Thanks for the reply...and I appreciate the link to the abstract that I think reiterates the hopelessness of most pre hospital arrests that have not responded to defibrillation. I work within NZ's largest metro system, yet our closest hospital at best is 15 minutes away (under lights and sirens). We have lost a considerable number of our higher qualified (clinical wise) staff to management positions, and often cardiac arrests are attended only by our mid level and low level qualifications. We need to be realistic, make a prudent decision and rapidly decide if a resus is viable. I can only think of a couple of situations where active cardiac arrests have arrived at ED - pregnant female arrest post seizure, TCA OD with refractory VF, arrest whilst enroute to ED, or arrest post trauma during transport or extremely close to ED. There are I am sure plenty of other situations, but the core basic arrest where the initial presenting rhythm is asystole are not transported to ED and more often than not would never have a determined resus attempt started. We too have to wait for police or a GP to assume responsibility/commence coroner activities - and the delay is usually around an hour. Our advanced para's can sign a certificate of life extinct now, which luckily (if all parties are happy) allows the crew to clear from the scene. This appears to be increasingly an important requirement as (like most services) we rush from job to job all shift long. I guess my big issue with it is that I feel we are giving the relatives totally unrealistic expectations about the potential prognosis which we all realistically know in an asystolic arrest will be nil survival to discharge in all but the most rare situation. Are we not duck shoving responsibility? How do our USA counterparts manage? Interesting debate and I am most definitely not picking on you/your co-workers scene management. Just interested in continuing the discussion thread.