DNR Order

[AtlantaEMT]

If a family member can act as a medical proxy, do we need full confirmation that she/he is their husband/wife? The reason I am wondering this is becuase I had a guy in a hemorragic stroke and we had this woman who I thought was this guy's wife at the time. Now if this guy went into full arrest and we had a DNR I wouldn't have put it past this woman to claim that she is his wife and want him to be resuscitated. She was crazy enough to claim an EMT who was trapped on the backside of the elevator by the stretcher assaulted/pushed her.

Would we need to match driver licenses? But then again my GF and I live together and we have the same address and two non-married partners could have the same last name too. I know it's usually easy to figure out if someone is married but I'd hate to tear up a DNR and find out that the person had no control over this person.

 

[Alas]

Very informative replies. I've had a few close DNR situations but they never came, but they made me ask questions. I do live in San Francisco. Followup scenario: who has the right to call off a dnr while in the ambulance? Spouse of PT? Brother? Distant Relative?

 

[JPINFV]

If only there was a government website that provides answers to questions of protocol and procedure for providers to look at...

d). In the case the patient is unconscious and family members present are requesting resuscitative measures, initiate BLS treatment and contact the base physician.

http://www.sfdem.org/Modules/ShowDocument.aspx?documentid=224

There's no mention to this being limited to just the scene and not transport.

Why do I enable people to not do their own research?

 

[Medic50321]

Reguardless of what state your in, you start CPR. THe DNR has become invalid.

Agreed, same in Iowa

 

[MrBrown]

Brown would politely decline to get involved and go back to surfing Facebook on his phone

/sarcasm

... well at least about the surfing Facebook on his phone part

 

[Saytuck99]

New York

In New York..


A living will or health care proxy is NOT valid in the prehospital setting.

Under what circumstances may an EMS provider disregard an Out of Hospital DNR order?

* Any case where there is reasonable evidence to suggest that the DNR order has been revoked or cancelled.
* If the patient is conscious and states that they wish resuscitative measures, the DNR Form should be ignored.
* If the patient is unable to state his or her desire and a family member is present and requests resuscitative measures for the patient and a confrontational situation is likely to result, if the request is denied.
* A physician directs that the order be disregarded.

This is part of the DOH regs and I recently taught a seminar on this topic..technically if a DNR Order is valid... a family member is unable to revoke it...even if they are the Health Care Proxy..POA or whatever..

Thats does not mean that if a guardian or Proxy authorized issuance of the DNR they cannot revoke it...it means that if the patient has a valid DNR they authorized technically only the patient and/or medical control/physician can invalidate it.... the pleading of a family member, however, might serve as evidence the DNR is invalid...wink wink..

This is a complicated area...and my response by no means covers all aspects...and no one should rely on this post without first checking with their state regs and dept policies.....

There...disclaimer over...

 

[jjesusfreak01]

If you are a family member and you don't want the DNR followed, don't show EMS the DNR. Its really that simple. If they don't know it exists, then they work it no matter what. All this talk about a family member revoking it means that they really didn't prepare well for this to happen (not that you can).

 

[jms81]

Know your local protocol, follow it, and always follow up with detailed documentation.

 

[Trip]

If only there was a government website that provides answers to questions of protocol and procedure for providers to look at...



http://www.sfdem.org/Modules/ShowDocument.aspx?documentid=224

There's no mention to this being limited to just the scene and not transport.

Why do I enable people to not do their own research?

I guess all I can say is take it as you will. Luckily there is a good faith clause to protect honoring a DNR or MOLST form.

New York is similar and a HCP cannot revoke, only a family member and, even then, it's only if a confrontation is imminent from the family member. However, a new act went into effect in June of 2010 that makes the whole thing somewhat confusing, but does state

The law does not expand the ability of EMS personnel to honor advance directives such as a Health Care Proxy or Living Will.

http://www.nyhealth.gov/nysdoh/ems/pdf/99-10.pdf

http://www.nyhealth.gov/nysdoh/ems/pdf/10-05.pdf

 

[DezertRanger-EMT]

here in Kern county the DNR order hast to be present, other wise you do what you can to keep them alive, if the family gets mad they cant do anything without the DNR order with them, you are just doing your job and following protocol.

 

[Shishkabob]

here in Kern county the DNR order hast to be present, other wise you do what you can to keep them alive, if the family gets mad they cant do anything without the DNR order with them, you are just doing your job and following protocol.

Erm... if you start working the code and the family says they don't want you to, regardless of whether or not they have a valid DNR you should call med control and punt the decision off to them.

Chances are the doc will tell you to call it.

 

[DezertRanger-EMT]

Erm... if you start working the code and the family says they don't want you to, regardless of whether or not they have a valid DNR you should call med control and punt the decision off to them.

Chances are the doc will tell you to call it.

yeah it is protocol to contact medical direction you are rite.

 

[lampnyter]

we were taught if they had a valid DNR no matter what the family says we follow the DNR

 

[EMS/LEO505]

We haven't covered legal aspects fully yet in class, but I asked about DNR orders and in NM the DNR must be in hand for it to apply in that situation.

 

[JPINFV]

here in Kern county the DNR order hast to be present, other wise you do what you can to keep them alive, if the family gets mad they cant do anything without the DNR order with them, you are just doing your job and following protocol.

Note entirely true per Kern County LEMSA's website.

Besides a DNR, the following are acceptable

Living wills

Power of attorney documents that specifically include DNR style language (the policy says it can be in lay person language with an example being "no breathing tube")

The durable power of attorney: health care can give a verbally decline.

Medic alert bracelets.


http://www.co.kern.ca.us/ems/DNRGuidelines1992.pdf

 

[JPINFV]

we were taught if they had a valid DNR no matter what the family says we follow the DNR

In general, every DNR policy I've seen has stated to begin resuscitation, and if need be, punt to medical control if the family member requests resuscitation. For all you know, the patient requested resuscitation prior to collapsing.

 

[Shishkabob]

we were taught if they had a valid DNR no matter what the family says we follow the DNR

I don't know where you live, therefor I don't know your local laws, but if a direct family member states work them, regardless of a DNR, we work them whilst contacting med control.

If one family member says work them, and 20 say don't work, you still work until you get a doc on the line.

 

[JPINFV]

We haven't covered legal aspects fully yet in class, but I asked about DNR orders and in NM the DNR must be in hand for it to apply in that situation.

http://www.nmems.org/Treatment guidlines/Microsoft Word - Treatment Guidelines 2008.pdf

Page 48.

When ever possible, go to the source document. The New Mexico DNR protocol trumps anything your teacher or future bosses say.

 

[lampnyter]

Revocation (19a-580d-7)

A DNR order may be revoked by the patient or authorized representative by removing the bracelet from the patient, or telling an individual licensed healthcare provider or certified emergency medical technician. Such healthcare provider or emergency medical technician must enter the statement in the patient's permanent medical record and notify the attending physician and the physician who issued the DNR order.

http://www.cga.ct.gov/2005/rpt/2005-R-0455.htm

 

[Charmeck]

How about a MOST form?