title: The perspective of paramedics about on-scene termination of resuscitation efforts for pediatric patients.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA. uschibill@yahoo.com
authors.forename: William L
authors.initials: WL
authors.lastname: Hall
authors.forename: John H
authors.initials: JH
authors.lastname: Myers
authors.forename: Paul E
authors.initials: PE
authors.lastname: Pepe
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Larkin
authors.forename: Paul E
authors.initials: PE
authors.lastname: Sirbaugh
authors.forename: David E
authors.initials: DE
authors.lastname: Persse
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D016887:Cardiopulmonary Resuscitation / Q000941:ethics / Q000592:standards* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000941:ethics / Q000379:methods*; D004634:Emergency Medical Technicians / Q000523:psychology*; D005260:Female; D019538:Health Care Surveys; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007400:Interprofessional Relations; D016365:Liability, Legal; D016015:Logistic Models; D008297:Male; D018447:Medical Futility / Q000523:psychology*; D011368:Professional-Family Relations; D016414:Resuscitation Orders; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014481:United States