Resuscitation decision making by New Mexico emergency medical technicians

The extent to which Emergency Medical Service personnel are placed in situations in which difficult cardiopulmonary resuscitation decisions must be made has been poorly explored. Further, it is not known whether this kind of decision making is troubling to emergency medical technicians. Although it is likely that emergency medical service systems handle withholding cardiopulmonary resuscitation in a variety of ways, the authors chose to examine a cross-section of New Mexico emergency medical technicians. Using a survey instrument, emergency medical technicians of all training levels, representing several emergency medical service systems around the state were asked how many times in their career they had been in a situation in which cardiopulmonary resuscitation had been withheld without a direct physician order. Of 310 individuals surveyed, 211 (66.8%) responded that this had occurred at least once. When asked whether they had been troubled by one of these situations, 86 of 211 (41%) individuals responded "yes." When a variety of demographic factors were evaluated, only training to the paramedic level was identified as being an independent predictor of those who were troubled (P = .019). Emergency medical technician training, protocols, and do not resuscitate programs may need to be expanded to give further guidance to prehospital personnel when making difficult resuscitation decisions.