DNR's, DPOA's, LW's, etc.

[Handsome Robb]

This is our DNR protocol:

• When to START resuscitation
 As soon as the absence of pulse and respiration is established.
 Major blunt trauma victims who have no pulse or respiration upon
arrival of ***** personnel, and cardiac monitor shows asystole; until base
physician contact can be made. In this case, BLS resuscitation efforts should
be initiated until base physician contact can be made.

• Patients with suspected hypothermia will have resuscitation initiated
and prompt consultation with base station physician will be made.

• When NOT to start resuscitation (assuming no possibility of hypothermia)
□ Any patient, pulseless and apneic, displaying irreversible, obvious and
accepted signs of death:
o Rigor mortis
o Injuries incompatible with life
o Decomposition
o Dependent lividity
o Incineration
o Decapitation
o Visible brain matter
□ On interfacility transfers including nursing home to hospital, when
current, physician signed, DNR orders are present in the transport records
and are clearly presented to the crew.
□ Patient has a state-recognized Prehospital DNR Order (NRS 450B.400 to
NRS 450B.590). It will state ―Nevada State Prehospital DNR‖ either on the
card or the piece of paper. If the patient’s Prehospital DNR is from a different
state, that DNR will be honored.

• When to Stop Resuscitation
 When base physician, after thorough report from paramedic, declares
time of death.

• When to Contact Base Physician
 Blunt trauma arrest
 Penetrating trauma arrest with transport time >10 minutes
 Medical full arrest with asystole or PEA after initial ALS techniques
unsuccessful
□ Suspected Hypothermia and arrest

• When Death Has Been Established
 If obvious death with the possibility of criminal implications, try to leave
patient in position found. Obvious death as described above does NOT
require a cardiac monitor strip showing asystole. Complete chart in a
thorough and descriptive manner, as the report will contribute to the legal
documentation of death. Secure the body and surrounding area until law
enforcement takes custody of the scene.

**All other cases of pronounced death MUST be documented by a Nurse or
Paramedic and have a cardiac monitor strip attached to the chart. On the
chart place time of death, names and numbers of all ***** personnel on
scene, name of physician who pronounced death and the names of law
enforcement personnel who take custody of patient if coroner not available.

 

[emtmomof2]

I too work in an independent living facility. I am also a volunteer emt for my town. We have had similar situations with DNRs, living wills etc. The good news is that we have a medical center on site with about 90% of the residents using it. With that, the resident's have want DNR's are advised to have them posted in their apartments, or they may be attached to their medical documents that we gain access to for medical calls. The biggest problem we have is the do not hospitalize papers. It has become an issue for us since we do not transport, we call an outside service. We have had a few incidents with this when we call for BLS and/or ALS and the resident or resident's family member(s) get upset when we call. It's such a gray area for this too. As far as any of this goes, we do our best to follow state protocols. We are trying to come up with a better policy for all of the above mentioned but it's tough.