Field experience with prehospital advance directives

Some states have enacted legislation authorizing EMS providers to adhere to prehospital advance directives (ADs) in the terminally ill. This study was conducted to assess EMS providers' knowledge of and experience with prehospital ADs.

An anonymous survey was conducted of 142 EMS providers employed by a local, private ambulance service in the northeastern United States. The survey was administered during a 2-month period from January to March 1995.

Of 142 participating providers, 106 (74.6%) completed questionnaires. Respondents included EMTs (61. 3%), paramedics (33.9%), and chair van operators (4.8%). The majority (58.6%) had at least 5 years of field experience. Almost all respondents (93.4%) were familiar with ADs, usually do-not-resuscitate orders. Most providers (78.3%) consider ADs before implementing extraordinary life support measures in terminally ill patients. Few (28.0%) have implemented prehospital ADs without medical control. The most commonly reported objections to withholding life support measures were fear of legal consequences, personal difficulty withholding care they are trained to provide, and ambiguity in the ADs received. Nearly all respondents (96.7%) support enactment of prehospital AD statutes.

Most prehospital care providers recognize the need to withhold resuscitative care in terminally ill patients who have prepared ADs. However, a sizable minority fail to consider prehospital ADs as a routine part of their practice. The majority of our respondents support enactment of prehospital AD statutes to minimize confusion and provide legal authorization to limit resuscitation.