Emergency Care

Skip anything

Every question is optional. No one has to retell painful events, name a diagnosis, or choose a religion or identity to begin.

Pause or stop

Stop at any point. Nothing is sent anywhere, and nothing is shared unless the person chooses it in the sharing review.

Whose words

Record who said each thing: the person, a caregiver or surrogate, or a professional. A caregiver's needs get their own field.

Support to take part

Extra time, a quieter place, pictures, an interpreter or a trusted person can help someone say what matters. Ask what helps.

Barriers are not preferences

Cost, travel, work, housing, caring for others and digital access are written down as barriers, not as what the person wants.

Meaning, religious or not

Hope, purpose, faith, relationships and identity can be part of the conversation if the person wants. None is assumed.

• Emergency doctor: The medical picture and options, explained as time allows.
• Emergency nurse: Care, updates and where family can be.
• Social worker: Family support, practical needs and who speaks for the person.
• Palliative care team: Comfort, and conversations about what matters most, where such a team exists.
• Chaplain or spiritual-care provider: Meaning, distress, hope and relationships, for people of any faith or none.
• Interpreter or communication specialist: Language and communication support so the person's own words come through.
• People the person chooses: Family, friends, or a community or faith contact, only if the person wants them. Never assumed safe, available or wanted.

Roles, titles and training differ by country and service. Not every role exists everywhere.

A small set of places chosen for contrast, not a ranking or a representative survey: Global, France, Rwanda, Peru, Brazil, Iran, Pakistan, Singapore, Australia, United States. Each example states what its source establishes and what it does not. Policy on paper is not proof that a service is available.

• Global · Policy · 2019

  In resolution WHA72.16 (May 2019), the World Health Assembly urged Member States to create policies for universal access to emergency care for all, without regard to sociocultural factors and without requiring payment before care.

  What others could learn: Payment before care can be named as a barrier to emergency care. The same resolution urges toll-free universal access numbers for prehospital care, and plans in emergency units to protect providers and patients from discrimination.

  Conditions, limits and source

  Conditions that matter:

  Depends on sustainable funding, governance that links prehospital and hospital emergency care, dedicated emergency training for frontline providers, and financial risk protection within universal health coverage. The resolution notes that frontline workers, nurses in particular, often lack dedicated emergency training.

  Cannot be inferred:

  Does not show how many countries require payment before emergency care, or whether any changed policy after 2019. Does not set clinical standards. Does not describe what patients or families experience in emergency units.

  Limits:

  A resolution that urges Member States; it is not binding law and does not show that any country acted on it. It does not address goals-of-care conversations, family presence or interpreters in emergency units. The 2021 progress report (A74/39, IRIS handle 10665/358742) was located but not read.

  Source: World Health Organization (Seventy-second World Health Assembly), Emergency care systems for universal health coverage: ensuring timely care for the acutely ill and injured (Resolution WHA72.16, operative paragraph 2(1), printed p. 3 (PDF p. 3); adopted at the seventh plenary meeting, 28 May 2019; IRIS lists the item as issued 2019-10-15). Where: Global. Population: People with acute illness or injury across the life course; WHO Member States. Published 2019-05-28; retrieved 2026-10-12.

• France · Measured outcome · 2013

  In a French trial reported in 2013, relatives of people in cardiac arrest whose prehospital emergency unit systematically offered them the chance to watch CPR had PTSD-related symptoms less often at day 90 than relatives in standard-practice units.

  What others could learn: Offering relatives the choice to be present during resuscitation, rather than deciding for them, can be part of routine emergency practice. The authors report family-witnessed CPR did not affect resuscitation characteristics, patient survival or team stress, and did not result in medicolegal claims.

  Conditions, limits and source

  Conditions that matter:

  Prehospital teams able to offer the choice systematically while resuscitating. Funded by the French Ministry of Health (Programme Hospitalier de Recherche Clinique 2008). Outcomes concern relatives' psychological symptoms and resuscitation process, not patients' wishes.

  Cannot be inferred:

  Does not show that presence helps every relative, or that relatives should be pressed to stay. Does not show effects in emergency departments or in-hospital resuscitation. Does not describe how relatives' backgrounds or beliefs shaped their choices.

  Limits:

  Abstract only; the full text was not read (publisher host blocked). One country and a prehospital setting. In the intervention group 79% of relatives witnessed CPR, against 43% in the control group, so both groups mixed witnesses and non-witnesses. Symptoms are reported, not diagnoses. A one-year follow-up (PubMed 24852952) was found but not read.

