FIELD EXPERIENCE WITH PREHOSPITAL ADVANCE DIRECTIVES

Study objective: Some states have enacted legislation authorizing EMS providers to adhere to prehospital advance directives (ADs) in the ter minally ill. This study was conducted to assess EMS providers' knowled ge of and experience with prehospital ADs. Methods: An anonymous surve y was conducted of 142 EMS providers employed by a local, private ambu lance service in the northeastern United States. The survey was admini stered during a 2-month period from January to March 1995. Results: Of 142 participating providers, 106 (74.6%) completed questionnaires. Re spondents included EMTs (61.3%), paramedics (33.9%), and chair van ope rators (4.8%). The majority (58.6%) had at least 5 years of field expe rience. Almost all respondents (93.4%) were familiar with ADs, usually do-not-resuscitate orders. Mast providers (78.3%) consider ADs before implementing extraordinary life support measures in terminally ill pa tients. Few (28.0%) have implemented prehospital ADs without medical c ontrol. The most commonly reported abjections to withholding life supp ort measures were fear of legal consequences, personal difficulty with holding care they are trained to provide, and ambiguity in the ADs rec eived. Nearly all respondents (96.7%) support enactment of prehospital AD statutes. Conclusion: Most prehospital care providers recognize th e need to withhold resuscitative care in terminally ill patients who h ave prepared ADs. However, a sizable minority fail to consider prehosp ital ADs as a routine part of their practice. The majority of our resp ondents support enactment of prehospital AD statutes to minimize confu sion and provide legal authorization to limit resuscitation.