The perspective of paramedics about on-scene termination of resuscitation efforts for pediatric patients

Objectives: The purpose of this study was to assess the attitude of paramedics to on-scene termination of cardiopulmonary resuscitation (T-CPR) efforts in children prior to developing a pediatric T-CPR policy. Methods: A 26-item anonymous survey was conducted of all of the active paramedics in a large urban EMS system where T-CPR had been practiced routinely for adults. Questions addressed paramedic demographics, training level, experience with adult and pediatric advanced cardiac life support (ACLS), experience with T-CPR in adults, T-CPR case scenarios, and T-CPR in children. Results: All 201 paramedics in the system (mean age = 34.2 years; mean years as paramedic = 8.5) completed all relevant items of the survey (100% compliance). Two-thirds had provided ACLS for cardiac arrest to >50 adults (93% >10 adults) and more than one-third had performed ACLS on >20 children (72% >5 children). In addition, 90% had participated in T-CPR for adults. The majority of paramedics reported at least occasional (pre-defined) difficulty with adult T-CPR including family confrontation, 43%; personal discomfort, 13%; disagreement with physician decision to continue efforts, 11%; and fear of liability, 10%. Paramedic self ratings of comfort with terminating CPR on a scale from 1 to 10 (1: very comfortable; 10: uncomfortable) for adults and children were 1 and 9, respectively (P < 0.001). In addition, the clear majority (72%) responded that children deserve more aggressive resuscitative efforts than adults. Conclusions: Paramedics feel relatively uncomfortable with the concept of terminating resuscitation efforts in children in the pre-hospital setting.