Family Response to Out–of–hospital Death

Schmidt, Terri A.; Harrahill, Maureen

doi:10.1111/j.1553-2712.1995.tb03250.x

Cited by 42 publications

(28 citation statements)

References 33 publications

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“…However, studies show that the family of a patient where CPR has been terminated generally accepts this decision and even in the case when the patient is transported from the scene they would have accepted termination at the scene. [34][35][36] We support the conservative strategy that when the ambulance professional is unsure as to whether CPR would be futile or not, CPR should be administered. This will then give the professional some time to prepare the significant others for the fact that CPR might turn out to be futile, while making reasonably sure that CPR will be futile in saving the patient's life.…”

Section: Background and Previous Researchmentioning

confidence: 82%

Futile cardiopulmonary resuscitation for the benefit of others: An ethical analysis

Bremer

Sandman

2011

Nurs Ethics

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It has been reported as an ethical problem within prehospital emergency care that ambulance professionals administer physiologically futile cardiopulmonary resuscitation (CPR) to patients having suffered cardiac arrest to benefit significant others. At the same time it is argued that, under certain circumstances, this is an acceptable moral practice by signalling that everything possible has been done, and enabling the grief of significant others to be properly addressed. Even more general moral reasons have been used to morally legitimize the use of futile CPR: That significant others are a type of patient with medical or care needs that should be addressed, that the interest of significant others should be weighed into what to do and given an equal standing together with patient interests, and that significant others could be benefited by care professionals unless it goes against the explicit wants of the patient. In this article we explore these arguments and argue that the support for providing physiologically futile CPR in the prehospital context fails. Instead, the strategy of ambulance professionals in the case of a sudden death should be to focus on the relevant care needs of the significant others and provide support, arrange for a peaceful environment and administer acute grief counselling at the scene, which might call for a developed competency within this field.

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Section: Background and Previous Researchmentioning

confidence: 82%

Futile cardiopulmonary resuscitation for the benefit of others: An ethical analysis

Bremer

Sandman

2011

Nurs Ethics

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“…Patients' wishes are ignored, 4 family members and friends face prolonged suffering prior to their loved one's inevitable death, 5 fewer patients may opt for outpatient palliative care for fear their DNR order will be ignored, unwanted resuscitations tie up paramedic resources 6 and paramedics face added emotional stress. 7 Our a priori hypotheses were: 1) that EMT-Ds frequently encounter situations where they are required to resuscitate palliative care patients with DNR orders; 2) that a significant proportion of EMT-Ds comply with patient DNR orders and therefore disobey current regulations; 3) that more experienced EMT-Ds are more likely to comply with patient DNR orders; and 4) that the majority of EMT-Ds are comfortable honouring a patient's DNR order.…”

Section: Introductionmentioning

confidence: 99%

Prehospital emergency medical services’ ethical dilemma with do-not-resuscitate orders

Sherbino

Guru

Verbeek

et al. 2000

CJEM

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Objectives: Our primary objectives were to estimate how frequently emergency medical technicians with defibrillation skills (EMT-Ds) are forced to deal with prehospital do-not-resuscitate (DNR) orders, to assess their comfort in doing so, and to describe the prehospital care provided to patients with DNR orders in a system without a prehospital DNR policy (i.e., where resuscitation is mandatory). Methods: Using Dillman methodology, the authors developed a 13-item survey and mailed it to 382 of 764 EMT-Ds in the metropolitan Toronto area. Responses were evaluated using 5-point Likert scales, limited-option and open-ended questions. Narrative responses were categorized. Two authors independently categorized narrative responses from 20 surveys, and kappa values for agreement beyond chance were determined. Results: Among 382 EMT-Ds surveyed, 236 (62%) responded, of whom 221 (94%) answered the questionnaire. Overall, 126 of 219 (58%) indicated that they were called to resuscitate patients with DNR orders "sometimes," "frequently," or "all the time." In such situations, 22 of 207 (11%) stated they would honour the DNR order and 55 of 207 (27%) would honour the order but appear to provide basic resuscitation, in order to adhere to mandatory resuscitation regulations. Willingness to honour a DNR order did not vary by years of emergency medical service. EMT-Ds cited concern for the family and the patient, fear of repercussions and conflict with personal ethics as key factors contributing to this ethical dilemma. If legally allowed to honour DNR orders, 212 of 221 (96%) respondents would be comfortable with a written order and 137 of 220 (62%) with a verbal order. Conclusions: Prehospital DNR orders are common, and a significant number of EMT-Ds disregard current regulations by honouring them. EMT-Ds would be more comfortable with written than verbal DNR orders. An ethical prehospital DNR policy should be developed and applied. RÉSUMÉ Objectifs : Nos principaux objectifs étaient d'estimer la fréquence à laquelle des techniciens médi-caux d'urgence ayant une formation en défibrillation (TMU-D) sont confrontés à des demandes de ne pas réanimer en situation pré-hospitalière, d'évaluer leur niveau de confort face à de telles situations et de décrire les soins pré-hospitaliers administrés aux patients ayant fait une demande de ne pas réanimer au sein d'un système doté d'aucune politique à ce sujet en situation pré-hospitalière (i.e. la réanimation est obligatoire). Méthodes : À l'aide de la méthodologie de Dillman, un sondage en 13 points fut élaboré et envoyé par la poste à 382 des 746 TMU-D de la région métropolitaine de Toronto. Les réponses furent éval-uées à l'aide d'échelles de Likert en 5 points, de questions à choix limités et de questions à développement. Les réponses à développement furent classées. Deux auteurs (P.R.V. et L.J.M.) classèrent indépendamment les réponses à développement provenant de 20 sondages et les valeurs kappa pour une concordance non aléatoire furent déterminées.

