Arthur Kellermann, MD; Joanne Lynn, MD
Grant Support: None.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Arthur Kellermann, MD, MPH, Department of Emergency Medicine, School of Medicine, Emory University, 531 Asbury Circle Annex, Suite N340, Atlanta, GA 30322; e-mail, email@example.com.
Current Author Addresses: Dr. Kellermann: Department of Emergency Medicine, School of Medicine, Emory University, 531 Asbury Circle Annex, Suite N340, Atlanta, GA 30322.
Dr. Lynn: RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202.
Kellermann A., Lynn J.; Withholding Resuscitation in Prehospital Care. Ann Intern Med. 2006;144:692-693. doi: 10.7326/0003-4819-144-9-200605020-00014
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Published: Ann Intern Med. 2006;144(9):692-693.
Resuscitating people who will otherwise die defines a major mission for emergency medical services (EMS) (1). Having the technical capacity to resuscitate some patients, however, does not mandate attempting it nor ensure its success. As cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) became widespread, clinicians formulated guidelines and policymakers passed laws to direct their appropriate use (2-4).
Clearly, we should not attempt resuscitation if the patient is obviously dead (5). Sometimes, however, we should not attempt resuscitation when it might succeed—when the patient is approaching death and does not want resuscitation (5, 6). For hospitalized patients, we have well-established routines for avoiding unwanted resuscitation: Physicians anticipate the situation, discuss matters with the patient or family, and write orders forgoing resuscitation.
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