It’s all fine and good to say what you would do in a similar situation and that you have the luxury to make decisions based on your “optimistic mood”, but as EMT’s and Paramedics, we function under protocols set by the systems we work in. Other than our frequent flyers, we usually don’t have prior contact with patients to know what their personal or cultural wishes are. Especially regarding end-of-life decisions. I think the superior EMS systems are the ones that allow EMS to stop resuscitation after a set period of time (30 minutes being reasonable) thereby sparing family members some of the trauma associated with treatment and transport out of the home. I don’t think it serves any purpose to extricate an obviously unsavable patient, sometimes overweight and off of a second or third floor. The patient’s are half dressed, while CPR is being performed and they end up being displayed to all of their neighbors. They get driven expeditiously through traffic, putting the public at risk and all of this just so the ER Doctor can pronounce the patient dead thirty seconds after you arrive at the hospital. Your point regarding a patient not wanting to be resuscitated, even though they called for an ambulance, is true. A lot of misconceptions surround, Do Not Resuscitate (DNR) orders . Nurses in nursing homes often think that a DNR means Do Not Treat the patient. There is no reason to have simple treatments withheld because a DNR exists. It may be a simple condition such as hypoglycemia that is causing the distress. Give them some Dextrose and they are good to go. But if that same patient goes into cardiac arrest, EMS is not allowed to decide whether or not they are going to resuscitate or not. That’s where a DNR order comes in. Family and patient confusion comes from Doctors writing orders for a DNR and never educating them on what to expect when they call for an ambulance. In the system I work for in the US, we are required to resuscitate if the DNR order isn’t present. This sometimes causes tension between family members and EMS. At certain times I would like to honor the family’s wishes of not doing anything, but like Reynolds, we are bound to perform our duty. It’s not a pleasant position to be in. If a resuscitation is to have any chance for success, it must be initiated immediately. If the first ten minutes after arriving at the patient are spent trying to decipher if a DNR exists, we are clearly decreasing any chance of survival.