Document Detail

Prehospital resuscitation practices: a survey of prehospital providers.
MedLine Citation:
PMID:  12554050     Owner:  NLM     Status:  MEDLINE    
Numerous factors affect decision making in the prehospital provision of resuscitative care. This study was undertaken to determine current practices involved in the initiation, continuation and termination of resuscitative efforts, and the impact of advance directives, in the prehospital resuscitation setting. This cross-sectional mailed questionnaire surveyed 3807 members of the National Association of Emergency Medical Technicians. The study instrument included questions regarding the termination and withholding of resuscitative efforts in the prehospital setting, as well as survival rates, local protocols and compliance with advance directives. Of 1546 respondents (41% response rate), with a mean 9.0 years of experience, most (89%) indicated that they would withhold resuscitative efforts in the presence of an official state-approved advance directive. However, very few providers would withhold resuscitative efforts if only an unofficial document (4%) or verbal report of an advance directive (10%) were available. Providers with more than 10 years experience were more likely to withhold resuscitation attempts in the presence of only a verbal report of an advance directive (p = 0.02, Chi-square), and were more likely to withhold resuscitation attempts in situations they considered futile (p = 0.001, Chi-square). Most (77%) respondents have local EMS guidelines for termination of resuscitation in the prehospital setting, but 23% of those consider existing guidelines to be inadequate. The majority of prehospital providers stated that they honor official state-approved advance directives, but do not follow directives from unofficial documents or verbal reports of advance directives. More experienced providers stated that they withhold resuscitative efforts more often in futile situations, or in the presence of unofficial advance directives. Advance directives should be utilized more uniformly among patients who wish to forgo resuscitative efforts in the event of cardiac arrest. Because many local protocols are judged to be inadequate, we support the institution of improved clinical guidelines regarding the prehospital termination of resuscitative efforts.
Catherine A Marco; Raquel M Schears
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of emergency medicine     Volume:  24     ISSN:  0736-4679     ISO Abbreviation:  J Emerg Med     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2003-01-29     Completed Date:  2003-05-15     Revised Date:  2007-01-12    
Medline Journal Info:
Nlm Unique ID:  8412174     Medline TA:  J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  101-6     Citation Subset:  E; IM    
Copyright Information:
Copyright 2003 Elsevier Science Inc.
Acute Care Services, St Vincent Mercy Medical Center, Toledo, Ohio 43608-2691, USA.
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MeSH Terms
Advance Directives*
Attitude of Health Personnel
Cardiopulmonary Resuscitation / standards*,  trends
Cross-Sectional Studies
Emergency Medical Services / standards*,  trends
Health Care Surveys
Heart Arrest / mortality,  prevention & control*
Professional Competence
Quality of Health Care
Risk Assessment
United States
Withholding Treatment / statistics & numerical data*
Comment In:
J Emerg Med. 2003 Jan;24(1):87-9   [PMID:  12554047 ]

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