  Source: Jabre P, Belpomme V, Azoulay E, et al.; New England Journal of Medicine, Family presence during cardiopulmonary resuscitation. (Abstract, Results (PubMed 23484827)). Where: France (15 prehospital emergency medical service units). Population: 570 relatives of patients in cardiac arrest who received CPR from prehospital emergency teams. Published 2013-03-14; retrieved 2026-10-12.

• Rwanda · Reported experience · 2023

  In a 2023 Rwandan qualitative study, few rural injured participants reported reaching facilities by ambulance; ambulances were perceived as scarce and used only to transport pregnant women and children from home to hospital.

  What others could learn: Asking how a person reached care, and what they believed about ambulance eligibility, cost and insurance, can surface access barriers. Participants also described delays from community health insurance procedures and from paying for medicines and materials outside government facilities.

  Conditions, limits and source

  Conditions that matter:

  Rwanda has a national ambulance service (founded in 2008, up to 225 ambulances, per the authors) and community-based health insurance held by over 91% of individuals, yet distance, hilly terrain, transport costs and referral rules shaped access.

  Cannot be inferred:

  Does not measure ambulance response times or use. Does not show that ambulances are in fact reserved for pregnant women and children. Findings from two sites do not describe all of Rwanda.

  Limits:

  Two sites; the authors say Kigali findings may not represent other urban settings and rural nuances may be missed. Most patients (75%) were male. Ambulance views are perceptions; the discussion notes participants may not have known how to access the service. Urban participants reported ambulances as their main route to care.

  Source: Nzasabimana P, Ignatowicz A, Alayande BT, et al.; BMJ Open, Barriers to equitable access to quality trauma care in Rwanda: a qualitative study. (Full text, Results, 'Delays in reaching care', paragraph following the description of rural transport (PMC10546151)). Where: Rwanda (Burera District, Northern Province, and Kigali City). Population: 51 participants: 36 people treated for injuries in the previous 6 months, plus caregivers and community leaders; 13 women and 38 men aged 21 to 68. Published 2023-09-28; retrieved 2026-10-12. Source in English; summarized from our own translation, not an official one.

• Peru · Reported experience · 2024

  Twelve caregivers of people with advanced non-cancer illness, interviewed in 2021 at a Lima referral hospital, described despair and anguish in the emergency department from long waits, scarce resources, incomplete information and staff they called insensitive.

  What others could learn: Caregivers linked distress to delayed or uncoordinated information, often given by telephone; some valued daily virtual updates that included care recommendations and spiritual support. Caregivers reported finding strength in their faith; this is what participants said, not a rule for care.

  Conditions, limits and source

  Conditions that matter:

  Social security hospital; COVID-19 visiting limits; overcrowded waiting areas; gaps in home care and outpatient follow-up that brought patients back to the emergency department.

  Cannot be inferred:

  Does not measure waiting times or information quality. Does not show how many caregivers share these views. Does not describe experiences in other hospitals or outside the pandemic period.

  Limits:

  Small sample (12) at a single hospital, during COVID-19 restrictions that limited accompanying patients. The authors note participants did not include the poorest people, who lack adequate access to the health system, minority populations or older female caregivers.

  Source: Amado-Tineo J, Oscanoa-Espinoza T, Loli-Ponce R, Delgado-Guay MO; BMC Palliative Care, Experiences of caregivers of patients with noncancer diseases readmitted to an emergency department at the end of life. (Abstract, Results; detail in full text, Results (PMC11566118)). Where: Peru (Lima, one social security referral hospital). Population: 12 primary caregivers, aged 38 to 76 and mostly daughters or wives, of adults with advanced non-cancer chronic disease and more than one emergency department admission. Published 2024-11-15; retrieved 2026-10-12. Source in English; summarized from our own translation, not an official one.

• Brazil · Measured outcome · 2025

  At a Brazilian tertiary emergency hospital, among 6,211 adults who died there in 2014 to 2024, a palliative care consultation before any CPR attempt was associated with a lower likelihood of CPR (adjusted hazard ratio 0.35).

  What others could learn: An emergency-based palliative care team can be called early, including at arrival, to help clarify and document treatment preferences before a crisis. The team here included a physician, social worker, psychologist, pharmacist, occupational therapist and interfaith chaplaincy, and held family meetings.

  Conditions, limits and source

  Conditions that matter:

  Requires a funded multidisciplinary palliative care team, referral triggers (instruments named in the source: PPS, ECOG, SPICT-BR), electronic records that capture consultations, and emergency physicians able to request consultation at arrival.

