Jurnal Internasional Afrika vol.10 issue.3 2020
African Journal of Emergency Medicine
Providing end-of-life care in the emergency department: Early experience from Médecins Sans
Frontières during the Covid-19 pandemic

Jurnal Internasional Afrika vol.10 issue.3 2020
African Journal of Emergency Medicine
Providing end-of-life care in the emergency department: Early experience from Médecins Sans
Frontières during the Covid-19 pandemic

SARS-CoV-2 (Covid-19)

While most infections attributable to SARS-CoV-2 (Covid-19) are

mild, a considerable percentage of affected people require hospitalisa-
tion and critical care. In European and North American centres, the

mortality rate amongst individuals that are hospitalised, particularly
those requiring mechanical ventilation, is high [1–3].
Earlier identification of impending severe disease is imperative to
reducing mortality from CoVid-19 [4]. Health authorities and others
responding to the epidemic should prioritise activities that support this
life-saving approach, which includes improving access to health care for
persons that are most susceptible to develop critical illness. However, as
evidenced in Europe and the USA, maintaining access to health care and

prioritising care for the most vulnerable during an epidemic are com-
plex. While resource allocation related to shortages of critical equip-
ment has been heavily emphasized in reports coming from European

and North American settings, in African contexts these shortages are

more pronounced, and high-complexity care is non-existent in nu-
merous regions. Given underlying issues of access to care in many lo-
cations, patients frequently present to African emergency services in an

advanced stage of disease suffering from organ failure that cannot be
reversed.
While the emergency department is not typically an environment
associated with the provision of palliative care, we anticipate that the
gravity of presentation of certain CoVid-19 patients, particularly those

with underlying comorbidities, means that some will be more appro-
priately treated with informed, symptom-based end-of-life care than

aggressive resuscitation. The decision process regarding resource allo-
cation is outside the scope of this paper, but the scale of this pandemic

highlights the necessity to implement ethical and compassionate pal-
liative care in settings where it has not previously been considered.

Médecins Sans Frontières (MSF) has combined research and field-
based experience to develop a guidance document for clinicians with

limited experience in the provision of palliative care, including those

working in emergency services. In this paper we describe how evidence-
based palliative care protocols can be adapted to less-resourced con-
texts at the necessary scale for a rapidly spreading epidemic whilst still

respecting the physical and emotional needs of critically unwell in-
dividuals and their families.

Guest Editorial

https://doi.org/10.1016/j.afjem.2020.05.012

01 June 2020

peri irawan

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