Table 1.
Fate of Indicators That Passed Appropriateness and Feasibility and Would Change Policy
| Indicator Class and Number* | Appropriateness | Feasibility | EMS Commission | Medical Council | Policy Change |
|---|---|---|---|---|---|
| A. Patient preferences | (1–9) | (1–9) | A/R | A/R | Y/N |
| A.1. IF EMS is called to a cardiac arrest in the home, THEN while proceeding to resuscitation they must ask if there is an Advance Directive | 9 | 7 | A | A | Y |
| A.2. IF EMS is called to a cardiac arrest in a long-term skilled nursing facility THEN while proceeding to resuscitation they must ask if there is an Advance Directive or DNR order | 9 | 9 | A | A | Y |
| A.4. IF EMS is called to a cardiac arrest in a long-term skilled nursing facility and there is no DNAR order in the chart, but an Advance Directive indicates a desire to forgo resuscitation, THEN EMS should forgo resuscitation | 9 | 9 | A | A | Y |
| A.5. IF EMS is called to a cardiac arrest in a home and a written Advance Directive indicates a desire to forgo resuscitation, THEN EMS should forgo resuscitation | 9 | 8 | A | A | Y |
| A.6. IF EMS is called to a cardiac arrest in the home or a public place and the apparent surrogate decision maker verbally requests no resuscitation and there is no written Advance Directive or DNAR form, THEN EMS should forgo resuscitation | 7 | 7 | A | A | Y |
| B. Asystole | (1–9) | (1–9) | A/R | A/R | Y/N |
| B.1. IF initial rhythm is asystole and patient is known by apparent surrogate decision maker to have a terminal illness, THEN forgo resuscitation | 9 | 8 | R | A | N |
| B.3a. IF initial rhythm is asystole, patient has a witnessed cardiac arrest, and apparent surrogate decision maker states patient is 70–79 years old and is not a hypothermia or drowning victim, THEN forgo resuscitation | 8 | 8 | R | A | N |
| B.3b. IF initial rhythm is asystole, patient has an unwitnessed cardiac arrest, and apparent surrogate decision maker states patient is 70–79 years old and is not a hypothermia or drowning victim, THEN forgo resuscitation | 8 | 8 | R | A | N |
| B.4a. IF initial rhythm is asystole, patient has a witnessed cardiac arrest, and apparent surrogate decision maker states patient is older than 80 years and is not a hypothermia or drowning victim, THEN forgo resuscitation | 9 | 8 | R | A | N |
| B.4b. IF initial rhythm is asystole, patient has an unwitnessed cardiac arrest, and apparent surrogate decision maker states patient is older than 80 years and is not a hypothermia or drowning victim, THEN forgo resuscitation | 9 | 8 | R | A | N |
| B.5. IF initial rhythm is asystole and patient has a time from witnessed collapse to ACLS without CPR that is 10–15 minutes and is not a hypothermia or drowning victim, THEN forgo resuscitation | 9 | 8 | A | A | Y |
| B.6. IF initial rhythm is asystole and patient has a time from witnessed collapse to ACLS without CPR that exceeds15 minutes, and is not a hypothermia or drowning victim, THEN forgo resuscitation | 8 | 8 | A | A | Y |
| B.7. IF initial rhythm is asystole and patient has an unwitnessed arrest, no bystander CPR BLS-response time is 10–15 minutes, and is not a hypothermia or drowning victim, THEN forgo resuscitation | 9 | 8 | A | A | Y |
| B.8. IF initial rhythm is asystole and patient has an unwitnessed arrest, no bystander CPR, BLS-response time that exceeds 15 minutes, and is not a hypothermia or drowning victim, THEN forgo resuscitation | 9 | 8 | A | A | Y |
| B.9a. IF initial rhythm is asystole, patient has a witnessed cardiac arrest, is <65 years old, and a long-term skilled nursing facility resident, THEN forgo resuscitation | 8 | 8 | R | A | N |
| B.9b. IF initial rhythm is asystole, patient has an unwitnessed cardiac arrest, is <65 years old, and a long-term skilled nursing facility resident, THEN forgo resuscitation | 8 | 8 | R | A | N |
| B.10a. IF initial rhythm is asystole, patient has a witnessed cardiac arrest, is 65 years or older, and a long-term skilled nursing facility resident, THEN forgo resuscitation | 8 | 8 | R | A | N |
| B.10b. IF initial rhythm is asystole, patient has an unwitnessed cardiac arrest, is 65 years or older, and is a long-term skilled nursing facility resident, THEN forgo resuscitation | 9 | 9 | R | A | N |
| C. PEA | (1–9) | (1–9) | A/R | A/R | Y/N |
| C.1. IF initial rhythm is PEA and patient is known by surrogate decision maker to have terminal illness, THEN forgo resuscitation | 8 | 7 | R | R | N |
| C.4b. IF initial rhythm is PEA, patient has an unwitnessed cardiac arrest, apparent surrogate decision maker states patient is older than 80 years, and is not a hypothermia or drowning victim, THEN forgo resuscitation | 7 | 7 | R | R | N |
| C.8. IF initial rhythm is PEA and patient has an unwitnessed arrest, no bystander CPR, BLS-response time that exceeds 15 minutes, and is not a hypothermia or drowning victim, THEN forgo resuscitation | 8 | 7 | A | R | N |
| D. Additional indicators† | |||||
| D.1. IF EMS is called to a cardiac arrest in the home, THEN while proceeding to resuscitation they must ask if there is a Prehospital DNAR | 9 | 8 | A | A | Y |
Notes.
*
Numbering corresponds to our original numbering system in prior publications that included all indicators.
†
Those added during the expert panel.
A, accepted; ACLS, advanced cardiac life support; BLS, basic life support; CPR, cardiopulmonary resuscitation; DNAR, do not attempt resuscitate; DNR, do not resuscitate; EMS, Emergency Medical Services; N, no; PEA, pulseless electrical activity; R, rejected; Y, yes.