Implementation strategies for a do-not-resuscitate program in the prehospital setting**

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Implementation of a do-not-resuscitate (DNR) program in the prehospital setting in the greater Kansas City area using a standardized form created by a consortium of ethics committees began in January of 1989. This paper describes the strategies for implementation of the program.

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INTRODUCTION

It had been customary medical practice and American Heart Association recommendation to assume that CPR is to be performed on all patients found to be in acute or impending cardiac or respiratory arrest. However, is CPR always the "right" thing to do? Probably not. For hospitalized patients, a physician could write a do-not-resuscitate (DNR) order on the patient's chart, and the patient will be protected from the inappropriate use of CPR. However, in most instances, for persons outside the

CONCLUSION

CPR is neither desired by all persons nor beneficial for many people who are chronically or terminally ill. To ensure the right of adults to be self-determining, it is important to have a mechanism in place so that people can refuse CPR when they arrest outside the hospital. The emegency nature of most EMS calls makes it difficult to recognize those citizens who would decline CPR in a timely fashion. The Kansas City community project has successfully provided such a vehicle. Paramedics report

Acknowledgements

The authors acknowledge Johnson County, Kansas Emergency Medical Services (MED-ACT), and Metropolitan Ambulance Services Trust (MAST) of Kansas City, Missouri, for taking a lead role in the development and implementation of this program and thank all other groups who participated.

References (6)

  • R Crampton

    Prehospital advanced cardiac life support: Evaluation of a decade of experience. Topics in Emergency Medicine: The Prehospital Care System

    (1980)
  • M Eisenberg et al.

    Evaluation of paramedic services for cardiac arrest

    National Center for Health Services Research Report

    (December 1980)
  • M Szczygiel et al.

    Prognostic indicators of ultimate long-term survival following advanced life support

    Ann Emerg Med

    (1981)
There are more references available in the full text version of this article.

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Reprint no. 47/1/55101

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