Emergency medical services (EMS) paramedics are often called on to decide whether to attempt resuscitation for people who have suffered cardiac arrest. Resuscitation efforts may run counter to patient and family preferences, paramedics' clinical judgment, and best medical practice. Some patients wish to forego resuscitation but have not executed a Do Not Resuscitate document (DNR), or an existing DNR cannot be accessed in an emergency.

In 2007 the Los Angeles County (LAC) EMS system implemented a new resuscitation policy developed in partnership with medical researchers at the University of California, Los Angeles (UCLA). Previous policy had allowed paramedics to forego resuscitation only if presented with a written DNR or if there were obvious signs of irreversible death. The new policy further permits paramedics to forego resuscitation if:

• A family member on the scene verbally requests DNR in accordance with patient wishes but without a DNR document; or
• A patient is found without a heartbeat and at least ten minutes have elapsed before CPR starts.

This issue brief reports on a study of EMS responses under the revised policy. The study showed a small but meaningful reduction in attempted resuscitation, especially when a family DNR request was made. EMS personnel reported considerable satisfaction with the new guidelines, and there were no reports of adverse consequences attributable to them. The work of the joint LAC EMS/UCLA project may help other EMS systems to make a similar change.

The complete issue brief is available under Document Downloads below.