# CPR in progress, with a DNR



## PotatoMedic (Jan 5, 2009)

While reading the forums tonight I came across this...



Illini_emt said:


> OH my favorite!!!
> 
> Tones Drop
> Dispatch: 17-Ambulance-1 Code Responce, Report to XXXXNorth XXXXEast Rd for 85F not breathing.
> ...




My question is would you continue to provide resuscitation efforts after finding the DNR assuming that the patient verbally voided it... or do you stop all efforts?

Has anyone come across situations like this or have any advice on how you would handle the situation and why.  I am just thinking you could open your self up to legal litigations either way you take it.


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## KEVD18 (Jan 5, 2009)

a valid, double signed and present dnr is grounds for immediate cessation of rescue effort.

my question back to you, why would you resuscitate someone who wants to be allowed to die?


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## JPINFV (Jan 5, 2009)

Nope. Simple answer. Every DNR protocol I've seen has basically made it so that any family member can revoke a DNR at any time.

MA DNR/Comfort Care protocol


> If an *individual identifying him/herself as* the health care agent or guardian revokes the CC/DNR Order Verification, EMS personnel shall resuscitate, as this raises an issue of doubt as to the validity of the CC/DNR Order Verification [emphasis added]
> ...
> *In any situation where EMS personnel have a good faith basis to doubt the continued validity of the CC/DNR Order Verification, EMS personnel shall resuscitate.* [emphasis not added]



http://www.mass.gov/?pageID=eohhs2t...services_p_comfort_care_overview&csid=Eeohhs2
Orange County, CA DNR protocol


> G. Base contact should be made and the Base Physician consulted and resuscitation should be initiated:
> 1. If there are any questions regarding validity of the DNR order,
> ...
> 5. If there is disagreement among family members regarding the provision or withdrawal of resuscitative measures, or
> 6. Anytime emergency response employees have concerns or require assistance.


http://ochealthinfo.com/docs/medical/ems/P&P/330.51.pdf

EDIT: 



KEVD18 said:


> a valid, double signed and present dnr is grounds for immediate cessation of rescue effort.
> 
> my question back to you, why would you resuscitate someone who wants to be allowed to die?



Plans change, things happen. I'm all for honoring verbal DNRs from immediate family (something I can't do in MA) and contacting med control if need be. Unfortunately, if the patient or family changes their mind or disagrees with each other, then it is something that should be handled at the hospital in a controlled setting. You can end resuscitation at any time, but, practically speaking, you can't restart it once you stop.


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## KEVD18 (Jan 5, 2009)

for a family member to make that call on scene, they have to prove they are the proxy or guardian. this means showing me the proper documentation.

im sorry, but i dont believe in people being kept alive past their natural life span for the benefit of the family that doesnt want to let go.


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## jrm818 (Jan 5, 2009)

KEVD18 said:


> for a family member to make that call on scene, they have to prove they are the proxy or guardian. this means showing me the proper documentation.
> 
> im sorry, but i dont believe in people being kept alive past their natural life span for the benefit of the family that doesnt want to let go.




That's your belief - but MA protocols do not require proof of legal guardianship, and implicitly require that the family be accepting of the decision to die without resuscitation attempts.  JPINFV quotes them above - all one has to do is "identify" themselves as a health care agent, not provide any evidence.  The CC/DNR has to be proven to be in effect, but not proof is required to revoke it.  The burden was intentionally placed such that with any dispute, the patient is resuscitated.

Seriously, I doubt very many properly appointed health care proxies could provide proof of proxy ship immediatly in an emergency situation.  There is no bracelet form for that - the documentation is likely filed and locked away somewhere.  Are you going to wait to initiate CPR while they go search through the "p's"?  What if they are not at home?  in MA, the law states that they need only claim proxyship, not prove it.

the CC/DNR protocol only works when the family is on-board with the patients decision.  It needs to be discussed and agreed upon beforehand by everyone involved in the patient's care.  A child asking for resuscitation or disputing the desire of the patient to die means full resuscitation efforts in MA.

From the Q/A on the MA OEMS site:

"4. What if someone identifies themselves as the health care agent and states they do want you to resuscitate and there is a CC/DNR form with the individual?

Even if there is a valid CC/DNR verification form, if there is any question as to the validity of the verification, CPR must be initiated."

