Ethical Issues of Resuscitation

Ethical Issues of Resuscitation

Policy Statements REFERENCE 1. American College of Emergency Physicians. Patient satisfaction surveys [policy statement]. Approved by the Board Septem...

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Policy Statements REFERENCE 1. American College of Emergency Physicians. Patient satisfaction surveys [policy statement]. Approved by the Board September 2010. Available at: http://www.acep.org/Clinical—Practice-Management/PatientSatisfaction-Surveys/. http://dx.doi.org/10.1016/j.annemergmed.2016.04.046

Disaster Planning and Response [Ann Emerg Med. 2016;68:149.] The American College of Emergency Physicians (ACEP) encourages emergency physicians to: 1. Assist their institutions and community to prepare for and respond to disasters. 2. Continue to serve their communities and nation during time of disasters. 3. Implement actions to protect themselves, their families, their coworkers, and their patients from risks. 4. Work with institutional and public leaders to effectively communicate public health and safety information to coworkers and the public. 5. Serve as subject-matter experts on the allocation of scarce health care resources, when necessary. ACEP will, when possible and appropriate during disasters, use its resources to disseminate current, scientifically based information from national experts. Revised June 2015 Revised and approved by the ACEP Board of Directors June 2015 Originally approved by the ACEP Board of Directors June 2008 http://dx.doi.org/10.1016/j.annemergmed.2016.04.047

Ethical Issues of Resuscitation [Ann Emerg Med. 2016;68:149.] The American College of Emergency Physicians supports the following principles:  Patients who may benefit from resuscitation efforts should have equitable access to such efforts.  Decisions to attempt resuscitation must take into account the accepted standards of medical care and the safety of the medical personnel, as well as known patient preferences. It is appropriate for out-of-hospital providers to honor valid orders to limit life-sustaining interventions at the end of life. Standardized guidelines and protocols should exist in all emergency medical services (EMS) systems to direct out-of-hospital personnel’s resuscitative efforts. Educational information about such policies should be disseminated to the community and to out-of-hospital and hospital providers. Volume 68, no. 1 : July 2016

Patient goals for end-of-life care should be honored by out-of-hospital and hospital providers at the end of life. EMS out-of-hospital order systems should support efforts to intervene or forgo these treatments in accordance with available information. The appropriate surrogate decision maker, as defined by state law, should be involved in decisions about lifesustaining treatments if immediately available. Additional sources of information to guide treatment decisions may come from patient advance directives, family, or primary physicians as time permits. EMS systems should honor state-recognized orders addressing life-sustaining treatments such as Physician Orders for Life-Sustaining Treatments (POLST). If the patient’s goals or medical circumstances are unclear, medically appropriate resuscitative measures should be undertaken. It is ethically permissible for treatments, once started, to be withdrawn when additional information is available. This information may include the lack of response to treatment or definitive information about the patient’s goals for life-sustaining treatments. Resuscitative efforts may be appropriately withheld, withdrawn, or limited in circumstances such as the lack of immediately available resuscitation resources, or when there is no realistic likelihood of benefit to the patient according to existing scientific evidence and reasonable medical judgment. When resuscitative efforts are not indicated, emergency physicians should ensure appropriate medical and psychosocial care during the dying process. Approved June 2015 Revised and approved by the ACEP Board of Directors June 2015 Approved by the ACEP Board of Directors June 2008 titled “Ethical Issues of Resuscitation” by combining “Ethical Issues of Resuscitation” approved October 2001 and “Do Not Attempt Resuscitation (DNAR) in the Out-of-Hospital Setting” approved September 2003 http://dx.doi.org/10.1016/j.annemergmed.2016.04.050

Expanded Roles of EMS Personnel [Ann Emerg Med. 2016;68:149-150.] The American College of Emergency Physicians (ACEP) acknowledges expanded scope-of-practice programs are being developed to meet unique and local health care needs, as well as disaster scenarios. ACEP recognizes that emergency medical services (EMS) providers are likely to be used in the workforce for these programs. With proper design and medical oversight, potential benefits may include improved access to health care in underserved areas, improved patient care, and reduced costs. Annals of Emergency Medicine 149