Variation of current protocols for managing out-of-hospital XXXX in prehospital settings among Asian countries.

@entity1 @entity4610 @entity1167
BACKGROUND/PURPOSE: Protocols for managing @entity1 with out-of-hospital @entity1167 (OHCA) may vary due to legal, cultural, or socioeconomic concerns. We sought to assess international variation in policies and protocols related to OHCA. METHODS: A brief survey was developed by consensus. Elicited information included protocols for managing @entity1 with nontraumatic OHCA or traumatic OHCA, policies for using @entity4610 ( @entity4610 ) during transportation of @entity1 with ongoing resuscitation, and application of terminations of resuscitation (TOR) rules in prehospital settings in the respondent's city or country. The populations of interest were emergency physicians, medical directors of emergency medical services (EMS), and policy makers. RESULTS: Responses were obtained from eight cities in six Asian countries. Only one (12.5%) city applied TOR rules for OHCAs. Do-not-resuscitate (DNR) orders were valid in prehospital settings in five (62.5%) cities. All cities used @entity4610 for nontraumatic OHCAs; seven (87.5%) cities did not routinely use @entity4610 for traumatic OHCAs. For nontraumatic OHCAs, four (50%) cities performed 2  minutes of on-scene cardiopulmonary resuscitation (CPR) and then transported the @entity1 with ongoing resuscitation to hospitals; three (37.5%) cities performed 4  minutes of on-scene CPR; one (12.5%) city allowed variation in the duration of on-scene CPR. CONCLUSION: International variation in practices and polices related to OHCAs do exist. Concerns regarding prehospital TOR rules include medical evidence, legal considerations, EMS manpower, public perception, medical oversight, education, EMS characteristics, and cost-effectiveness analysis. Further research is needed to achieve consensus regarding management protocols, especially for EMS that perform resuscitation during transportation of OHCA @entity1 .
