Palliative Extubation in the ED (Yes, the ED)

From Emergency Medicine News:

Let’s talk about palliative extubation. Yes, in the ED, and yes, by you. Palliative extubation, also known as compassionate extubation, is the removal of the endotracheal tube from a patient who is not expected to sustain independent respirations while easing the patient’s suffering. (Clin Interv Aging 2015;10:679.) The procedure is intended to provide a patient with comfort and freedom from the ventilator with the understanding that the goal is quality of life, not quantity of life.

This is certainly something that can and should be carried out in the ED. The goal of care is clear: This patient would not have wanted her death to be like this. Reversing this procedure in the ED would be honoring this patient’s wishes, avoiding prolonged, unnecessary physical and emotional suffering, and offering the family some peace during this difficult time. An ICU admission may be avoided, and if necessary, a private bed in the ED or the floors would offer the patient and family some quiet respite in the patient’s last moments.

How do you carry this out in the ED?