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Translation of Evidence-Based Clinical Standards into a New Prehospital Resuscitation Policy in Los Angeles County

Authors


Address correspondence to Corita R. Grudzen, M.D., M.S.H.S., Department of Emergency Medicine, Mount Sinai School of Medicine, Box 1620, One Gustave L Levy Place, New York, NY 10029; e-mail corita.grudzen@mssm.edu; corita.grudzen@mountsinai.org.

Abstract

Objective

To translate a set of evidence-based clinical standards designed to allow paramedics to forgo unnecessary and potentially harmful resuscitation attempts into a feasible new policy.

Data Sources/Setting

Policy documents, meeting minutes, and personal communications between a large urban Emergency Medical Services (EMS) agency serving all of Los Angeles County (LAC) and a research group were reviewed over 12 months.

Study Design

LAC EMS and University of California, Los Angeles (UCLA) formed a partnership (the EMS-UCLACollaborative) to develop and translate the standards into new EMS protocols. Clinical indicators considered appropriate and feasible by an expert panel were submitted to the agency for inclusion in the new policy.

Findings

The Collaborative submitted the results to the LAC EMS Commission and a physician advisory group for review. Of the 41 indicators approved by the expert panel, 22 would have resulted in changes to the current policy. All six involved asking family members about or honoring written and verbal Do Not Attempt Resuscitate requests, but only 4 of the 16 indicators based on clinical characteristics were included in the new policy. Ultimately, 10 of the 22 indicators that would have changed policy were approved and implemented.

Conclusions

By collaboration, a large EMS agency and a research team were able to develop and implement a revised resuscitation policy within 1 year.

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