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Out-of-Hospital CPR-Reply

Paul E. Pepe, MD
JAMA. 1994;271(10):749. doi:10.1001/jama.1994.03510340037029.
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In Reply.  —The letter from Dr Jolly addresses a very important issue and we concur with his remarks. Implementing a policy that would allow for on-scene termination of resuscitation efforts may not be so easy in many communities. The traditional expectation of the public has been that the EMS system was established primarily to transport patients to a hospital. However, this simplistic perception of the role of EMS is rapidly evolving.1 The provision of out-of-hospital care does not always necessitate hospital transport, particularly in sophisticated EMS systems with intensive and expert medical supervision.1-3Nevertheless, because of traditional public expectations, field termination policies would require the clear support (and widespread education of the public) by the EMS medical director. Communities such as Seattle and Milwaukee, Wis, have always allowed for termination of resuscitative efforts at the scene. In these EMS programs, the physician leadership and overall survival rates have


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