Recognizing/accepting futility: prehospital, emergency center, operating room, and intensive care unit.

Trauma has been perceived by the public as occurring as an isolated event, always resulting in favorable outcomes. There has therefore been a lack of discussion of futility of care and termination of care when dealing with the sick trauma patient. Several stages exist where issues of futility and early termination of care must be considered. These include the prehospital setting and involve the emergency medical service system in recognizing those patients who are nonsurvivors. Next is in the emergency room, where heroic measures may not benefit the very sick patient. In the operating room, the surgeon must always reassess and recognize when massive resuscitation will not benefit a particular trauma patient. Lastly, the intensivist must recognize those patients who may or may not benefit from continued efforts to sustain life.