Standards and limits: emergency physicians' attitude toward prehospital resuscitation

The attitudes of emergency physicians toward using medical techniques in out-of-hospital medical cardiac arrest scenarios were assessed. The physicians' willingness to further limit the use of these techniques through prehospital Do Not Attempt Resuscitation (DNAR) protocols and their personal use of advance directives were also assessed. Questionnaires were distributed to the 1990 Council of the American College of Emergency Physicians, San Francisco, CA, to elicit demographic and clinical information. Of the 172 ACEP Council members (emergency physicians) asked to participate, 136 (79%) returned a questionnaire. These physicians represented all of the 50 United States, Puerto Rico, and two Canadian provinces. In two scenarios, most respondents recognized the uselessness of continued resuscitation for themselves, their spouse, and their parent. However, in these same situations approximately half of them would continue treating their child. Although nearly two thirds of the respondents did not have a prehospital DNAR policy in their emergency medicine system (EMS), 95% felt that they needed such a protocol. Only one-third of respondents had any type of advance directive for themselves. Experienced emergency physicians recognize that there are limits to the application of medical techniques, but are less willing to stop pediatric resuscitations, than they are to stop adult resuscitations. Emergency physicians agree on the need for prehospital DNAR protocols, but few have completed their own advance directives.