program.

"The tendency is to put a breathing tube in, but a very good treatment is giving morphine," Rosenberg says. "A lot of people think this will shorten life, but studies show it will actually lengthen life.

Rosenberg adds that ED managers and their staffs have a lot to learn about treating these patients. "My feeling is there is great opportunity for emergency doctors to provide better care by better understanding EOL [end of life] initiatives," he says. "From a clinical point of view, it's a better opportunity to learn how to manage acute chronic pain, narcotics like morphine, methadone, and dilaudid in particular. You can get very skilled."

There are several recommended drugs for EOL care that can help mask symptoms such as dizziness, nauseas, vomiting, constipation, and diarrhea, Rosenberg adds.

Executive summary

The new Life-Sustaining Management and Alternative (LSMA) services program in the emergency department at St. Joseph's Regional Medical Center in Paterson, NJ, is designed to offer patients with life-limiting disease greater control over their care choices and also help them contact services such as hospice if they are needed.

• Two ED physicians and one nurse are on call 24/7 for consulting referrals from ED physicians.

• The consultants meet with the patient and their family to review the case and present alternatives.

• The program shifts the traditional ED focus of curing to one of caring.