Heck, you don't even have to be a health care proxy, all you have to do is say the (now unresponsive) patient changed their minds:

"Revocation of the CC/DNR Order Verification is possible, at any time, by the patient or the authorized decision maker by either: 1) destroying the CC/DNR Order Form, 2) directing that the CC/DNR Order Form, if used, be destroyed; or 3) simply stating or otherwise indicating that the patient wishes to be resuscitated."


to the OP: look at your own state protocols.  I suspect they're similar to MA's, but who knows.


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## KEVD18 (Jan 5, 2009)

scenariobtw this is a real call)

you respond for the unresponsive at a private residence.

u/a you find an elderly female supine and unresponsive. assesment reveals a pulseless and apneic patient. there is a double signed and non expiring cc/dnr form present listing a female nok as the hcp/guardian. this person is not present on the scene.

a distraught male person identifying himself as the patients son(the person who handed you the blue paper) asks, the demands recusitative efforts. fwiw, this person is in fact the patients son, but he has a cognitive developmental disability that isnt immediatley apparent due to his hysteria. 

the nok is not able to be live contacted. 

the resolution of this case will be with held pending comments.


the question(directed mainly at the massachusetts certified dissenters, but open to anyone with very closely similar protocols):

do you work this code?


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## Brandi (Jan 5, 2009)

if ems dnr I would stop.  if not, go to the hospital,  in Kentucky we can only honor EMS DNR, all others are not any good for us


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## JPINFV (Jan 5, 2009)

Pending medical control contact (since it is an option here), yes. I have no idea what conversation the patient had with her son prior to departing from this world and it is possible that the patient verbally revoked the DNR prior to collapsing.


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## boingo (Jan 5, 2009)

No, I probably wouldn't work it.  She's an elderly woman in cardiac arrest with a signed, legal DNR order. The patient has signed it, the doctor has signed it, now she is in arrest.  Per the order, no resuscitation is desired.  I might try and find out how long ago she arrested, was it witnessed?  I would try to explain to the son that this is his mothers wishes, that this is a end of life event and she is already dead.  Explain the procedure, pushing on her chest, fx ribs perhaps, putting a tube down here throat, needles in her arm, neck or bone...If that was no good, then I'd contact medical control, and most likely would be told not to work it.


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## jrm818 (Jan 5, 2009)

ditto JPINFV.  EMT's don't speak to doctors very often in MA, but this is one decision I'd dump on one.  Until then, as an EMT without  I'm not sure if I'd start CPR or not before I called, depending on the circumstances of the arrest (time down, condition of pt, CPR already in progress, etc.)  Any obvious signs of death and I'd not work it.

Did the son say that his mother wanted to be resuscitated, or that he wanted her recussitated?  It seem strange that he would hand you the CC/DNR unless he did it with a statement along the line as "she has a DNR but doesn't really want it followed."

If for some extraordinary reason medical command could not be reached, my reaction would depend on the exact actions of the son.  If he appears to be simply distraught over the loss of his mother, I'd probably try to calm him down and talk about her wishes to try to get him to agree to withold lifesaving attempts.  If he was excited but specific that he wanted her worked regardless of the DNR, I'd probably work it.  

Really it's the patients and families responsibility to make sure that everyone, including those with whatever form of developmentally disabled we're talking about understand and are OK with the decision.


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## boingo (Jan 5, 2009)

jrm818 said:


> Really it's the patients and families responsibility to make sure that everyone, including those with whatever form of developmentally disabled we're talking about understand and are OK with the decision.



I'd have to say its the decision of the PATIENT, sons, daughters, sisters, brothers be damned.  A DNR should be discussed with your family and loved ones, however the final word should be the patients.  If my family over rode my DNR, I'd come back and haunt them.


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## KEVD18 (Jan 5, 2009)

jrm818 said:


> ditto JPINFV. EMT's don't speak to doctors very often in MA


 

i guess i have to call the docs i spoke to the thre or four thousand times ive called for med control since i got my ticket in ma an apoligize.

thanks for the heads up, i have a lot of work to do.


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## JPINFV (Jan 5, 2009)

jrm818 said:


> ditto JPINFV.  EMT's don't speak to doctors very often in MA, but this is one decision I'd dump on one.  Until then, as an EMT without  I'm not sure if I'd start CPR or not before I called, depending on the circumstances of the arrest (time down, condition of pt, CPR already in progress, etc.)  Any obvious signs of death and I'd not work it.



If you don't start CPR prior to calling, then don't bother calling. Response time+assessment (verification of DNR/CC order and verification of full arrest)+time to get medical control clarification=enough time to make resuscitation futile. 