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“…Fortunately, researchers who have evaluated the response of family members and EMS personnel to on-scene pronouncement of death have shown that on-scene pronouncement, at least in adults, is generally well-accepted. [4][5][6] However, education of the EMS providers is central in terms of appropriate sequential procedures, including the best stepwise approaches to initiate the discussion of pronouncement of death with family members.…”

Section: Implementation Of Guidelines and Associated Concernsmentioning

confidence: 99%

“…However, resuscitation decisions in the out-of-hospital setting, including on-scene pronouncement of death, often are complicated by medical, legal, ethical, and sociological considerations for the emergency medical services (EMS) practitioner. [1][2][3][4][5][6][7] For example, according to the philosophy presented in the Uniform Determination of Death Act, 1-3 which has been adopted by many states and endorsed by both the American Bar Association and the American Medical Association, "an individual who has sustained either 1) irreversible cessation of circulatory and respiratory functions or 2) irreversible cessation of all functions of the entire brain, including brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.…”

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confidence: 99%

R Esuscitation in the O Ut-of-Hospital S Etting : M Edical F Utility C Riteria for O N-Scene P Ronouncement of D Eath

Pepe¹,

Swor

Ornato

et al. 2001

Prehospital Emergency Care

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The complete and irreversible cessation of life is often difficult to determine with complete confidence in the dynamic environment of out-of-hospital emergency care. As a result, resuscitation efforts often are initiated and maintained by emergency medical services (EMS) providers in many hopeless situations. Medical guidelines are reviewed here to aid EMS organizations with respect to decisions about: 1) initiating or waiving resuscitation efforts; 2) the appropriate duration of resuscitation efforts; and 3) recommended procedures for on-scene or prehospital pronouncement of death (termination of resuscitation). In cases of nontraumatic cardiac arrest, few unassailable criteria, other than certain physical signs of irreversible tissue deterioration, exist for determining medical futility at the initial encounter with the patient. Thus, the general medical recommendation is to attempt to resuscitate all patients, adult or child, in the absence of rigor mortis or dependent lividity. Conversely, wellfounded guidelines now are available for decisions regarding termination of resuscitation in such patients once they have received a trial of advanced cardiac life support. In practice, however, the final decision to proceed with on-scene pronouncement of death for these patients may be determined more by family and provider comfort levels and the specific on-scene environment. For patients with posttraumatic circulatory arrest, the type of injury (blunt or penetrating), the presence of vital signs, and the electrocardiographic findings are used to determine the futility of initiating or continuing resuscitation efforts. In general, patients who are asystolic on-scene are candidates for on-scene pronouncement, regardless of mechanism. With a few exceptions, blunt trauma patients with a clearly associated mechanism of lethal injury are generally candidates for immediate cessation of efforts once they lose their pulses and respirations. Regardless of the medical futility criteria, specialized training of EMS providers and targeted related testing of operational issues need to precede field implementation of on-scene pronouncement policies. Such policies also must be modified and adapted for local issues and resources. In addition, although the current determinations of medical futility, as delineated here, are important to establish for societal needs, the individual patient's right to live must be kept in mind always as new medical advances are developed.

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Family Response to Out–of–hospital Death

Cited by 42 publications

References 33 publications

Futile cardiopulmonary resuscitation for the benefit of others: An ethical analysis

Futile cardiopulmonary resuscitation for the benefit of others: An ethical analysis

Prehospital emergency medical services’ ethical dilemma with do-not-resuscitate orders

R Esuscitation in the O Ut-of-Hospital S Etting : M Edical F Utility C Riteria for O N-Scene P Ronouncement of D Eath

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