CPR: unified approach to implementing advanced care plans vital for ambulance crews

Pre-hospital systems for respecting end of life wishes need to be explored for true person-centred care

Pre-hospital systems for respecting end of life wishes need to be explored for true person-centred care

Picture: iStock

In January 2017, The Resuscitation Council, the Royal College of Nursing and the British Medical Association issued a joint statement on cardiopulmonary resuscitation (CPR).

The statement noted that ‘where no explicit decision about CPR has been considered and recorded in advance there should be an initial presumption in favour of CPR’.

However, it needed to be emphasised that initial presumption in favour of CPR ‘does not mean indiscriminate application of CPR that is of no benefit and not in the person’s best interest’. 

Common scenario

For any emergency nurse a common scenario is that of being pre-alerted by the ambulance service to a crew en route with a patient receiving CPR.

What is not uncommon is that after the initial adrenaline of preparing to receive the patient, emergency hospital staff soon realise that it is a person who is at the end of their life.

Our ambulance colleagues work in a high-pressured environment where commencing lifesaving or sustaining treatment is a default action, especially in the absence of a clear do not attempt resuscitation order (DNA CPR) or an advanced directive.

Skills and experience

Withholding life-sustaining treatment requires significant confidence, skills and experience in the face of being questioned by your governing body.

The Compassion in Dying charity contacted 13 ambulance trusts in the UK under the Freedom of Information Act to explore their processes and policies for acknowledging and holding information on:

  • Advance decisions to refuse treatment.
  • DNA CPR.
  • Lasting powers of attorney.
  • Whether ambulance crews receive training on identifying and implementing such directives.
  • How adherence or lack of adherence is recorded and analysed.

Absence of unified approach

What was evident was the absence of a unified approach for recording and implementing advanced care plans among our ambulance services.

For crews who are the initial responders, they are limited to the care they can provide, which includes end of life care due to the absence of information about patients. This often results in assuming the default position – commencing life-sustaining treatment.

However, if a true person-centred approach is to become a reality, we need to explore, consider and influence pre-hospital systems for respecting end of life wishes. This includes not only our ambulance colleagues, but the public themselves.

Further information


About the author

Linsey Sheerin is clincial coordinator at the emergency department at the Royal Victoria Hospital, Belfast


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