  Cannot be inferred:

  Does not show that consultation causes fewer resuscitation attempts, or that each decision matched the patient's wishes. Comfort and family satisfaction were not measured. Does not apply to people who survived.

  Limits:

  Single center, retrospective, and limited to people who died. The authors state the association is not causal: consultation may have clarified and documented existing preferences rather than changed them, and acute severity was not fully measured. CPR was classified from free-text notes by a GPT-4-based model, so misclassification is possible. The abstract gives 1,757 consultations; the full text gives 1767.

  Source: Dos Santos TH, da Silva RP, de Campos MR, et al.; BMC Palliative Care, Association between palliative care in the emergency department and cardiopulmonary resuscitation decisions in patients with poor prognosis: a retrospective observational study. (Abstract, Results; setting, team and limitations in full text, Methods and Discussion (PMC12512536)). Where: Brazil (Ribeirão Preto, São Paulo State; one tertiary emergency hospital). Population: 6,211 adults admitted to a referral emergency hospital who died during hospitalization, 2014 to 2024; mean age 72. Published 2025-10-09; retrieved 2026-10-12.

• Iran · Measured outcome · 2017

  In a survey published in 2017 from four Iranian hospitals, 57.2% of 136 family members felt it was their right to be present during resuscitation, citing benefits such as seeing that everything was done.

  What others could learn: Asking families whether they wish to be present, rather than assuming, can reveal a wish staff may not expect. The authors report nurses with prior education on family presence were more willing to implement it.

  Conditions, limits and source

  Conditions that matter:

  Staff attitudes and training shape whether the option is offered. The abstract says family presence is not regularly practiced by nurses, especially in low- to middle-income countries.

  Cannot be inferred:

  Does not show outcomes for relatives who were present. Does not explain why women more often held this view. Does not represent all Iranian hospitals.

  Limits:

  Abstract only; the full text was not read (publisher host blocked). Attitudes, not experience: the abstract does not say whether family members had been present at a resuscitation. Hospitals, units and survey dates are not given in the abstract. In the same survey, 62.5% of nurses disagreed with adult family presence.

  Source: Zali M, Hassankhani H, Powers KA, Dadashzadeh A, Rajaei Ghafouri R; International Emergency Nursing, Family presence during resuscitation: A descriptive study with Iranian nurses and patients' family members. (Abstract, Results (PubMed 28528270)). Where: Iran (four hospitals; author affiliations in Tabriz). Population: 136 family members of patients and 178 nurses, randomly sampled. Published 2017-05-17; retrieved 2026-10-12.

• Pakistan · Reported experience · 2026

  In Karachi interviews published in 2026, parents of children who recently needed an ambulance thought video links to a remote physician would build trust in technicians and reduce stress, but some were reluctant about cameras for privacy reasons.

  What others could learn: Ambulance teams can ask parents for consent before using a camera and keep a parent present. The authors report privacy for female patients was the most reported concern; parents, to whom the decision was deferred, said they would prioritize timely care.

  Conditions, limits and source

  Conditions that matter:

  Depends on reliable telecommunication, joint training of technicians and remote physicians, and public awareness. Long travel in Karachi traffic, and the distance of tertiary hospitals from suburban and rural areas, motivated the proposal.

  Cannot be inferred:

  Does not show that ambulance telemedicine improves survival or works as intended. Does not describe adult patients or other cities.

  Limits:

  Views on a proposed intervention before a trial, not experience of using it. Single city; the authors say results may not transfer to other cities or provinces. No children were interviewed, and there were no female technicians to interview.

  Source: Hassan S, Woolfall K, Atiq H, et al.; BMJ Global Health, Acceptability of ambulance-based telemedicine (ABT) for paediatric emergencies in Karachi, Pakistan. (Abstract, Results; setting, privacy and limitations in full text, Methods and Discussion (PMC12815148)). Where: Pakistan (Karachi). Population: 18 parents of children who recently needed an ambulance, 5 telemedicine physicians, and emergency medical technicians in 4 focus groups (47 participants in all). Published 2026-01-09; retrieved 2026-10-12. Source in English; summarized from our own translation, not an official one.

• Singapore · Reported experience · 2023

  In 2019 to 2020 focus groups and interviews about three Singapore public hospital emergency departments, participants said the cramped, open department was not ideal for end-of-life care and that a dedicated private space was essential.

