ReSPECT – the Recommended Summary Plan for Emergency Care and Treatment

Cathryn James, Clinical Support for the National Ambulance Service Medical Directors (NASMeD), Association of Ambulance Chief Executives (AACE) and Dhushy Surendra Kumar, chair of JRCALC provide an outline of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT).

What is it?
The ReSPECT process, launched on 28th February 2017, creates personalised recommendations for clinical care in emergency situations in which a person is unable to decide or communicate their wishes.

Who is it for?
ReSPECT can be for anyone, of any age. It is most likely to benefit people:

> with complex health needs or
> at risk of sudden collapse or cardiac arrest or
> nearing the end of their lives or
> who want to record their preferences for any reason.

How does it work?
The plan is agreed following discussion between a person and their healthcare professional. It is recorded on a double-sided form that should be with the patient and made available immediately to ambulance crews in an emergency.

What does it cover?

ReSPECT can recommend elements of emergency care and treatment that:

> should be considered and would be wanted
> the person would not want
> would not work in their situation
> could cause them harm.

It recommends whether CPR should be attempted or not. Importantly for ambulance clinicians, it can include whether or not hospital admission would be wanted and in what circumstances.

ReSPECT guides clinicians who have to make these rapid decisions in choosing the right balance of treatment between sustaining life and providing comfort.

ReSPECT is much more than a DNACPR form. It’s a person-centred plan and records treatments that should be considered as well as those that are not recommended.

It is available for UK-wide adoption and should be recognised by health and social care professionals across organisational and geographical boundaries, avoiding problems that exist with different forms in different organisations or localities.

Whilst it records recommendations to guide clinical decision-making in an emergency, those are not legally-binding. The final decision rests with the clinician(s) dealing with the emergency.

ReSPECT encourages people to plan ahead for their care and treatment in a future emergency in which they are unable to make choices, and promotes more conversations between people and their clinicians.

Who developed it?
The ReSPECT process has been developed by a working group which has wide representation, including patients and the public, JRCALC, the Resuscitation Council (UK), Royal College of Nursing, Association of Ambulance Service Chief Executives, Medical Royal Colleges, General Medical Council, and the Care Quality Commission, together with leaders of successful local and regional initiatives to develop robust processes and documents for similar decisions.

Further information about ReSPECT and supporting materials are available at