To clarify when I mean "actually an option," the location where I worked prior to coming to Mass for grad school didn't have online control set up for EMT-Bs. Even if an EMT-B wanted to call medical control, they couldn't.


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## frogtat2 (Jan 5, 2009)

*CPR - yes or no*

I found this thread interesting.  Here in Wyoming, we have a program called "Do Not Resucitate" - you send your money into the state office, they send you back a form that you and your doctor sign, then you send the form back to the state, and then they send you a bracelet and paper back.  You wear the bracelet, place the form either on your refrigerator, or by your bed.  This form/bracelet are formal notifications of the patients wishes.  If the pt has one you don't start, regardless of what the family says.  If the pt decides they want CPR, they take off the bracelet, send it back and it's rescinded.

I know that leaves you all sorts of questions.  Fortunately in WY they have made this fairly easy for EMS.  (one of the few instances)  If CPR is in progress, you run the code.  Families can't make the decision whether its run or not run.  

In the scenario that started this thread, we would continue the code.  CPR was started.  Yes, a DNR was handed to us, but it was AFTER the CPR had already been started, and there are so many variables, that we would run the code, but while doing that contact medical control and tell them exactly what happened and then follow their direction.


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## JPINFV (Jan 5, 2009)

frogtat2 said:


> Families can't make the decision whether its run or not run.



I wouldn't be too sure of that. 



> Cardiopulmonary Resuscitation Directives
> Ch. 4 - Requirements and Principles
> 
> Section 2. General Principles:
> ...


 Emphasis added
http://soswy.state.wy.us/Rules/RULES/1521.pdf



> I know that leaves you all sorts of questions.  Fortunately in WY they have made this fairly easy for EMS.  (one of the few instances)  If CPR is in progress, you run the code.  Families can't make the decision whether its run or not run.





> Ch. 3 - Responsibilities
> 
> Section 4. Emergency Medical Services Personnel Responsibilities:
> 
> ...


Emphasis added. 
http://soswy.state.wy.us/Rules/RULES/1520.pdf

In the end, anyone who thinks that DNR rules/protocols are simple is being mislead. Unless you've read the laws and protocols yourself, I would not trust what your coworkers or EMT-B class taught you since these issues are no where close to being universal.


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## KEVD18 (Jan 5, 2009)

frogtat2 said:


> I found this thread interesting. Here in Wyoming, we have a program called "Do Not Resucitate" - you send your money into the state office, they send you back a form that you and your doctor sign, then you send the form back to the state, and then they send you a bracelet and paper back. You wear the bracelet, place the form either on your refrigerator, or by your bed. This form/bracelet are formal notifications of the patients wishes. If the pt has one you don't start, regardless of what the family says. If the pt decides they want CPR, they take off the bracelet, send it back and it's rescinded.
> 
> I know that leaves you all sorts of questions. Fortunately in WY they have made this fairly easy for EMS. (one of the few instances) If CPR is in progress, you run the code. Families can't make the decision whether its run or not run.
> 
> In the scenario that started this thread, we would continue the code. CPR was started. Yes, a DNR was handed to us, but it was AFTER the CPR had already been started, and there are so many variables, that we would run the code, but while doing that contact medical control and tell them exactly what happened and then follow their direction.


 

see in mass its one giant charlie foxtrot.

they issue a paper called the comfort care dnr form. this is duly filled out an autographed by both the md and the patient/guardian. it is in effect until such time as it is physically destroyed by the patient, the doctor, or the duly appointed health care proxy. they are not registered with anyone. now it quite clearly states that one must be identified as the guardian or health care proxy to cancel an active dnr. to me(after a fair bit of research and discussion with officials and experienced providers) this means showing me your papers. some disagree with this, but its the scenario above that makes this sort of thing necessary.

the system here is very grey and ambiguous. its a veritable mine field. about the only saving grace in this miasma of a system is this clause:

*In any situation where EMS personnel have a good faith basis to doubt the continued validity of the CC/DNR Order Verification, EMS personnel shall resuscitate.*

so basically, if you're scratching your head over whether or not to proceede, proceede and sort it out later; but that can cause a poop storm of epic proportions.

further, this one piece of paper(or the accompanying bracelet) is the only type of dnr we can accept. living wills, health care proxys, hospital dnr's etc can not be honored by prehospital providers. you can tatoo a bloody picture of the paper on your chest, but without the blue paper, its a no go.

its a very ridic system that full of potential landmines and pitfalls, but hey its massachusetts, what else is new.


