RSS Feeds
Limiting Resuscitation: Emerging Policy in the Emergency Medical System
- Greg A. Sachs, MD;
- Steven H. Miles, MD; and
- Rebekah A. Levin, PhD
Abstract
Patients, families, and physicians frequently decide that a hospitalized patient will forgo cardiopulmonary resuscitation and document this decision with a do-not-resuscitate (DNR) order. In community settings (home, nursing home, hospice), these orders may conflict with paramedics' standing orders to provide cardiopulmonary resuscitation whenever it is medically indicated. We did a nationwide telephone survey of state offices for coordination of emergency medical services (EMS) to see how the states deal with this potential conflict. We identified eight states that have specific policies enabling EMS personnel to accept DNR orders for patients being transported by ambulance. State officials identified administrative complexities and legal concerns as the primary barriers to enacting prehospitalization DNR policies. We also identified 21 local EMS systems that have developed policies for accepting orders to withhold life-sustaining treatment. Four types of policy models, characterized according to procedure for validating DNR orders and telephone accessing the EMS system, show that regulatory reform can address policy barriers in the absence of enabling legislation.
Article and Author Information
-
From the Pritzker School of Medicine of the University of Chicago, Chicago, Illinois; and the Hennepin County Medical Center at the University of Minnesota, Minneapolis, Minnesota. For current author addresses, see end of text.
-
Grant Support: By the Pew Charitable Trusts, the Andrew W. Mellon Foundation, and the Henry J. Kaiser Family Foundation. Dr. Sachs is a Brookdale Foundation National Fellow. Dr. Miles is a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine.
-
Requests for Reprints: Greg Sachs, MD, University of Chicago Hospitals, Department of Medicine, Box 72, 5841 South Maryland Avenue, Chicago, IL 60637-1470.
-
Current Author Addresses: Dr. Sachs: University of Chicago Hospitals, Department of Medicine, Box 72, 5841 South Maryland Avenue, Chicago, IL 60637-1470.
Dr. Miles: Hennepin County Medical Center, Internal Medicine, Geriatric Medicine Division, 701 Park Avenue South, Minneapolis, MN 55415.
Dr. Levin: 1044 South Gunderson, Oak Park, IL 60304.
- ©1991 American College of Physicians
