Termination of Resuscitative Efforts

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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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Thomas M., Jr. -

Josh and Anand

Thanks for discussing this topic. I have a bit of a different view. I was an EMS MD for 15 years in a large, just over 100K calls per year, urban/suburban EMS agency until 2015. Within our protocols I had provided "Field Death" and "Termination of CPR" protocols which were quite explicit and empowered our crews to make these calls on the scene without involving a whole other layer of medical command. Of course, in any questionable situations, they could either call me directly, available 24/7/365 for on line medical command with me or my partner, or they could raise the receiving facility for medical control. Having said that, they required this back up quite infrequently and that was the point. They were educated and empowered to make these decisions much like any other decision in the field. Granted, there were those extraordinary situations such as you described in your segment, i.e., large public gatherings, concerns about scene safety and the like. But again, these were rare occurrences. Today, our ED, located in another jurisdiction, receives regular calls from another agency to "call patients" in the field after EMS has been working on the scene for 20 minutes or more (this is their new cardiac arrest protocol, which I also have issues with-another topic for another day). I believe the MDs of those agencies that require "routine" calls to receiving EDs for terminations and declarations are abrogating their responsibilities and placing them onto the shoulders of the EPs at these EDs. Love to hear your thoughts on my thoughts!
Thanks,
Thomas H. Matese, Jr., DO, FACP, FACEP

Joshua B. -

Hi Tom! Thanks for the comments. I am fully supportive of empower our medics in the field to be able to make certain decisions. In NJ, their practice is very restricted and outside of very basic treatments included under standing orders (issued by the state, written into legislation about 10 years ago), they require medical control for anything, including giving ondansetron. It is outdated but an unfortunately reality of the system we practice in.

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