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Barriers Hinder EMS Workers From Using Best Resuscitation Practices
Date:6/30/2009

  • community members who overestimate the chance for survival and believe a hospital can provide better care than responders on site.

  • "If an EMS team spends 30 minutes and can't get a patient's pulse back, they will not be reimbursed by Medicare for the level of care they have provided, or the time the ambulance was out of service," said Comilla Sasson, M.D., M.S., Robert Wood Johnson Clinical Scholar and a clinical lecturer in the department of Emergency Medicine at the University of Michigan Medical School in Ann Arbor.

    "However, transporting a patient before a full attempt at resuscitation reduces the chance of survival -- getting a pulse prior to transport is really important. Paramedics can't provide good CPR in the back of an ambulance while flying down the road at 90 miles an hour, with lights and sirens blazing, to the hospital."

    The American Heart Association recommends that paramedics on the scene administer good-quality CPR, shock the heart to try to re-establish a normal heart rhythm and provide appropriate advanced cardiovascular life support. The final decision to stop resuscitation efforts must be based on clinical judgment and respect for human dignity. Cessation of efforts in the out-of-hospital setting, following system-specific criteria and under direct medical control, should be standard practice in all EMS systems.

    "The point at which we're talking about terminating resuscitation is when you've done everything you can and there is virtually no chance of survival," said Sasson, lead author of the study. "Unfortunately, the current public policies for reimbursement, state laws and public perceptions, do not allow EMS providers to do the appropriate thing for the patient."

    Each year in the United States, EMS treats nearly 300,000 out-of-hospital cardiac arrests, according to the American Heart Association. Less
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    SOURCE American Heart Association
    Copyright©2009 PR Newswire.
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