Implementation strategies for a do-not-resuscitate program in the prehospital setting**
Section snippets
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.
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Reprint no. 47/1/55101