  What others could learn: A private room big enough for next-of-kin can be planned for people dying in the emergency department. Participants described families arriving lost and scared, often unprepared for the dying phase despite earlier discussions.

  Conditions, limits and source

  Conditions that matter:

  Crowded emergency departments, competing priorities, limited community end-of-life resources, delayed transfer to wards and complex coordination of terminal discharge.

  Cannot be inferred:

  Does not measure how often private space is available or its effect on families. Does not represent patients' own views. Three hospitals do not describe all Singapore emergency departments.

  Limits:

  Only 7 of 59 participants were family members and no patients took part, so most views are staff views. Voluntary participation allows responder bias, and focus groups may be shaped by dominant members. Professionals and next-of-kin were interviewed separately.

  Source: Tiah L, Chua MT, Kuan WS, et al.; Medicina (Kaunas), Perspectives towards End-of-Life Care in the Emergency Department of Tertiary Public Hospitals-A Qualitative Analysis. (Full text, Results, section 3.2.2 'Conduciveness of ED Environment' (PMC10053832)). Where: Singapore (three tertiary public hospitals and community care settings). Population: 59 participants: 36 emergency department staff, 16 community healthcare professionals and 7 family members who were primary caregivers. Published 2023-02-24; retrieved 2026-10-12.

• Australia · Service in operation · 2023

  In one Queensland emergency department's Deadly RED project, yarns with First Nations patients showed waiting-room placement and paracetamol prescription interpreted as dismissal; the authors report these themes were gone after communication and process changes.

  What others could learn: Asking First Nations patients, through yarning, what waiting and treatment meant to them can show where routine steps read as dismissal. Common themes also included harm from long waits and value in holistic care.

  Conditions, limits and source

  Conditions that matter:

  Participatory research with First Nations people sharing design, knowledge and ownership of results; Indigenous research methodology; links to alternative community healthcare.

  Cannot be inferred:

  Does not show that the pathway reduced take-own-leave rates or improved health outcomes. Does not describe all First Nations patients or other emergency departments.

  Limits:

  Abstract only; the full text was not read (publisher host blocked) and no PMC copy was found. Single emergency department. The abstract gives no take-own-leave rates before and after, and theme elimination is the authors' summary. Of 18 patients who took their own leave, only eight believed their treatment was incomplete.

  Source: Davison M, Chan J, Clarke M, Mitchell C, Yan A, Henaway E; Health Promotion Journal of Australia, Yarning to reduce take own leave events in First Nations patients presenting to the Emergency Department-presenting the qualitative themes and co-design of the Deadly RED project. (Abstract, Results (PubMed 38097211)). Where: Australia (Queensland; one emergency department). Population: First Nations patients presenting to the emergency department (85 yarns; 18 patients who took their own leave in post-implementation yarns). Published 2023-12-14; retrieved 2026-10-12.

• United States · Measured outcome · 2026

  In one Chicago emergency department, interpreter use was documented in 49.2% of 5,665 adult encounters with a non-English preferred language from October 2024 to September 2025, and stayed between 46.9% and 50.6% across crowding levels.

  What others could learn: About half of encounters with a non-English preferred language had no documented interpreter, whether the department was crowded or not. The authors conclude other factors drive interpreter use, so a department could review its own workflows and documentation.

  Conditions, limits and source

  Conditions that matter:

  Professional interpreter services available in the emergency department; electronic records that capture preferred language and interpreter use. Language-access law is not described in the abstract.

  Cannot be inferred:

  Does not show whether patients without a documented interpreter had interpreting by other means, or how their care differed. Does not explain why interpreters were not used.

  Limits:

  Abstract only; the full text was not read (publisher host blocked). Single site. The outcome is documented interpreter use; the abstract does not say how undocumented or informal interpreting was handled, and reports no patient outcomes or language groups.

  Source: Gottlieb M, Gatling K, Haq F, et al.; American Journal of Emergency Medicine, Effect of emergency department crowding on documented interpreter use among patients with limited English proficiency. (Abstract, Results (PubMed 42418919)). Where: United States (Chicago, Illinois; one academic emergency department, per author affiliations). Population: Adult emergency department encounters with a non-English preferred language (n=5,665). Published 2026-07-02; retrieved 2026-10-12.

• The sourced examples include policy, measured outcome, reported experience, service in operation. Each quote was matched to the source text; that is not independent expert review.
• The prompts and fictional case are original. They have not been tested with patients, caregivers or clinicians.
• Whether this workflow helps anyone is an open research question.
• Content is in English. Interface translations are not reviewed for this topic.