Withholding Resuscitation


 
 

Keith Wesley, MD, FACEP | | Wednesday, June 27, 2007


In this column, we ll review the current literature regarding all areas of prehospital medicine. These articles and papers represent the science of medicine as viewed by the researchers. How we interpret the results and what we do with those interpretations refine the care we provide on the street. I ll attempt to provide the most unbiased view of the science and translate that into what it means to those of us in the field.

Feder S, Matheny RL, Loveless RS Jr, et al: Withholding Resuscitation: A new approach to prehospital end-of-life decisions. Annals of Internal Medicine. 144(9):634 640, 2006.

The Science

King County, Wash., recently implemented guidelines that would allow EMS personnel to more liberally withhold resuscitation from patients in cardiac arrest who had a terminal condition and whose family or caregivers indicated in writing or verbally that no resuscitation was desired. Prior to this implementation, resuscitation was withheld only for those with a written Do Not Resuscitate order. After implementing the guidelines in 16 of 35 local EMS agencies, researchers tracked its effect on 2,770 EMS-attended cardiac arrests. Services using the new guidelines withheld resuscitation in 11.8 percent of patients compared with 5.3 percent in the services using the old guidelines. The reason for withholding resuscitation in the new guideline group was based on verbal requests alone 53 percent of the time.

The Street

Of course the biggest weakness of this paper is that the mere implementation of the new guideline and provision of education regarding end-of-life events is going to increase the number of field terminations. The agencies that did not adopt the new guidelines were not provided any additional education regarding this important topic, and, therefore, the marked increase in field termination in the study agencies may be due in large part to increased awareness. However, it s remarkable that verbal requests represented such a significant basis for withholding resuscitation. Although more liberal guidelines and education do increase field terminations, it s vital that any such program require on-line medical control authorization. Further studies should look at these cases and determine whether the decisions were appropriate.




Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Administration and Leadership, Cardiac and Circulation, Legal and Ethical, Research

Author Thumb

Keith Wesley, MD, FACEP

Keith Wesley, MD, FACEP, is the Minnesota State EMS medical director and the EMS medical director for HealthEast Ambulance in St. Paul, Minn. and and can be reached at drwesley@emsconsulting.net.

BROWSE FULL BIO & ARTICLES >

What's Your Take? Comment Now ...

Featured Careers & Jobs in EMS





 

Get JEMS in Your Inbox

 

Fire EMS Blogs


Blogger Browser

Today's Featured Posts

 

EMS Airway Clinic

Innovation & Progress

Follow in the footsteps of these inspirational leaders of EMS.
More >

Multimedia Thumb

Las Vegas Fire, AMR Reach New Deal

Tentative agreement reached over ambulance calls.
Watch It >


Multimedia Thumb

Fire Damages Several Homes in California Earthquake

Four homes destroyed and others damaged after quake rattles Napa.
Watch It >


Multimedia Thumb

Image Trend: ALS Ice Bucket Challenge

ImageTrend just challenged NEMSIS TAC and a couple others.
Watch It >


Multimedia Thumb

Where in the World of EMS is A.J.?

A.J. Heightman participated in the ALS Ice Bucket Challenge in a big way!
Watch It >


Multimedia Thumb

Where in the World of EMS is A.J.? Scranton

JEMS Editor-in-Chief visits his hometown of Scranton, Pa.
More >


Multimedia Thumb

Over 100 Injured in California Earthquake

172 patients treated at Napa hospital after 6.0-magnitude earthquake.
More >


Multimedia Thumb

Numerous Rescues during Arizona Flooding

Severe flooding across the region prompted several rescues.
More >


Multimedia Thumb

LMA MAD Nasal™

Needle-free intranasal drug delivery.
Watch It >


Multimedia Thumb

Field Bridge Xpress ePCR on iPad, Android, Kindle Fire

Sneak peek of customizable run forms & more.
Watch It >


Multimedia Thumb

Braun Ambulances' EZ Door Forward

Helps to create a safer ambulance module.
Watch It >


More Product Videos >