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Emergency medical service interpretation of Physician Orders for Life‐Sustaining Treatment (POLST) in cardiopulmonary arrest
OBJECTIVE: Physician Orders for Life‐Sustaining Treatment (POLST) forms exist in some form in all 50 states. This study evaluates emergency medical service (EMS) practitioners interpretation of the POLST in cardiopulmonary arrest. METHODS: This study used a prospective convenience sample of Californ...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8931303/ https://www.ncbi.nlm.nih.gov/pubmed/35342899 http://dx.doi.org/10.1002/emp2.12705 |
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author | Breyre, Amelia M. Vertelney, Haley Sporer, Karl A. Davenport, Glen Issacs, Eric D. Glomb, Nicolaus W. |
author_facet | Breyre, Amelia M. Vertelney, Haley Sporer, Karl A. Davenport, Glen Issacs, Eric D. Glomb, Nicolaus W. |
author_sort | Breyre, Amelia M. |
collection | PubMed |
description | OBJECTIVE: Physician Orders for Life‐Sustaining Treatment (POLST) forms exist in some form in all 50 states. This study evaluates emergency medical service (EMS) practitioners interpretation of the POLST in cardiopulmonary arrest. METHODS: This study used a prospective convenience sample of California Bay Area EMS practitioners who reviewed 6 fictional scenarios of patients in cardiopulmonary arrest and accompanying California POLST forms. Based on the cases and POLST, EMS practitioners identified patient preference for “attempt resuscitation,” “do not attempt resuscitation/DNR,” or “unsure” and subsequently selected medical interventions (ie, chest compressions, defibrillation, and so on). They also rated their confidence in POLST use and interpretation. RESULTS: In scenarios of cardiopulmonary arrest and POLST that indicated do not resuscitate (DNR)/do not attempt resuscitation (DNAR) and full treatment, only 45%–65% of EMS practitioners correctly identified the patient as DNR/DNAR. EMS practitioners were more likely to interpret the POLST correctly in scenarios where patients were DNR/DNAR but indicated selective treatment (86%; 168/196) or comfort‐focused treatment (86%; 169/196). In cardiopulmonary arrest scenarios where the patient was correctly identified as DNR/DNAR, EMS practitioners frequently selected defibrillation, advanced airway, or epinephrine as appropriate treatment. For all 6 scenarios, there was no statistical difference in response selection with level of training (emergency medical technician/paramedics) or type of EMS personnel (fire based/private). CONCLUSION: The POLST is a powerful tool to convey medical treatment preferences; however, there is significant variation in the interpretation and application by EMS practitioners. To improve the POLST effectiveness, the authors suggest more EMS input into POLST development, concise language that defines resuscitation, and more EMS education about clinical application. |
format | Online Article Text |
id | pubmed-8931303 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-89313032022-03-24 Emergency medical service interpretation of Physician Orders for Life‐Sustaining Treatment (POLST) in cardiopulmonary arrest Breyre, Amelia M. Vertelney, Haley Sporer, Karl A. Davenport, Glen Issacs, Eric D. Glomb, Nicolaus W. J Am Coll Emerg Physicians Open Emergency Medical Services OBJECTIVE: Physician Orders for Life‐Sustaining Treatment (POLST) forms exist in some form in all 50 states. This study evaluates emergency medical service (EMS) practitioners interpretation of the POLST in cardiopulmonary arrest. METHODS: This study used a prospective convenience sample of California Bay Area EMS practitioners who reviewed 6 fictional scenarios of patients in cardiopulmonary arrest and accompanying California POLST forms. Based on the cases and POLST, EMS practitioners identified patient preference for “attempt resuscitation,” “do not attempt resuscitation/DNR,” or “unsure” and subsequently selected medical interventions (ie, chest compressions, defibrillation, and so on). They also rated their confidence in POLST use and interpretation. RESULTS: In scenarios of cardiopulmonary arrest and POLST that indicated do not resuscitate (DNR)/do not attempt resuscitation (DNAR) and full treatment, only 45%–65% of EMS practitioners correctly identified the patient as DNR/DNAR. EMS practitioners were more likely to interpret the POLST correctly in scenarios where patients were DNR/DNAR but indicated selective treatment (86%; 168/196) or comfort‐focused treatment (86%; 169/196). In cardiopulmonary arrest scenarios where the patient was correctly identified as DNR/DNAR, EMS practitioners frequently selected defibrillation, advanced airway, or epinephrine as appropriate treatment. For all 6 scenarios, there was no statistical difference in response selection with level of training (emergency medical technician/paramedics) or type of EMS personnel (fire based/private). CONCLUSION: The POLST is a powerful tool to convey medical treatment preferences; however, there is significant variation in the interpretation and application by EMS practitioners. To improve the POLST effectiveness, the authors suggest more EMS input into POLST development, concise language that defines resuscitation, and more EMS education about clinical application. John Wiley and Sons Inc. 2022-03-17 /pmc/articles/PMC8931303/ /pubmed/35342899 http://dx.doi.org/10.1002/emp2.12705 Text en © 2022 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Emergency Medical Services Breyre, Amelia M. Vertelney, Haley Sporer, Karl A. Davenport, Glen Issacs, Eric D. Glomb, Nicolaus W. Emergency medical service interpretation of Physician Orders for Life‐Sustaining Treatment (POLST) in cardiopulmonary arrest |
title | Emergency medical service interpretation of Physician Orders for Life‐Sustaining Treatment (POLST) in cardiopulmonary arrest |
title_full | Emergency medical service interpretation of Physician Orders for Life‐Sustaining Treatment (POLST) in cardiopulmonary arrest |
title_fullStr | Emergency medical service interpretation of Physician Orders for Life‐Sustaining Treatment (POLST) in cardiopulmonary arrest |
title_full_unstemmed | Emergency medical service interpretation of Physician Orders for Life‐Sustaining Treatment (POLST) in cardiopulmonary arrest |
title_short | Emergency medical service interpretation of Physician Orders for Life‐Sustaining Treatment (POLST) in cardiopulmonary arrest |
title_sort | emergency medical service interpretation of physician orders for life‐sustaining treatment (polst) in cardiopulmonary arrest |
topic | Emergency Medical Services |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8931303/ https://www.ncbi.nlm.nih.gov/pubmed/35342899 http://dx.doi.org/10.1002/emp2.12705 |
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