Local Practices May Go Against Resuscitation Guidelines

Emergency medical staff can find it difficult to implement national rules
By Jane Parry
HealthDay Reporter

WEDNESDAY, July 1 (HealthDay News) -- Despite the fact that the American Heart Association has developed national guidelines for the termination of out-of-hospital resuscitation, it is difficult for emergency medical services personnel to implement them because of local barriers and protocols, according to a study published online June 30 in Circulation: Cardiovascular Quality and Outcomes.

Comilla Sasson, M.D., of the University of Michigan in Ann Arbor, and colleagues recruited 19 emergency medical services physicians, two emergency medical services providers, one research director, one nurse and one medical student to three focus groups, lasting 90 to 120 minutes, to identify key themes in the impediment to implementation of termination of resuscitation rules.

The policies and perceptions of three groups may act as an impediment to the adoption of national termination of resuscitation guidelines, the focus groups revealed; namely, payers who offer incentives for transport but do not reward effective technologies; legislators who allow only narrow use of do-not-resuscitate orders; and communities where cultural norms go against termination of resuscitation.

"National organizations, such as the American Heart Association and American College of Emergency Physicians, may serve as potential facilitators in addressing these barriers by: taking the lead in asking payers to change reimbursement structures; encouraging legislators to revise laws to reflect the best available medical evidence; and educating the public that rapid transport to the hospital cannot substitute for optimal provision of prehospital care, including bystander cardiopulmonary resuscitation," the authors conclude.

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