Navigation Links
Even After Death, Heart Attack Treatment May Not End
Date:6/30/2009

Too often, EMS crews feel obliged to bring unresponsive patient to hospital, study finds

TUESDAY, June 30 (HealthDay News) -- Chances of surviving a heart attack that occurs outside of a hospital are slim, but paramedics often take people who have died to a hospital anyway because a variety of factors keep them from following recommended guidelines, a new study finds.

In the United States, paramedics treat almost 300,000 people with cardiac arrest each year. But despite what's portrayed on TV, fewer than 8 percent survive, according to the American Heart Association.

The association's guidelines include the recommendation that people who have not responded to cardiopulmonary resuscitation (CPR) and advanced cardiac life support in the field not be taken to a hospital. After paramedics have tried and failed to resuscitate a patient, they should stop, researchers say.

"Paramedics provide all the same lifesaving procedures that we can provide in the emergency department," said the study's lead researcher, Dr. Comilla Sasson, Robert Wood Johnson clinical scholar and clinical lecturer in emergency medicine at the University of Michigan Medical School.

"Once you have done 20 to 30 minutes of cardiac resuscitation, the best practice guidelines are to cease if a patient does not have a pulse," she said. But the study, published online June 30 in Circulation: Cardiovascular Quality and Outcomes, found that several factors inhibit this from happening, including:

  • Local laws that mandate procedures for paramedics and other responders
  • Insurance policies that allow higher reimbursement when someone is taken to a hospital
  • Public misperception about the odds of survival

"When you look at TV shows, 90 to 95 percent of the people survive cardiac arrest," Sasson said. "In reality, it's less than 8 percent, so there is a big disconnect about what people understand about cardiac arrest survival and what happens in the real world."

She said that paramedics often feel pressured by these expectations to transport the patient to a hospital. What people don't realize, Sasson said, is that the care paramedics provide in the field is exactly the same treatment that the patient would receive in the hospital.

Another problem, Sasson said, is that health insurers -- including Medicare -- pay less for paramedic care than for care in a hospital. "There is a large financial disincentive for paramedics to stay on scene," she said.

Also, she said, some states "mandate that every cardiac arrest patient get transported to the hospital." And some require that even people with do-not-resuscitate orders must be treated if the person does not have the proper state form in his or her possession, she said.

Taking people to a hospital needlessly for treatment also creates what Sasson described as an opportunity cost.

"When you bring in a patient that is essentially dead, all of your resources go to that patient, which leaves the rest of the emergency department unmanned," she said. "When you are trying to resuscitate someone who should have never been transported to the hospital in the first place, you are shifting away resources from people who actually have conditions that are treatable."

The findings explained by Sasson stemmed from three small focus groups, including emergency physicians and emergency medical services (EMS) directors, conducted during the 2008 National Association of Emergency Medical Services Physicians meeting in Jacksonville, Fla.

Sasson and her fellow researchers concluded that, to help solve the problems pointed out by the focus group members, state laws need to be brought into line with American Heart Association guidelines and payment for paramedic care needs to be based on the care that's given, not on where it's given. Also, she said, the public needs to be made more aware of the realities of surviving a heart attack.

Dr. Kathleen Schrank, a professor of medicine and chief of emergency medicine at the University of Miami Miller School of Medicine -- and also an EMS medical director for Miami Fire Rescue -- said she agrees that barriers to stopping resuscitation exist.

Public perception that most people survive a cardiac arrest is a particular problem, Schrank said.

"Families have not only the hope but the expectation that their loved one is going to survive," she said. "They think that the emergency department has more to offer than what EMS can do."

She pointed out, though, that exceptions to stopping resuscitation do exist -- including children and pregnant women, in cases where the fetus might survive.

But Schrank noted that every situation is different and that paramedics and the doctors they're communicating with via radio need to be sensitive as they prepare family members to accept that their loved one has died and need not be taken to a hospital.

