title: Reasons 9-1-1 is called for cardiac arrest cases in which no resuscitation is attempted.
abstract: OBJECTIVE
  The goal of this investigation was to describe the reasons emergency medical services (EMS) is activated when resuscitation is not desired or when patients show signs of irreversible death.
  
  
  METHODS
  All medical incident report forms (MIRFs) indicating a cardiac arrest for which resuscitation was withheld were obtained from five participating fire departments. For each eligible case (N = 196), one of the emergency medical technicians (EMTs) present at the scene was interviewed and the dispatch tape of the 9-1-1 call was reviewed. Patient and caller characteristics were abstracted from the MIRFs and dispatch tapes. The EMTs were asked about the reasons for the call, whether the family expected this death, and the caller's emotional state when EMS arrived at the scene. In addition, EMS providers were asked open-ended questions about the services they provided for the patient and patient's family. Using chi-square statistics and t-tests, we compared two groups: 1) patients for whom resuscitation was not desired as indicated by a do-not-resuscitate (DNR) order, terminal illness, or hospice (n = 66) and 2) patients for whom resuscitation was not started because of signs of irreversible death (n = 130).
  
  
  RESULTS
  Compared with callers for patients with signs of irreversible death, callers for patients for whom resuscitation was not desired were less likely to access EMS because they needed medical assistance (11% versus 30%) and more likely to call 9-1-1 because they thought it was "required by law" (30% versus 8%). Other common reasons in both groups for activating 9-1-1 were confusion regarding what to do and a request to confirm death. The most frequently reported service provided by EMTs for both groups was to "offer to contact a chaplain."
  
  
  CONCLUSIONS
  In a third of patients for whom EMS did not initiate resuscitation, resuscitation was withheld primarily because it was not desired rather than because there was evidence of irreversible death. Efforts to improve education may prevent EMS activation in these cases. An alternative EMS response could also help ensure patient autonomy and decrease costs to the EMS system.
authors.affiliation: Department of Health Services, University of Washington, Seattle, Washington 98195, USA. hendrika@u.washington.edu
authors.forename: Hendrika
authors.initials: H
authors.lastname: Meischke
authors.forename: Devora
authors.initials: D
authors.lastname: Chavez
authors.forename: Sylvia
authors.initials: S
authors.lastname: Feder
authors.forename: Tom
authors.initials: T
authors.lastname: Rea
authors.forename: Tyler
authors.initials: T
authors.lastname: Albert
authors.forename: Mickey
authors.initials: M
authors.lastname: Eisenberg
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation; D004631:Emergency Medical Service Communication Systems; D005260:Female; D006323:Heart Arrest; D006801:Humans; D008297:Male; D008875:Middle Aged; D011908:Rationalization; D016079:Refusal to Treat; D012189:Retrospective Studies