Paramedic and emergency medical technicians views on opportunities and challenges when forgoing and halting resuscitation in the field.
OBJECTIVE
The objective was to assess paramedic and emergency medical technicians (EMT) perspectives and decision-making after a policy change that allows forgoing or halting resuscitation in prehospital atraumatic cardiac arrest.


METHODS
Five semistructured focus groups were conducted with 34 paramedics and 2 EMTs from emergency medical services (EMS) agencies within Los Angeles County (LAC), 6 months after a policy change that allowed paramedics to forgo or halt resuscitation in the field under certain circumstances.


RESULTS
Participants had an overwhelmingly positive view of the policy; felt it empowered their decision-making abilities; and thought the benefits to patients, family, EMS, and the public outweighed the risks. Except under certain circumstances, such as when the body was in public view or when family members did not appear emotionally prepared to have the body left on scene, they felt the policy improved care. Assuming that certain patient characteristics were present, decisions by paramedics about implementing the policy in the field involve many factors, including knowledge and comfort with the new policy, family characteristics (e.g., agreement), and logistics regarding the place of arrest (e.g., size of space). Paramedic and EMT experiences with and attitudes toward forgoing resuscitation, as well as group dynamics among EMS leadership, providers, police, and ED staff, also play a role.


CONCLUSIONS
Participants view the ability to forgo or halt resuscitation in the field as empowering and do not believe it presents harm to patients or families under most circumstances. Factors other than patient clinical characteristics, such as knowledge and attitudes toward the policy, family emotional preparedness, and location of arrest, affect whether paramedics will implement it.
Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY, USA. corita.grudzen@mountsinai.org
Corita R
CR
Grudzen
Stefan
S
Timmermans
William J
WJ
Koenig
Jacqueline M
JM
Torres
Jerome R
JR
Hoffman
Karl A
KA
Lorenz
Steven M
SM
Asch
D000328:Adult; D001291:Attitude of Health Personnel; D002140:California; D016887:Cardiopulmonary Resuscitation / Q000523:psychology*; D003625:Data Collection; D003657:Decision Making; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians / Q000523:psychology*; D005190:Family / Q000523:psychology; D017144:Focus Groups; D006291:Health Policy; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D028761:Withholding Treatment; D055815:Young Adult