Background: Emergency medical technicians (EMTs) play a crucial role in resuscitating patients with out-of-hospital cardiac arrest. Perception of prognosis may affect level and quality of treatment. The aim of this study was to investigate if EMTs delay start of cardiopulmonary resuscitation (CPR) if they believe resuscitation to be futile. Furthermore, to investigate if different patient and resuscitation attempt characteristics result in EMTs deliberately performing substandard CPR.
Methods: This was a cross-sectional questionnaire survey study conducted in 2016 through 2017 including EMTs from a Danish Emergency Medical Service. Data was collected at four different ambulance bases in the Central Denmark Region. EMTs were randomly approached at an ambulance base and handed the questionnaire, which they were ask to fill truthfully.
Results: In total, 100 EMTs (13% female, median age (Q1;Q3): 39 years (30;49)) participated with a response rate of 100 %. Mean (SD) number of cardiac arrests treated was 75 (40;130) over a median of 13 (7;25) years clinical service. When EMTs anticipated resuscitation to be futile 61% fully agreed or agreed that they would delay start of resuscitation (defibrillation, ventilation and compressions). Overall, 22% and 51% would perform substandard CPR if the patient were 80 or 90 years old respectively, 46% if the patient was living in a nursing home and up to 31% due to comorbidity such as cancer. EMTs (51%) would deliberately perform substandard CPR in case of on-going bystander CPR >20 minutes. EMTs (72%) felt competent to terminate resuscitation, but only 9% knew international termination guidelines.
Conclusion: EMTs delay start of resuscitation if they anticipate resuscitation to be futile. Furthermore, they deliberately perform substandard CPR based on controversial patient and resuscitation attempt characteristics.