Do not attempt CPR’ in the community: the experience of ambulance clinicians

Abstract

Abstract

Background. Ambulance clinicians must make time-critical decisions concerning treatment and resuscitation. Little is known concerning the impact of the presence (or absence) of Do-Not- Attempt-Cardiopulmonary-Resuscitation (DNACPR) decisions in the community.

Aims. To investigate ambulance clinician’s experiences of DNACPR documentation and views concerning potential future changes.

Methods. Multi-methods study comprising semi-structured face-to-face interviews (n=10) and on-line questionnaire (n=123).

Findings. Ambulance clinicians report a statistically significant increase in numbers of community DNACPR forms. Most state they have not had formal DNACPR education and experience difficulties making clinical judgements in patients at the end of life, reporting inappropriate cardiopulmonary resuscitation (CPR) attempts and poor communication among stakeholders.

Conclusion. Assessment of patients near the end of life with (and especially without) a DNACPR is challenging for ambulance clinicians. There is a need for 1. education about resuscitation recommendations to be integrated into training and 2. a national approach to decisions and their documentation.