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March 9, 1994

Out-of-Hospital CPR

Author Affiliations

The George Washington University Medical Center Washington, DC

JAMA. 1994;271(10):747-748. doi:10.1001/jama.1994.03510340037025

To the Editor.  —As an emergency physician, I read with great interest the recent articles by Kellermann et al,1 Bonnin et al,2 and the accompanying Editorial by Gray.3 The authors address an area that will take on added importance as the attention of the nation turns to health system reform with its apparent emphasis on global cost containment. However, a major area of practical importance has not been addressed by the authors.A death in the emergency department involves more than just physiological determinations of viability. Perhaps a majority of eventual outcomes are obvious on initial presentation of the patient. What happens after the death is a much more difficult subject to study. Sociological realities of our nation typically demand that some authority, usually a physician, preside over the ritual of death. In the simplest terms, the authority must tell the family and friends what has happened,

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