Resuscitation of residents with do not resuscitate orders in long-term care facilities.
BACKGROUND
A considerable number of emergency medical services (EMS) responses for cardiac arrest occur in long-term care facilities. In some instances, these responses are for residents who have expressed wishes not to be resuscitated by signing a do not resuscitate (DNR) order.


OBJECTIVE
To assess the magnitude of EMS use for cardiac arrest in long-term care facilities for residents with DNR orders and to determine reasons why EMS is called.


METHODS
A retrospective study was conducted using data collected from medical incident reports between July 1999 and December 2000 for all persons experiencing cardiac arrest in long-term care facilities defined as nursing homes, adult family homes, and assisted-living centers in King County, Washington, excluding Seattle. The authors also surveyed facilities to determine their policies for calling 9-1-1 in the event of cardiac arrest. Results. Of the 392 cardiac arrests in long-term care facilities to which EMS responded, 139 (35%) of the residents had DNR orders. Of these 139, 29 (21%) received attempted resuscitation by EMS. The problem appeared to be greater among nursing homes and adult family homes than in assisted-living centers. Among nursing homes, the primary reason for an EMS call was concern for validity of the DNR order, whereas among adult family homes, the primary concern was appropriate medical authority to declare death.


CONCLUSIONS
Efforts to clarify existing regulations, streamline the DNR transfer process, and improve communication between EMS and long-term care facilities may result in better fulfillment of residents' end-of-life wishes and a saving of EMS resources.
Becker
Linda J
LJ
Emergency Medical Services Division, Public Health of Seattle and King County, Seattle, Washington 98104, USA. linda.becker@metrokc.gov
Yeargin
Kimberlee
K
Rea
Thomas D
TD
Owens
Merrili
M
Eisenberg
Mickey S
MS
D000368:Aged; D040561:Assisted Living Facilities / Q000458:organization & administration* / Q000706:statistics & numerical data; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D016352:Group Homes / Q000458:organization & administration* / Q000706:statistics & numerical data; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration; D009735:Nursing Homes / Q000458:organization & administration* / Q000706:statistics & numerical data; D016134:Organizational Policy; D016414:Resuscitation Orders; D012189:Retrospective Studies; D014861:Washington