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AP189

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Ambulancezorg GGD Haaglanden
Ambulancezorg GGD Haaglanden

This study compared the recognition of a "Do Not Resuscitate" (DNR) medal by trained lay rescuers and emergency medical services (EMS) providers responding to a medical emergency. Forty lay rescuers and 39 EMS providers participated. Most lay rescuers (80%) and EMS providers (74.4%) noticed the DNR medal. However, some EMS providers (23.1%) decided to continue resuscitation efforts despite the DNR protocol requiring them to stop. The study found that while lay rescuers recognized DNR directives, some EMS professionals did not always notice the medal or comply with DNR wishes.

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Will a ‘Do not resuscitate’ medal’ be recognised by rescuers? Wiebe de Vries PhD, educational consultant HeartsafeLiving Sander van Goor RN, ambulance nurse at GGD Haaglanden EMS The Hague, The Netherlands Frank de Pooter RN, ambulance nurse at White Cross EMS, The Netherlands pURPOSE OF THE STUDY In The Netherlands every citizen is allowed to refuse lifesaving help if they feel that this would harm their quality of life. This wish should be written and undoubtable be the wish of the victim.1 The Dutch Resuscitation Council recommends lay rescuers not to start CPR if a ‘Do not resuscitate’ (DNR) declaration is available with the victim and the rescuer is sure it belongs to the victim. But they should not lose any time in searching for it. If the lay rescuer finds a DNR- declaration while unbarring the chest, he is allowed to stop CPR. However, this might be of great psychological benefit and therefore the lay rescuer is not responsible if he decides to continue.2,3 CPR is an automated skill in a well-trained provider. Therefore it might be that a lay rescuer provides CPR without noticing any specific information. This study was undertaken to compare the recognition of a DNR medal by (trained) lay rescuers to EMS providers. Materials and methods Participants were trained lay rescuers and EMS providers. The lay rescuers followed a CPR/AED provider course in accordance with the ERC guidelines and recommendations. They were taken from their daily work situation without any warning before. They were invited to provide help to a victim who collapsed. No additional information was given. The EMS providers were dispatched to the test location. Dispatch centre told them that life support had tobeengiventothepatient.TwocertifiedBLS/ALSinstructorsassessedeachsituation,usingavalidated form. For all items, time from entering was taken. A face impression or spoken words, indicating that the medal was observed, was taken as start of recognition. Results Forty lay rescuers and 39 EMS providers were included. The table shows the mean time per item. From the lay rescuers 32/40 (80,0%) notified the DNR medal. Of those providers 5 (12,5%) decided to continue CPR as they declared that it was to healthcare professionals to decide to stop or not. From the EMS providers 29/39 (74,4%) notified the DNR medal. Of those providers 9 (23,1%) decided to continue CPR, despite of the fact that national protocol required them to stop CPR and additional life support. Conclusions Lay rescuers seems to be well informed about the non-resuscitation medal. However, EMS professionals, who have a duty to respect the declaration do not all recognizes the medal, and if they do, 23,1 % still decides to continue help. References 1. MinisterofHealth,WelfareandSport(VWS),Letterconcerningoneuniformnon-resuscitationmedalof11November2014(2014Z14120). The Hague, Ministry of Health, Welfare and Sport (VWS) 2014. 2. ZijlstraJA,BeesemsSG,DeHaanRJ,KosterRW.Psychologicalimpactondispatchedlocallayrescuersperformingbystander.Resuscitation. 2015 May 6;92:115-121. 3. Van Drenth J, Henny W, Koster RW, De Vries W. Guidelines for Resuscitation 2010 in The Netherlands and Belgium; Basic Life Support to Adults. Uden/Leuven Dutch Resuscitation Council/Belgian Resuscitation Council 2011. Number of participants Items (in seconds from arrival) Check Responsiveness; Talk Check Responsiveness; Shake Check Responsiveness; Shout for help Open Airway Check Breathing Phone 112 Compression to Rescue breath Switch on AED Remove clothing Recognition medal Defibrillator electrode pads attached Shock button pushed Lay rescuer 40 Mean (SD) 4,5 (2,3) 5,3 (2,2) 15,8 (16,6) 10,3 (3,9) 12,0 (8,4) 23,5 (11,6) 40,3 (47,1) 85,9 (52,4) 46,6 (30,4) 60,3 (42,2) 100,2 (38,0) 146,3 (53,9) EMS personel 39 Mean (SD) 4,0 (1,7) 5,1 (2,2) 19,6 (21,7 14,2 (21,4) 11,1 (5,2) 24,4 (17,2) 28,1 (9,5) 66,4 (33,7) 52,4 (33,7) 76,3 (47,0) 86,0 (27,3) 116,6 (29,6)

