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T J Crimmins

Publications and source records attributed to T J Crimmins.

17 recordsLinked to original sources
PubMed1993

Ethical issues in adult resuscitation.

The ethics panel of the American Heart Association recommended that ethical values, including patient autonomy and provider advocacy, should guide the provision of advanced cardiac life support (ACLS) and emergency cardiac care (ECC). The panel developed guidelines regarding the institution and withdrawal of basic life support, ACLS, and the criteria for the determination of death. A discussion of futility, No-CPR orders, living wills, advance directives, and their impact on ECC is included.

Adult↗
PubMed1991

Communicating DNR orders to ambulance personnel.

To summarize, the MMA will provide a standard DNR form and guidelines for implementation in local communities. Local physicians, nursing home administrators, and ambulance service operators need to agree on an established set of guidelines that long-term care facilities, hospices, and private homes will follow to inform ambulance personnel of DNR orders. Ambulance medical directors should instruct ambulance staff on the proper implementation and use of DNR orders. The decision to write a DNR order rests with the attending physician, based on disclosure and consent of the patient, family, or proxies. Full implementation of a prehospital DNR system will reduce the suffering that patients and family members endure when inappropriate and unnecessary cardiopulmonary resuscitation is given by ambulance personnel. A similar program, administered by the county health department, has been successful in the west metropolitan Twin Cities area for the past five years. The model offered by the MMA to individual physicians and their medical societies may be modified to meet local needs. This community emergency medical services DNR program helps ensure the provision of appropriate ambulance service based on patients' individual needs and requests.

Advance Directives↗
PubMed1985

Orders to limit emergency treatment for an ambulance service in a large metropolitan area.

We describe a policy allowing paramedics and emergency physicians to honor orders from nursing home records not to perform resuscitation or endotracheal intubation. The policy was adopted by the regional body coordinating emergency medical care and endorsed by the county medical society. The policy establishes community-wide definitions for "do not resuscitate" and "do not intubate" orders. It requires physicians to write such directives in patient's medical records and to update them every two years. It urges long-term care facilities to adopt policies to help ensure good decision-making practices in the formulation of these directives. The policy intends to partially address the unnecessary loss of patient autonomy that occurs when emergency care is administered according to routine orders.

Ambulances↗