title: Variation of current protocols for managing out-of-hospital cardiac arrest in prehospital settings among Asian countries.
abstract: OBJECTIVE
  Protocols for managing patients with out-of-hospital cardiac arrest (OHCA) may vary due to legal, cultural, or socioeconomic concerns. We sought to assess international variation in policies and protocols related to OHCA.
  
  
  METHODS
  A brief survey was developed by consensus. Elicited information included protocols for managing patients with nontraumatic OHCA or traumatic OHCA, policies for using automated external defibrillators (AEDs) during transportation of patients with ongoing resuscitation, and application of terminations of resuscitation (TOR) rules in prehospital settings in the respondent's city or country. The populations of interest were emergency physicians, medical directors of emergency medical services (EMS), and policy makers.
  
  
  RESULTS
  Responses were obtained from eight cities in six Asian countries. Only one (12.5%) city applied TOR rules for OHCAs. Do-not-resuscitate (DNR) orders were valid in prehospital settings in five (62.5%) cities. All cities used AEDs for nontraumatic OHCAs; seven (87.5%) cities did not routinely use AEDs for traumatic OHCAs. For nontraumatic OHCAs, four (50%) cities performed 2 minutes of on-scene cardiopulmonary resuscitation (CPR) and then transported the patients with ongoing resuscitation to hospitals; three (37.5%) cities performed 4 minutes of on-scene CPR; one (12.5%) city allowed variation in the duration of on-scene CPR.
  
  
  CONCLUSIONS
  International variation in practices and polices related to OHCAs do exist. Concerns regarding prehospital TOR rules include medical evidence, legal considerations, EMS manpower, public perception, medical oversight, education, EMS characteristics, and cost-effectiveness analysis. Further research is needed to achieve consensus regarding management protocols, especially for EMS that perform resuscitation during transportation of OHCA patients.
authors.affiliation: Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC. Electronic address: emergency.lin@gmail.com.
authors.forename: Chih-Hao
authors.initials: CH
authors.lastname: Lin
authors.affiliation: Medical Department, Singapore Civil Defense Force, Singapore.
authors.forename: Yih Yng
authors.initials: YY
authors.lastname: Ng
authors.affiliation: Department of Emergency Medicine, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan, ROC.
authors.forename: Wen-Chu
authors.initials: WC
authors.lastname: Chiang
authors.affiliation: Department of Emergency Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
authors.forename: Sarah Abdul
authors.initials: SA
authors.lastname: Karim
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Sang Do
authors.initials: SD
authors.lastname: Shin
authors.affiliation: Department of Emergency System, Kokushikan University Graduate School of Sport System, Tokyo, Japan.
authors.forename: Hideharu
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Acute Medicine, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nishiuchi
authors.affiliation: Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kajino
authors.affiliation: Department of Emergency Medicine, Rajavithi Hospital, Bangkok, Thailand.
authors.forename: Nalinas
authors.initials: N
authors.lastname: Khunkhlai
authors.affiliation: Department of Emergency Medicine, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan, ROC.
authors.forename: Matthew Huei-Ming
authors.initials: MH
authors.lastname: Ma
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore.
authors.forename: Marcus Eng Hock
authors.initials: ME
authors.lastname: Ong
mesh_terms: D001208:Asia; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D002947:Cities; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D047548:Defibrillators / Q000592:standards*; D004632:Emergency Medical Services; D006801:Humans; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D010820:Physicians; D016414:Resuscitation Orders; D011795:Surveys and Questionnaires
keywords: Out-of-hospital Cardiac Arrest; Prehospital; Protocol