Sylvia Feder, MA, MICP; Roger L. Matheny, MICP; Robert S. Loveless Jr, PhD, EMT-D; Thomas D. Rea, MD, MPH
Acknowledgments: The authors thank Dr. Thomas Hearne, Dr. Mickey Eisenberg, Dr. Jack Murray, and John Jerin, King County Emergency Medical Services, for supporting the withholding resuscitation program; Ed Plumlee, King County Medic One, for advocating the program to the local fire chiefs; Linda Becker, King County Emergency Medical Service, for assistance with data acquisition; and Dr. Ned Feder for advice.
Grant Support: By the Medic One Foundation and King County Emergency Medical Services.
Potential Financial Conflicts of Interest: Grants: S. Feder, R.L. Matheny (Medic One Foundation).
Corresponding Author: Sylvia Feder, King County Medic One, 7064 South 220th Street, Kent, WA 98032; e-mail, firstname.lastname@example.org.
Current Author Addresses: Ms. Feder and Mr. Matheny: King County Medic One, 7064 South 220th Street, Kent, WA 98032.
Dr. Loveless: Kent Fire Department, 24611 116 Avenue SE, Kent, WA 98030.
Dr. Rea: University of Washington/King County Emergency Medical Services, 999 3rd Avenue, Suite 700, Seattle, WA 98104.
Author Contributions: Conception and design: S. Feder, R.L. Matheny.
Analysis and interpretation of the data: S. Feder, R.S. Loveless Jr., T.D. Rea.
Drafting of the article: S. Feder.
Critical revision of the article for important intellectual content: S. Feder, R.L. Matheny, R.S. Loveless Jr., T.D. Rea.
Final approval of the article: S. Feder, R.L. Matheny, R.S. Loveless Jr., T.D. Rea.
Statistical expertise: R.S. Loveless Jr., T.D. Rea.
Obtaining of funding: S. Feder, R.L. Matheny.
Administrative, technical, or logistic support: R.L. Matheny.
Collection and assembly of data: S. Feder, R.L. Matheny, R.S. Loveless Jr.
Emergency medical services (EMS) personnel often are not permitted to honor requests to withhold resuscitation at the end of life, particularly if there is no written do-not-resuscitate (DNR) order.
To determine whether EMS personnel from agencies implementing new guidelines would be more likely to withhold resuscitation from persons having out-of-hospital cardiac arrests than would personnel from agencies that did not implement the guidelines.
Observational study in which 16 of 35 local EMS agencies volunteered to implement new guidelines for withholding resuscitation.
King County, Washington.
2770 patients with EMS-attended cardiac arrest.
New guidelines adopted by participating agencies permitted EMS personnel to withhold resuscitation if the patient had a terminal condition and if the patient, family, or caregivers indicated, in writing or verbally, that no resuscitation was desired.
Proportion of resuscitations withheld in agencies that implemented new guidelines compared with those that did not.
Emergency medical services personnel from agencies implementing new guidelines withheld resuscitation in 11.8% of patients (99 of 841 patients) having cardiac arrests, compared with an average of 5.3% (range, 4.2% to 5.9%) of patients (103 of 1929 patients) in 3 historical and contemporary control groups. Honoring verbal requests alone accounted for 53% of withheld resuscitations in the intervention group (52 of 99 patients) compared with an average of 8% (range, 7% to 9%) in the control groups (8 of 103 patients).
The study was not a randomized, controlled trial; individual agencies chose whether to implement the guidelines.
Implementation of new guidelines was associated with an increase in the number of resuscitations withheld by EMS personnel. This increase was primarily due to honoring verbal requests.
Feder S, Matheny RL, Loveless RS, et al. Withholding Resuscitation: A New Approach to Prehospital End-of-Life Decisions. Ann Intern Med. 2006;144:634–640. doi: https://doi.org/10.7326/0003-4819-144-9-200605020-00006
Download citation file:
Published: Ann Intern Med. 2006;144(9):634-640.
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use