FOR IMMEDIATE RELEASE-EMERGENCYNET NEWS SVC.-10/18/93-1000CDT JAMA STUDIES CALL FOR PARAMEDICS TO STOP "FUTILE" TREATMENT By Clark Staten, EMT-P, I/C Chicago, IL - Two studies published in the Journal of the American Medical Association (JAMA) say that paramedics should be allowed to discontinue Cardio-Pulmonary Resuscitation (CPR) and other advanced life support procedures when faced with a cardiac arrest patient that doesn't respond to aggressive care. Primary reasons cited by the study include economic efficiency and more appropriate use of limited emergency medical care resources. According to one JAMA study, the cost of "futile" resuscitations has risen to approximately one billion dollars ($1,000,000,000) per year. This figure includes the costs of paramedics, ambulances, nurses, doctors, emergency room supplies, and intensive care costs for people who never live to leave the hospital. The report shows that this enormous cost is the result of attempting to resuscitate patients who have suffered serious brain and heart damage and can only exist through "heroic" measures such as respirators, pacemakers, and heart-lung machines. Secondary in consideration is the fact that prolonged resuscitation of patients in asystole (no viable electrical activity in the heart) takes valuable community resources from those that could actually benefit from the efforts of paramedics and other emergency medical care providers. One of the studies reported that a single cardiac arrest patient may require as much as an hour or more of paramedic's time, two hours of nursing time, and an hour of emergency physician time. In many communities, the number of paramedics and Mobile Intensive Care Unit (M.I.C.U.) ambulances is extremely limited. Often, paramedics working on "hopeless" resuscitative procedures cannot respond to other calls where their presence could make a life-saving difference. Third, doctors say that the policy of "declaring the patient dead at the scene" will help to safeguard emergency responders who are often hurt while bouncing around the back of a speeding ambulance while enroute to the hospital for the patient to be pronounced "legally dead" by an emergency physician. Doctors say that little is gained by rapid transport of a non-viable person upon whom aggressive resuscitative measures have already been undertaken. In fact, this practice may put additional people at risk for little benefit. The doctors warn, however, that the idea of discontinued resuscitative efforts must be part of a paramedic system that includes only the "best" Emergency Medical Service (EMS) providers, (EMT-Paramedics) who have received competent training and have adequate radio/telephone communication with an experienced emergency physician. They cautioned that lessor trained or uninitiated paramedics or EMTs must continue to provide CPR and transport even questionable patients to the nearest appropriate hospital. Fears have been raised by some physicians that less capable paramedics will mistakenly not resuscitate patients with hypothermia, drug abuse, extremely low heart rates, or other conditions that may mimic death. At least one case has occured in New York City, involving a woman who was suffering from hypothermia, that was not correctly diagnosed by Emergency Medical Technicians (EMTs). She was found alive by a coroner's office worker after being "left for dead" by the ambulance. These types of conditions have been specifically excluded by the JAMA studies as causes for non-resuscitation. Other observers have suggested that paramedics, in general, are not adequately trained to make such important decisions. But, Dr. Paul Pepe of the Houston, TX and author of one JAMA study, disagrees and is quoted in USA Today as saying, "It's about time we all start doing this formally . . . this is a universal, aggressive, attempt to save everybody . . . but if they don't respond to treatment . . . they don't respond". Supporters of the policy point to EMS systems in Seattle, Pittsburgh, Milwaukee and Houston, where the concept has proved to be feasible. The JAMA report says that the best opportunities for successful resuscitations include fast access to emergency dispatch systems (911), immediate initiation of effective Cardio-Pulmonary Resuscitation (CPR), rapid defibrillation of fibrillating (uncontrolled quivering) hearts, good oxygenation of brain and heart tissue, and administration of appropriate medications to regulate the patient's heartbeat and blood pressure. Experts say that paramedic systems are the most timely and cost effective way of providing these essential services to those in greatest need. -30- (c) EmergencyNet NEWS Service Emergency Response & Research Institute 5656 N. Moody St., Chicago, IL 60646 (312) 631-1101 - Voice/Messages (312) 631-4703 - Fax (312) 631-3467 - Computer/Modem-EMERGENCY BBS-2400bps-24hrs. (312) 631-3950 - " " " 9600bps " (312) 631-0517 - " " " 14,400bps "