California Chapter Statement on LA County EMS Directive #6

January 8, 2021

The California Chapter of the National Association of EMS Physicians (Cal-NAEMSP) is aware of the public concern expressed over the Los Angeles County EMS Agency Directive #6 – EMS Transport of Patients in Traumatic and Non-Traumatic Cardiac Arrest. 

Directive #6 does not represent a change in the existing standard of care for prehospital patients. It emphasizes existing policy that discourages the transport of patients in whom further resuscitation in the emergency department will not yield a change in the patient’s outcome. Although some interpret the directive as a response by EMS to the pandemic that modifies care for patients with cardiac arrest, in fact, Los Angeles County EMS Agency Directive #6 provides guidance to our providers based upon the best available evidence for the management of out-of-hospital sudden death. 

For many years research has shown that patients in non-traumatic cardiac arrest have the greatest chance for survival when resuscitation is performed in the field, compared with a strategy of rapid transport. Our paramedics have the same tools for cardiac arrest resuscitation available at the emergency department and are continually training in the latest, evidence-based strategies to achieve the best outcomes for our patients. Field termination of resuscitation has been included in Los Angeles County EMS system protocols for more than 10 years, and it is the standard for EMS systems across the United States. Transporting patients in cardiac arrest after an unsuccessful resuscitation endangers the safety of EMS crews and utilizes limited EMS and emergency department resources and does not change the outcome for the patient.  Likewise, patients in traumatic cardiac arrest, as described in the directive, that do not respond to immediate on-scene interventions, have virtually zero chance of survival. 

Cal-NAEMSP represents 129 emergency physicians specializing in the oversight and provision of emergency medical services care in the prehospital setting for the 40 million residents of California, and we are devoted to delivering the best care possible for our communities.  We work collaboratively with physicians and scientists from numerous specialties to provide the most modern and effective care possible to the citizens of California.

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