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## jrm818 (Jan 5, 2009)

boingo said:


> I'd have to say its the decision of the PATIENT, sons, daughters, sisters, brothers be damned.  A DNR should be discussed with your family and loved ones, however the final word should be the patients.  If my family over rode my DNR, I'd come back and haunt them.



But in MA all the family has to do is say "mommy changed her mind," regardless if true, and poof...code gets worked.  My point was it's not my responsibility to keep the family in line with the patient's wishes.  Of course there's the chance that if they override your DNR you do live too...which puts a kink in your haunting plans temporarily....


KEV:

I've never been sure if you're a basic or medic (or intermediate...though I didn't think we had those anywhere in the eastern part of the state).  When I said EMT's don't call except for entry notifications, I meant "EMT-B's"  If you're a basic, what exactly are you calling doctors about?  "Hey doc, we have a guy with SOB, think he might need some O2?"  "What's up doc, got a kid with a hurt spine, want us to backboard it for ya?"  There's not that much that a basic can do that requires MD input.


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## JPINFV (Jan 5, 2009)

jrm818 said:


> I've never been sure if you're a basic or medic (or intermediate...though I didn't think we had those anywhere in the eastern part of the state).  When I said EMT's don't call except for entry notifications, I meant "EMT-B's"  If you're a basic, what exactly are you calling doctors about?  "Hey doc, we have a guy with SOB, think he might need some O2?"  "What's up doc, got a kid with a hurt spine, want us to backboard it for ya?"  There's not that much that a basic can do that requires MD input.



There are parts of the treatment protocol in Mass for EMT-Bs that require a base hospital order. 

For example:

If the patient requests a destination longer than 20 minutes away.

Activated charcoal.

Patient assist nitro if the patient is also taking a phosphodiesterase 5 inhibitor (why that's even available via med control, I don't know). 

EpiPen use for patients under 5. 

I think that there are a few more. 

Any time an EMT-B needs/wants guidance (Personally, I would consult online and attempt to get an online order if the family is in complete agreement about not resuscitating or a DNR is in the patient's chart at a health care facility with no CC/DNR paperwork). 

We can also use the same radio network that is used to obtain online control to give entry notification.


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## KEVD18 (Jan 5, 2009)

ive called the doc for many reasons, some mentioned just above there. also for orders to involuntarily take patients, for orders not to involuntarily take pt's, to ask if theres anything i can do besides nothing, to assist with meds not in my protocols(i.e. patient states they need a neb tx and cant set it up themselves(before nebbies were in the bls scope), to get orders to divert or not divert etc etc etc. you're also not considering that some services required olmc for standing orders(an abomination in and of it self, but the fact remains...).

i dont call the doc for every call(except als ift where you have to), but he's on the payroll for a reason. when you need help, man up and ask for it. theres no shame in it, but there is legal liability for not calling when you should have.

but none of that is really relevant to the topic at hand, which is withholding/ceasing efforts.


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## jrm818 (Jan 5, 2009)

JPINFV said:


> There are parts of the treatment protocol in Mass for EMT-Bs that require a base hospital order.
> 
> For example:
> 
> ...



I couldn't think of many more.

A) isn't an issue where I am
B) How often is charcoal given, really?  I don't know how many EMT's I could find who have given it.
C) acutally never happened to me, I suspect its not all that common
D) Epi under 5 or over 65: also, probably not all that common, but does happen I'm sure
E) suspected CVA with low BGL: probably not super common except for minor BGL changes
F) second dose of inhaler if max dosage not reached.  Usually the max dosage was reached prior to EMS being called.
G) chem burns with contact lenses: not that common, though calling for chemical issues in general I could see.  
H) trach problems: we'd have ALS for this, probably not uncommon, but I've never called as a basic on my own


Yea you use CMED to give notifications, but usually (if not always) its a nurse that answers the radio at the hospital, you would have to request a physician specifically.  In my experience at the basic level the need to speak to an MD is not common, though it certianly does happen.  Heck even the albuterol protocol doesn't require MD contact first.

Edit: 

Kev, your right this is off topic.  So what's the answer to your scenario?  I assume it wasn't worked...hopefully everyone was happy with that outcome?


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## JPINFV (Jan 5, 2009)

KEVD18 said:


> you're also not considering that some services required olmc for standing orders(an abomination in and of it self, but the fact remains...).


Don't go there. :wacko::sad:


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## BossyCow (Jan 5, 2009)

I had a call where the pt was a frequent flier and we had watched her slow decline due to CHF and Bladder Cancer over a number of years and dozens of calls. She was the grandmother of an EMT with a local private ambulance service and we all knew the family. 