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AP189

  • 1. Will a ‘Do not resuscitate’ medal’ be recognised by rescuers? Wiebe de Vries PhD, educational consultant HeartsafeLiving Sander van Goor RN, ambulance nurse at GGD Haaglanden EMS The Hague, The Netherlands Frank de Pooter RN, ambulance nurse at White Cross EMS, The Netherlands pURPOSE OF THE STUDY In The Netherlands every citizen is allowed to refuse lifesaving help if they feel that this would harm their quality of life. This wish should be written and undoubtable be the wish of the victim.1 The Dutch Resuscitation Council recommends lay rescuers not to start CPR if a ‘Do not resuscitate’ (DNR) declaration is available with the victim and the rescuer is sure it belongs to the victim. But they should not lose any time in searching for it. If the lay rescuer finds a DNR- declaration while unbarring the chest, he is allowed to stop CPR. However, this might be of great psychological benefit and therefore the lay rescuer is not responsible if he decides to continue.2,3 CPR is an automated skill in a well-trained provider. Therefore it might be that a lay rescuer provides CPR without noticing any specific information. This study was undertaken to compare the recognition of a DNR medal by (trained) lay rescuers to EMS providers. Materials and methods Participants were trained lay rescuers and EMS providers. The lay rescuers followed a CPR/AED provider course in accordance with the ERC guidelines and recommendations. They were taken from their daily work situation without any warning before. They were invited to provide help to a victim who collapsed. No additional information was given. The EMS providers were dispatched to the test location. Dispatch centre told them that life support had tobeengiventothepatient.TwocertifiedBLS/ALSinstructorsassessedeachsituation,usingavalidated form. For all items, time from entering was taken. A face impression or spoken words, indicating that the medal was observed, was taken as start of recognition. Results Forty lay rescuers and 39 EMS providers were included. The table shows the mean time per item. From the lay rescuers 32/40 (80,0%) notified the DNR medal. Of those providers 5 (12,5%) decided to continue CPR as they declared that it was to healthcare professionals to decide to stop or not. From the EMS providers 29/39 (74,4%) notified the DNR medal. Of those providers 9 (23,1%) decided to continue CPR, despite of the fact that national protocol required them to stop CPR and additional life support. Conclusions Lay rescuers seems to be well informed about the non-resuscitation medal. However, EMS professionals, who have a duty to respect the declaration do not all recognizes the medal, and if they do, 23,1 % still decides to continue help. References 1. MinisterofHealth,WelfareandSport(VWS),Letterconcerningoneuniformnon-resuscitationmedalof11November2014(2014Z14120). The Hague, Ministry of Health, Welfare and Sport (VWS) 2014. 2. ZijlstraJA,BeesemsSG,DeHaanRJ,KosterRW.Psychologicalimpactondispatchedlocallayrescuersperformingbystander.Resuscitation. 2015 May 6;92:115-121. 3. Van Drenth J, Henny W, Koster RW, De Vries W. Guidelines for Resuscitation 2010 in The Netherlands and Belgium; Basic Life Support to Adults. Uden/Leuven Dutch Resuscitation Council/Belgian Resuscitation Council 2011. Number of participants Items (in seconds from arrival) Check Responsiveness; Talk Check Responsiveness; Shake Check Responsiveness; Shout for help Open Airway Check Breathing Phone 112 Compression to Rescue breath Switch on AED Remove clothing Recognition medal Defibrillator electrode pads attached Shock button pushed Lay rescuer 40 Mean (SD) 4,5 (2,3) 5,3 (2,2) 15,8 (16,6) 10,3 (3,9) 12,0 (8,4) 23,5 (11,6) 40,3 (47,1) 85,9 (52,4) 46,6 (30,4) 60,3 (42,2) 100,2 (38,0) 146,3 (53,9) EMS personel 39 Mean (SD) 4,0 (1,7) 5,1 (2,2) 19,6 (21,7 14,2 (21,4) 11,1 (5,2) 24,4 (17,2) 28,1 (9,5) 66,4 (33,7) 52,4 (33,7) 76,3 (47,0) 86,0 (27,3) 116,6 (29,6)