By American Heart Association guidelines, a decision to stop resuscitation should be based on clinical judgment and respect for human dignity. Also, stopping lifesaving efforts should be approved by a doctor who is in contact with paramedics by radio, the guidelines say.

"Most families, when they see all the things a rescue crew goes through trying to save a person in cardiac arrest, usually do recognize that everything was done," Schrank said.

More information

The American Heart Association has more on cardiac arrest.



SOURCES: Comilla Sasson, M.D., Robert Wood Johnson clinical scholar, clinical lecturer, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich.; Kathleen Schrank, M.D., professor, medicine, and chief, division of emergency medicine, University of Miami Miller School of Medicine, Miami; June 30, 2009, Circulation: Cardiovascular Quality and Outcomes online


'/>"/>
Copyright©2009 ScoutNews,LLC.
All rights reserved  

Related medicine news :

1. Maybe Men Arent So Picky After All
2. Elite Athletes Use Active Recovery Muscle Stimulator to Prevent Muscle Soreness After Exercise
3. Positive CHMP Opinion for JAVLOR(R) in Metastatic Treatment of Bladder Cancer After Failure of a Prior Platinum-Containing Regimen
4. A.L.L. Promises Caritas Christi Investigation After July 1
5. Quick Angioplasty Best After Heart Attacks
6. Physician Receives Bachelors Degree After 50 Years
7. After Major Ruling on Unsafe Lead Levels in Paint, Experts Reveal How You Can Ensure Your Kids Are Safe
8. Radiation May Raise Stroke Risk After Hodgkins
9. Study Shows Increases in Working After 65 and Using Commercial Insurance
10. Woman Whose Health Insurance Was Cancelled by Blue Cross/WellPoint After She Got Sick Urges Congress to Protect Innocent Patients
11. After 10 Years A Stronger and More Enhanced Form of Viagra Now Available
Post Your Comments:
*Name:
*Comment:
*Email:
Related Image:
Even After Death, Heart Attack Treatment May Not End
(Date:12/2/2016)... ... December 02, 2016 , ... The PAINWeekEnd ... Beach Resort and Spa in Honolulu, offering local frontline clinicians the opportunity to ... , The demand for supplemental training related to pain management has surged ...
(Date:12/2/2016)... ... ... Yisrayl Hawkins, at The House of Yahweh in Abilene, Texas, has published ... Yisrayl says this generation, known as the Last Generation, started in 1934 A.Y. (After ... up exactly with Bible Prophecy – a protected way for those who will believe. ...
(Date:12/2/2016)... ... December 02, 2016 , ... Today CloudMine, a ... applications, was named the best Sales Team of 2016 as part of the ... today by the Software & Information Industry Association (SIIA), the principal trade association ...
(Date:11/30/2016)... (PRWEB) , ... November 30, 2016 , ... ... that they now offer a comprehensive in-house dental plan for all patients. Understanding ... developed a plan that gives patients a number of perks, including discounts on ...
(Date:11/30/2016)... ... November 30, 2016 , ... Center ... has announced the opening of a new residential mental health treatment program in ... health issues such as severe anxiety, depression, bi-polar disorder, and other related issues. ...
Breaking Medicine News(10 mins):
(Date:11/30/2016)... Research and Markets has announced the addition of the ... report to their offering. ... , The cerebrospinal fluid (CSF) acts ... it is circulated though the brain and its ventricles, the spine and ... surrounding the brain changes significantly. As a result, ...
(Date:11/30/2016)... Research and Markets has announced the addition ... report to their offering. ... , Detachable coil embolization is a ... The detachable coil embolization treatment of cerebral aneurysms is less invasive and ... area in the wall of an artery in the brain. This area ...
(Date:11/30/2016)... Calif. , Nov. 30, 2016 Varian ... it was named America,s Most JUST Company in the ... and Forbes magazine,s inaugural "JUST 100 List." ... of the largest surveys ever conducted on attitudes towards ... months. This inaugural list ranks U.S companies against their ...
Breaking Medicine Technology: