The perspective of paramedics about on-scene termination of resuscitation efforts for pediatric patients

Resuscitation. 2004 Feb;60(2):175-87. doi: 10.1016/j.resuscitation.2003.09.013.


Objectives: The purpose of this study was to assess the attitude of paramedics to on-scene termination of cardiopulmonary resuscitation (T-CPR) efforts in children prior to developing a pediatric T-CPR policy.

Methods: A 26-item anonymous survey was conducted of all of the active paramedics in a large urban EMS system where T-CPR had been practiced routinely for adults. Questions addressed paramedic demographics, training level, experience with adult and pediatric advanced cardiac life support (ACLS), experience with T-CPR in adults, T-CPR case scenarios, and T-CPR in children.

Results: All 201 paramedics in the system (mean age=34.2 years; mean years as paramedic = 8.5 ) completed all relevant items of the survey (100% compliance). Two-thirds had provided ACLS for cardiac arrest to >50 adults (93% >10 adults) and more than one-third had performed ACLS on >20 children (72% >5 children). In addition, 90% had participated in T-CPR for adults. The majority of paramedics reported at least occasional (pre-defined) difficulty with adult T-CPR including family confrontation, 43%; personal discomfort, 13%; disagreement with physician decision to continue efforts, 11%; and fear of liability, 10%. Paramedic self ratings of comfort with terminating CPR on a scale from 1 to 10 (1: very comfortable; 10: uncomfortable) for adults and children were 1 and 9, respectively (P<0.001). In addition, the clear majority (72%) responded that children deserve more aggressive resuscitative efforts than adults.

Conclusions: Paramedics feel relatively uncomfortable with the concept of terminating resuscitation efforts in children in the pre-hospital setting.

MeSH terms

  • Adult
  • Analysis of Variance
  • Attitude of Health Personnel*
  • Cardiopulmonary Resuscitation / ethics
  • Cardiopulmonary Resuscitation / standards*
  • Cardiopulmonary Resuscitation / statistics & numerical data
  • Child
  • Child, Preschool
  • Emergency Medical Services / ethics
  • Emergency Medical Services / methods*
  • Emergency Medical Technicians / psychology*
  • Female
  • Health Care Surveys
  • Heart Arrest / therapy*
  • Humans
  • Interprofessional Relations
  • Liability, Legal
  • Logistic Models
  • Male
  • Medical Futility / psychology*
  • Professional-Family Relations
  • Resuscitation Orders*
  • Statistics, Nonparametric
  • Surveys and Questionnaires
  • United States