What should we consider when applying termination of resuscitation rules?

“…In summary, this study provides new information about the usefulness and limitations of structured TOR training and can inform settings that are considering introducing similar protocols. In the implementation of a new TOR protocol, factors other than paramedics' psychological comfort should be considered, and these include the complexity of the protocol itself [7], public expectations of not dying at home [4] and legal barriers towards field death pronouncement by paramedics [5,27].…”

Section: Discussionmentioning

confidence: 99%

“…There are inherent challenges to the application of the TOR protocol itself. Applying TOR protocols involves the fulfilment of one pre-requisite and two components [5,7] (Figure 1). The pre-requisite is the performance of cardiac resuscitation on the patient, while the two components include assessing for suitability of TOR application based on pre-determined criteria and the breaking of bad news to the patient's loved ones.…”

Section: Introductionmentioning

confidence: 99%

Improving Psychological Comfort of Paramedics for Field Termination of Resuscitation through Structured Training

Bang

Mao

Cheng

et al. 2021

IJERPH

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This study examines the impact of a newly developed structured training on Singapore paramedics’ psychological comfort before the implementation of a prehospital termination of resuscitation (TOR) protocol. Following a before and after study design, the paramedics underwent a self-administered questionnaire to assess their psychological comfort level applying the TOR protocol, 22 months before and one month after a 3-h structured training session. The questionnaire addressed five domains: sociocultural attitudes on resuscitation and TOR, multi-tasking, feelings towards resuscitation and TOR, interactions with colleagues and bystanders and informing survivors. Overall psychological comfort total (PCT) scores and domain-specific scores were compared using the paired t-test with higher scores representing greater comfort. Ninety-six of the 345 eligible paramedics responded. There was no statistically significant change in the mean PCT scores at baseline and post-training; however, the “feelings towards resuscitation and TOR” domain improved by 4.77% (95% CI 1.42 to 8.13 and p = 0.006) and the multi-tasking domain worsened by 4.11% (95% CI −7.82 to −0.41 and p = 0.030). While the structured training did not impact on the overall psychological comfort levels, it led to improvements in the feelings of paramedics towards resuscitation and TOR. Challenges remain in improving paramedics’ psychological comfort levels towards TOR.

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“…This individualization gives providers – some of whom may question the appropriateness of CPR – input into what an appropriate code should entail for each patient, thereby minimizing provider discomfort/distress and maximizing expert engagement. A growing literature considers what an appropriate code might entail (and for how long), 56–58,60–62 but a comprehensive discussion of this is beyond the scope of this manuscript.…”

Section: Challenging the “All Or Nothing” Dichotomymentioning

confidence: 99%

Is There Ever a Role for the Unilateral Do Not Attempt Resuscitation Order in Pediatric Care?

Marron

Jones

Wolfe

2018

Journal of Pain and Symptom Management

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Care for children as they near the end of life is difficult and very complex. More difficult still are the decisions regarding what interventions are and are not indicated during these trying times. Occasionally, families of children who are nearing the end of life disagree with the assessment of the medical team regarding these interventions. In rare cases, the medical team can be moved to enact a do not attempt resuscitation order against the wishes of the patient's parents. This article presents one such illustrative case and discusses the ethical issues relevant to such challenging clinical scenarios. The authors posit that such a unilateral do not attempt resuscitation order is only appropriate in very limited circumstances in pediatric care. Instead, focus should be placed on open discussion between parents and members of the clinical team, shared decision making, and maintenance of the clinician-parent relationship while simultaneously supporting members of the clinical team who express discomfort with parental decisions. The authors propose an alternative framework for approaching such a conflict based on clinician-parent collaboration and open communication.

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What should we consider when applying termination of resuscitation rules?

Cited by 6 publications

References 24 publications

Is it possible to terminate resuscitation in accordance with the termination of resuscitation rule?

Is it possible to terminate resuscitation in accordance with the termination of resuscitation rule?

Improving Psychological Comfort of Paramedics for Field Termination of Resuscitation through Structured Training

Is There Ever a Role for the Unilateral Do Not Attempt Resuscitation Order in Pediatric Care?

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