The perspective of paramedics about on-scene termination of resuscitation efforts for pediatric patients

Hall, William L.; Myers, John; Pepe, Paul E.; Larkin, Gregory Luke; Sirbaugh, Paul E.; Persse, David

doi:10.1016/j.resuscitation.2003.09.013

Cited by 53 publications

(32 citation statements)

References 47 publications

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“…98 On the basis of the literature to date, the reluctance stems from provider and public ignorance of out-of-hospital arrest outcomes, [26][27]29,[103][104][105] fear related to inadequate preparation for communication with acutely grieving family members, 26,106 perceived determinants of family adaptation to loss, and concerns regarding legal liability for providers. The issue of whether families benefit from futile resuscitative measures in the field and ED has not been studied.…”

Section: Discussionmentioning

confidence: 99%

“…107,108 Increased training and information is desired by EMS providers 109 and seems to mitigate the discomfort in some settings. 26,29,109,110 There are no US studies of the needs of families of children at the scene of the death, although it is the time of the most tremendous shock and the time when EMS providers have the unique opportunity to positively affect the lives of the survivors forever. Most existing advice regarding the needs of families affected by the sudden, unexpected death of a child is based on extrapolations from the hospital setting or on anecdotal evidence.…”

Section: Discussionmentioning

confidence: 99%

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Withholding or Termination of Resuscitation in Pediatric Out-of-Hospital Traumatic Cardiopulmonary Arrest

Fallat¹,

Cooper²,

Salomone³

et al. 2014

Pediatrics

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This multiorganizational literature review was undertaken to provide an evidence base for determining whether recommendations for outof-hospital termination of resuscitation could be made for children who are victims of traumatic cardiopulmonary arrest. Although there is increasing acceptance of out-of-hospital termination of resuscitation for adult traumatic cardiopulmonary arrest when there is no expectation of a good outcome, children are routinely excluded from state termination-of-resuscitation protocols. The decision to withhold resuscitative efforts in a child under specific circumstances (decapitation or dependent lividity, rigor mortis, etc) is reasonable. If there is any doubt as to the circumstances or timing of the traumatic cardiopulmonary arrest, under the current status of limiting termination of resuscitation in the field to persons older than 18 years in most states, resuscitation should be initiated and continued until arrival to the appropriate facility. If the patient has arrested, resuscitation has already exceeded 30 minutes, and the nearest facility is more than 30 minutes away, involvement of parents and family of these children in the decision-making process with assistance and guidance from medical professionals should be considered as part of an emphasis on family-centered care because the evidence suggests that either death or a poor outcome is inevitable. Pediatrics 2014;133:e1104-e1116

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Withholding or Termination of Resuscitation in Pediatric Out-of-Hospital Traumatic Cardiopulmonary Arrest

Fallat¹,

Cooper²,

Salomone³

et al. 2014

Pediatrics

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show abstract

“…Possible directions for future research include prospective validation of these termination-of-resuscitation rules, competence and comfort level of BLS providers in grief management, 31,32 and public response to field pronouncement by BLS providers. 30 In conclusion, we found all 3 termination-of-resuscitation rules to have high sensitivity and high negative predictive value.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Termination-of-Resuscitation Guidelines for Basic Life Support: Defibrillator Providers in Out-of-Hospital Cardiac Arrest

Ong

Jaffey

Stiell

et al. 2006

Annals of Emergency Medicine

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“…36,37 No such data exist for children in the United States, but a Swedish study in adolescents with sudden cardiac death is supportive of pronouncement on scene as an option on the basis of parental report. 38 However, Hall et al 39 noted that paramedics are far more uncomfortable with termination of efforts in the field for a child than for an adult. Therefore, a child or infant may be transported to the hospital even though the resuscitative efforts may be futile, in order to provide a setting with better resources for support of the family and providers.…”

Section: Noninitiation and Termination Of Resuscitation Attemptsmentioning

confidence: 99%

Death of a Child in the Emergency Department

O’Malley¹,

Shook²,

Ackerman³

et al. 2014

Pediatrics

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The death of a child in the emergency department (ED) is one of the most challenging problems facing ED clinicians. This revised technical report and accompanying policy statement reaffirm principles of patient- and family-centered care. Recent literature is examined regarding family presence, termination of resuscitation, bereavement responsibilities of ED clinicians, support of child fatality review efforts, and other issues inherent in caring for the patient, family, and staff when a child dies in the ED. Appendices are provided that offer an approach to bereavement activities in the ED, carrying out forensic responsibilities while providing compassionate care, communicating the news of the death of a child in the acute setting, providing a closing ritual at the time of terminating resuscitation efforts, and managing the child with a terminal condition who presents near death in the ED.

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The perspective of paramedics about on-scene termination of resuscitation efforts for pediatric patients

Cited by 53 publications

References 47 publications

Withholding or Termination of Resuscitation in Pediatric Out-of-Hospital Traumatic Cardiopulmonary Arrest

Withholding or Termination of Resuscitation in Pediatric Out-of-Hospital Traumatic Cardiopulmonary Arrest

Comparison of Termination-of-Resuscitation Guidelines for Basic Life Support: Defibrillator Providers in Out-of-Hospital Cardiac Arrest

Death of a Child in the Emergency Department

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