Limiting resuscitation: Emerging policy in the emergency medical system

Greg A. Sachs, Steven H. Miles, Rebekah A. Levin

Research output: Contribution to journalArticle

45 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)151-154
Number of pages4
JournalAnnals of internal medicine
Volume114
Issue number2
DOIs
StatePublished - Jan 15 1991

Fingerprint

Resuscitation Orders
Emergency Medical Services
Emergencies
Cardiopulmonary Resuscitation
Telephone
Home Nursing
Allied Health Personnel
Hospices
Ambulances
Family Physicians
Nursing Homes
Legislation

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Limiting resuscitation : Emerging policy in the emergency medical system. / Sachs, Greg A.; Miles, Steven H.; Levin, Rebekah A.

In: Annals of internal medicine, Vol. 114, No. 2, 15.01.1991, p. 151-154.

Research output: Contribution to journalArticle

Sachs, Greg A. ; Miles, Steven H. ; Levin, Rebekah A. / Limiting resuscitation : Emerging policy in the emergency medical system. In: Annals of internal medicine. 1991 ; Vol. 114, No. 2. pp. 151-154.
@article{c91a3abca9024a92b1de7a4794bc87b1,
title = "Limiting resuscitation: Emerging policy in the emergency medical system",
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.",
author = "Sachs, {Greg A.} and Miles, {Steven H.} and Levin, {Rebekah A.}",
year = "1991",
month = "1",
day = "15",
doi = "10.7326/0003-4819-114-2-151",
language = "English (US)",
volume = "114",
pages = "151--154",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "2",

}

TY - JOUR

T1 - Limiting resuscitation

T2 - Emerging policy in the emergency medical system

AU - Sachs, Greg A.

AU - Miles, Steven H.

AU - Levin, Rebekah A.

PY - 1991/1/15

Y1 - 1991/1/15

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=0026034142&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026034142&partnerID=8YFLogxK

U2 - 10.7326/0003-4819-114-2-151

DO - 10.7326/0003-4819-114-2-151

M3 - Article

C2 - 1984394

AN - SCOPUS:0026034142

VL - 114

SP - 151

EP - 154

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 2

ER -