The perspective of paramedics about on-scene termination of resuscitation efforts for pediatric patients

William L. Hall, John H. Myers, Paul E. Pepe, Gregory L. Larkin, Paul E. Sirbaugh, David E. Persse

Research output: Contribution to journalArticlepeer-review

36 Scopus citations

Abstract

Objectives: The purpose of this study was to assess the attitude of paramedics to on-scene termination of cardiopulmonary resuscitation (T-CPR) efforts in children prior to developing a pediatric T-CPR policy. Methods: A 26-item anonymous survey was conducted of all of the active paramedics in a large urban EMS system where T-CPR had been practiced routinely for adults. Questions addressed paramedic demographics, training level, experience with adult and pediatric advanced cardiac life support (ACLS), experience with T-CPR in adults, T-CPR case scenarios, and T-CPR in children. Results: All 201 paramedics in the system (mean age=34.2 years; mean years as paramedic=8.5) completed all relevant items of the survey (100% compliance). Two-thirds had provided ACLS for cardiac arrest to >50 adults (93% >10 adults) and more than one-third had performed ACLS on >20 children (72% >5 children). In addition, 90% had participated in T-CPR for adults. The majority of paramedics reported at least occasional (pre-defined) difficulty with adult T-CPR including family confrontation, 43%; personal discomfort, 13%; disagreement with physician decision to continue efforts, 11%; and fear of liability, 10%. Paramedic self ratings of comfort with terminating CPR on a scale from 1 to 10 (1: very comfortable; 10: uncomfortable) for adults and children were 1 and 9, respectively (P<0.001). In addition, the clear majority (72%) responded that children deserve more aggressive resuscitative efforts than adults. Conclusions: Paramedics feel relatively uncomfortable with the concept of terminating resuscitation efforts in children in the pre-hospital setting.

Original languageEnglish (US)
Pages (from-to)175-187
Number of pages13
JournalResuscitation
Volume60
Issue number2
DOIs
StatePublished - Feb 2004

Keywords

  • Cardiac arrest
  • Cardiopulmonary resuscitation (CPR)
  • Ethics
  • Medical Futility
  • Paramedic
  • Pediatric Resuscitation

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

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