Abstract
Method: This prospective 16 month cohort study evaluated 188 events of recognition of adult death (ROAD) by paramedics in the period from November 1999 to February 2001.
Results: Of 188 ROAD applications, errors were made in 13 cases (6.9%, 95% CI 3.7 to 11.5. Additionally, there was one adverse clinical incident associated with a case in which ROAD was applied (0.5%, 95% CI 0.01 to 2.9%). ECG strips were unavailable for eight cases, although ambulance records indicated a rhythm of asystole for each of these. Assuming this diagnosis was correct, ROAD was used 174 times without errors (93%, 95% CI 88 to 96%). Assuming that it was not, the ROAD protocol was applied without errors in 166 cases (88.3%, 95% CI 82.8 to 92.5%). None of the errors made appeared to be attributable to poor clinical decision making, compromised treatment, or changed patient outcome. The mean on-scene time for ambulance crews using the ROAD policy was 60 minutes.
Conclusion: Paramedics can accurately apply a decision support algorithm when recognising adult death. It could be argued that the attendance of a medical practitioner to confirm death is therefore an inappropriate use of such personnel and may result in unnecessarily protracted on-scene times for ambulance crews. Further research is required to confirm this, and to determine the proportion of patients suitable for recognition of adult death who are actually identified as such by paramedics.
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Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bailey E. D., Wydro G. C., Cone D. C. Termination of resuscitation in the prehospital setting for adult patients suffering nontraumatic cardiac arrest. National Association of EMS Physicians Standards and Clinical Practice Committee. Prehosp Emerg Care. 2000 Apr-Jun;4(2):190–195. doi: 10.1080/10903120090941498. [DOI] [PubMed] [Google Scholar]
- Kahn C. A., Pirrallo R. G., Kuhn E. M. Characteristics of fatal ambulance crashes in the United States: an 11-year retrospective analysis. Prehosp Emerg Care. 2001 Jul-Sep;5(3):261–269. doi: 10.1080/10903120190939751. [DOI] [PubMed] [Google Scholar]
- Kellermann A. L., Hackman B. B., Somes G. Predicting the outcome of unsuccessful prehospital advanced cardiac life support. JAMA. 1993 Sep 22;270(12):1433–1436. [PubMed] [Google Scholar]
- Marsden A. K., Ng G. A., Dalziel K., Cobbe S. M. When is it futile for ambulance personnel to initiate cardiopulmonary resuscitation? BMJ. 1995 Jul 1;311(6996):49–51. doi: 10.1136/bmj.311.6996.49. [DOI] [PMC free article] [PubMed] [Google Scholar]