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Field experience with prehospital advance directives
R A Partridge1, A Virk, A Sayah
1Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, USA.
Annals of Emergency Medicine
|October 31, 1998
Summary
Most emergency medical service (EMS) providers are familiar with advance directives (ADs) and support legal statutes for their use. However, some hesitate to implement prehospital ADs due to legal concerns and training.
Area of Science:
- Pre-hospital care
- Medical ethics
- Emergency medicine
Background:
- Legislation now allows emergency medical service (EMS) providers to honor prehospital advance directives (ADs) for terminally ill patients.
- Understanding EMS providers' perspectives on ADs is crucial for effective implementation.
Purpose of the Study:
- To assess EMS providers' knowledge of and experience with prehospital advance directives (ADs).
Main Methods:
- An anonymous survey was distributed to 142 EMS providers in the northeastern United States.
- The survey was conducted between January and March 1995, with 106 (74.6%) providers completing the questionnaire.
Main Results:
- Nearly all respondents (93.4%) were familiar with ADs, primarily do-not-resuscitate orders.
- Most providers (78.3%) consider ADs before providing life support to terminally ill patients.
- Common barriers to implementing ADs included fear of legal repercussions, personal conflict with withholding care, and unclear directives.
Conclusions:
- The majority of EMS providers acknowledge the importance of withholding resuscitative care based on ADs.
- A significant minority do not routinely consider prehospital ADs in their practice.
- Most respondents advocate for prehospital AD statutes to clarify legalities and guide resuscitation decisions.