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VOLUME 47 | NUMBER 1.2 | FEBRUARY 2012


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

Keywords: End-of-life;health policy;clinical practice guidelines;Emergency Medical Services.

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 Setting: 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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