Towards the end, we were called to CPR in progress by the caregiver. Her husband was on scene and although we had all seen the POLST form many times in our runs to the residence and the pt had long before lost the ability to make an informed decision, the husband told us that her status was full code and said the POLST had been revoked. It hadn't. But, we couldn't corroborate her code status at the hospital and without the form (which he had hidden prior to our arrival) we gave her full code treatment. She arrived at the ER with a pulse, assisted respirations and died the next day. 

Was this a waste of resources, ignoring the wishes of the pt, or other heinous offenses? A case could probably be made for it.. but we chose to see it as honoring the grief of the husband who wasn't quite ready to say goodbye after sharing over 60 years with this woman. Yes the eventual decision was to avoid further interventions to prolong her life but you know what they say.. when the pt is gone.. the family becomes your pt.


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## KEVD18 (Jan 5, 2009)

the code was worked, and as a result a brown cloud of epic proportions eminated from the call.

the crew that took the call called the doc who told them to work it(remember, he doesnt know the whole story on the son). they had rosc in the field and went to the H. the patient lingered for a bit in the icu(at a rate of thousands a day). when the hcp was finally gotten a hold of, she tweaked like you read about. the pt was removed from life support and promptly kicked off, leaving one hell of a wake.

there were meetings and reports and all sorts of junk over this. after it was determined that the son was of inadequate mental competence, it really hit the fan. the service(i wish for the life of me i could remember which it was. they are defunct now though, so its pretty much irrelevant) pawned it off on the olmc doc stating that they were only doing what the doctor told them too(the nuremburg defense), who tried to kick it back down to the crew since they didnt tell him the brother was retarded. the crew kicked it back up stairs since they didnt know the about the brothers condition and therefore were acting in good faith with orders from a doc who was as informed as he could have been. 

the end result was no punitive action against any of the providers and what i can only imagine was a healthy check to the daughter. this si just one of the many examples of how the mass comfort care system is screwed up. this case was maybe as many as a dozen years ago, although my memory is a little hazy on the specifics. i wasnt involved personally, but a good freind of mine was on the rig that took the call. 

its a damned if you do, damned if you dont situation.


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## KEVD18 (Jan 5, 2009)

BossyCow said:


> ...honoring the grief of the husband who wasn't quite ready to say goodbye...


 

and here we have the fundamental problem in this and many other discussions.


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## boingo (Jan 5, 2009)

If the DNR is valid then the arrest doesn't get worked.  Unless it appears forged, is missing, or otherwise appears not legit, its a legal document stating the patients wishes, and a family member, other than a legal HCP or guardian cannot over ride it.  I suppose if the family member where to claim that they are the patients guardian or HCP I'd take their word for it, but otherwise its an emotional family member who hasn't come to terms with the patients decision, which is clearly noted by a signed, legal document.


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## PotatoMedic (Jan 6, 2009)

What it seams that I am getting from all the responses in general is 


know your local laws and protocols.  
If in doubt resuscitate.
talk to medical control and document extensively in odd situations.

Thank you all for you input and the more to come (if any).  I'll make sure I ask a similar question when we get to Advanced Directives and DNR's.


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## BossyCow (Jan 6, 2009)

boingo said:


> If the DNR is valid then the arrest doesn't get worked.  Unless it appears forged, is missing, or otherwise appears not legit, its a legal document stating the patients wishes, and a family member, other than a legal HCP or guardian cannot over ride it.  I suppose if the family member where to claim that they are the patients guardian or HCP I'd take their word for it, but otherwise its an emotional family member who hasn't come to terms with the patients decision, which is clearly noted by a signed, legal document.



if the document is there and you see it... but.. the husband in my case destroyed the document prior to our arrival. Not about to jump all over a highly emotional senior citizen that just happens to be a co-worker's grampa over an issue that is best handled by the ER staff and the family members who met him at the ER. Oh.. and into the equation.. the husband was Japanese and though he spoke fluent English would lapse into Japanese and pretend to not understand when stressed.


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## EMTWintz (Jan 6, 2009)

JPINFV said:


> Nope. Simple answer. Every DNR protocol I've seen has basically made it so that any family member can revoke a DNR at any time.
> 
> .



So what is the point of getting a DNR anyway? If the document was signed by pt and his/her doctor. What gives a family member the right to deny them that last request. In essence its a worthless peice of paper.


