TERMINATION OF NONTRAUMATIC CARDIAC-ARREST RESUSCITATIVE EFFORTS IN THE FIELD - A NATIONAL SURVEY

Objectives: 1) To describe elements of adult nontraumatic cardiac arre st protocols in those U.S. cities in which resuscitative efforts are b eing terminated in the out-of-hospital setting. 2) To determine the pr evalence and methods of on-scene family grief counseling delivered in this setting. Methods: Emergency medical services (EMS) systems in eac h of the 200 largest cities in the United States were surveyed by tele phone regarding the content of their adult cardiac arrest protocols. T ype of arrest (medical vs trauma), final dysrhythmia, termination poli cies, and presence or absence of a grief counseling protocol were reco rded. Results: All of the target population responded to the telephone survey. Most (135; 68%) EMS systems currently have written protocols that allow in-field termination of resuscitative efforts for adult non traumatic cardiac arrest patients who remain asystolic. Only 47 (24%) EMS systems allow cessation of efforts for patients without return of spontaneous circulation regardless of the dysrhythmia. Base station co ntact is required for authorization to end resuscitative efforts in 12 0/135 (89%) EMS systems. Only 26/135 (19%) EMS systems that cease effo rts in the field have written policies concerning on-scene family grie f counseling. This counseling is most likely to be conducted by the ou t-of-hospital providers themselves. Conclusion: Many U.S. urban EMS sy stems are terminating efforts for selected adult nontraumatic cardiac arrest patients, although few have written policies to address grief i ntervention for family members at the scene.