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## JPINFV (Jan 6, 2009)

EMTWintz said:


> So what is the point of getting a DNR anyway? If the document was signed by pt and his/her doctor. What gives a family member the right to deny them that last request. In essence its a worthless peice of paper.


Not really. A DNR is a serious decision that when used in deciding medical care (i.e. declining resuscitation) acts as an irrevocable act. You can't decide two days post arrest to resuscitate. As such, it is imperative that all family members are on the same page, just as if a patient was declining other types of medical care on religious or cultural reasons. What if in the patient's final minutes verbally rescinded the DNR order to a relative? EMS providers arriving post arrest have no clue to any conversation that did or did not occur prior to arrival. Furthermore, not all arrests are witnessed by family members.


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## EMTWintz (Jan 6, 2009)

JPINFV said:


> What if in the patient's final minutes verbally rescinded the DNR order to a relative?



This is why I think that people who are looking into DNR's especially the terminally ill need to go thru mandated counciling. Now before anyone jumps my butt, hear me out. Signing a DNR is a BIG deal not to be done in haste. Most people when they find out they are terminal decide they jump into requesting DNR's. If this is something they really want to do, they should have to go thru some sort of class with an expert that can FULLY inform them and their family's the ins and outs. Much like hospice. Studies show that those with family members who are on hospice are more prepared for whats to come and have an "easier" time coping with the passing of their loved ones. IMO this would work well with DNR cases.


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## boingo (Jan 6, 2009)

BossyCow said:


> if the document is there and you see it... but.. the husband in my case destroyed the document prior to our arrival. Not about to jump all over a highly emotional senior citizen that just happens to be a co-worker's grampa over an issue that is best handled by the ER staff and the family members who met him at the ER. Oh.. and into the equation.. the husband was Japanese and though he spoke fluent English would lapse into Japanese and pretend to not understand when stressed.



Hey, if its destroyed or missing, different case.  I'm speaking about a legal document in hand.


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## EeyoreEMT (Jan 29, 2009)

*Oh the mess-Know your protocols*

In Ohio, there are a wide variety of protocols that states what a basic can or cannot do. You have to run under YOUR protocols in your area. In my area under our protocols, If there is a valid DNR in hand, which has to be signed by the pt, or pt's power of attorney, and their physician, you honor the DNR. Our problem here is exactly the opposite, I have had so many codes where the family begs they wouldn't want this or we have a DNR but it's in our safety deposit box at the bank. When first on scene, my partner and I (as we are doing a rapid assesment on pt), asking about down time, history and the like. We are 30 miles from the closest hospital. Odds are, they don't make it. So basically, run the code unless you have VALID DNR, signs or rigor, or if the DNR is dated a awhile back the family insists she/he wouldn't want that, then they would know this - ask if their is a medical poa in place since the paper was signed, if so, and they are not present, run the code. It is better to be questioned on efforts to save a pt, than no effort, like gross neglect.


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## rhan101277 (Jan 30, 2009)

JPINFV said:


> Pending medical control contact (since it is an option here), yes. I have no idea what conversation the patient had with her son prior to departing from this world and it is possible that the patient verbally revoked the DNR prior to collapsing.



Same for here, have to contact med control then stop.


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## MRE (Jan 30, 2009)

jrm818 said:


> MA protocols do not require proof of legal guardianship, and implicitly require that the family be accepting of the decision to die without resuscitation attempts.



I did my basic in MA 2 years ago and this is what we were taught.  Any reason to disbelieve the validity of a DNR (including family members intervening and verbally revoking the DNR).  We were also told to err on the side of resuscitation.

This hasn't happened to me yet, but I'm not looking forward to it.


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## maxwell (Jan 31, 2009)

KEVD18 said:


> scenariobtw this is a real call)
> 
> you respond for the unresponsive at a private residence.
> 
> ...



Nope, I would not work this code.  My focus would turn to the son.


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## EeyoreEMT (Feb 1, 2009)

*good one*

These calls suck. First, I would  have to verify that the possible doa is in fact the female who is listed on the DNR sheet as the person who doesn't want to be "brought back". As I, or my partner would be assessing the pt, I would talk with the son for any type of identification on that person, driver's license, some type of photo ID to cover our butts, it case it is the wrong person. If in fact the person, who has coded, is the person on the VALID DNR, CPR would not be started, we would then work on our second pt, the hysterical son, while we wait for the coroner, which living here, takes anywhere from 1-3 hours. Per protocols, we have to have confirmation of assystole in all 3 leads which is printed to validate records. (this would have been done when we first entered the house regardless if there is a DNR or or not)


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