An odd question about an odd scenario

[thegreypilgrim]

So, yeah I got this from a JEMS issue.

So, imagine you are called to the scene of a cardiac arrest. You cut the patient's clothes off, and you find tattoed on the patient's chest "Do Not Resuscitate".

Would you honor that?

 

[Shishkabob]

Work it as it is not a valid OOH DNR in the state of Texas.



What do I win?

 

[bryncvp]

In RI we have very specific protocols that pertain to DNR (Comfort One in RI) and a tattoo does not count. Answer: no I wouldn't honor it....that could just have been a drunken night mistake as opposed to a legal declaration.

 

[thegreypilgrim]

Work it as it is not a valid OOH DNR in the state of Texas.

You have to have a piece of paper for that in TX?

What if it was a tattoo of that form? And there was a tattoo of the dude's signature along with "John Smith, MD"?

What do I win?

A herring.

 

[Veneficus]

So, yeah I got this from a JEMS issue.

So, imagine you are called to the scene of a cardiac arrest. You cut the patient's clothes off, and you find tattoed on the patient's chest "Do Not Resuscitate".

Would you honor that?

The first rule of medicine is to punt on first down...

I don't really agree with it, but the ethics of a prior stated wish has to be evaluated by more than 1 person. CPR prior to any invasive or pharmacological intervention likely wouldn't convert him. If it did you could probably ask him. Especially in patients where CPR allows them to regain consciousness. (rare but I have seen it)

"Call med control." is the answer.

 

[ExpatMedic0]

I would call medical control. Pass the buck

 

[Shishkabob]

No, the state of Texas also recognizes a type of bracelet / necklace much like a "Medic Alert" diabetic one.




But if it's not the form, bracelet or necklace, it's not a legit DNR.

 

[thegreypilgrim]

"Call med control." is the answer.

Haha, if this absurdity were to ever come to fruition I would demand a copy of the recording of this call for posterity.

 

[octoparrot]

I'd look around for a valid one...call med contol....and start workin it.

 

[Veneficus]

Haha, if this absurdity were to ever come to fruition I would demand a copy of the recording of this call for posterity.

If I was the med control, I think I would just terminate all efforts.

 

[thegreypilgrim]

If I was the med control, I think I would just terminate all efforts.

Are you serious?

 

[Akulahawk]

The tattooed DNR is not valid in Sacramento County. The correct bracelet is as good as the signed DNR form.

 

[thegreypilgrim]

The tattooed DNR is not valid in Sacramento County. The correct bracelet is as good as the signed DNR form.

I know this is kind of OT, but I find this really interesting about Sacramento County EMS:

 

[Akulahawk]

Yes. It is a bit odd. That particular policy does not have any cross-references to any other policies, though another Policy refers to it. Policy 2223.09 refers to on-duty Paramedic Scope of Practice. If you read the Off-Duty Policy, it can be read to mean ALL Accredited Sacramento County Paramedics... regardless of employment status unless that Paramedic wants/needs to carry their own ALS kit with meds. What the Off-Duty policy really means is that an Accredited Paramedic who is employed by an ALS provider can provide Full Scope while Off-Duty and any Accredited Paramedic can own/use advanced airway adjuncts, regardless of employment status.

But yes, it does appear to be a bit "odd" at first read.

 

[Sassafras]

We are not allowed to honor any DNRs that have not been notarized with a doctor's signature. They also are not honored unless the patient is in a medical facility of some sort or home with a hospice nurse present. So, I would use the tattoo to aid me with placement of my hand compression.

 

[MrBrown]

To me that is a clearly evident advance directive and I would follow it

 

[lampnyter]

i would do CPR because thats not a legal document and you can get totally screwed if you dont do anything. But i would still contact med control.

 

[TransportJockey]

We are not allowed to honor any DNRs that have not been notarized with a doctor's signature. They also are not honored unless the patient is in a medical facility of some sort or home with a hospice nurse present. So, I would use the tattoo to aid me with placement of my hand compression.

So if a terminal CA pt passed at home with just family present and a valid DNR, you would still work them? Everywhere I worked that would be asking for a lawsuit from family.

 

[FireResuce48]

Maybe the guy is just a big fan of the the department of natural resources.

 

[lightsandsirens5]

Maybe the guy is just a big fan of the the department of natural resources.

LOL! I like it. :lol:

I'd work it though. In WA if you don't have the lime green POLST or a valid living will, you are getting worked. I would call med. control and tell them what I have for sure. And if I was med. control, especially in my area, I'd reccomend temination of efforts. When you have a 45 minute transport time, sometimes it just isn't worth it. Considering your chance of survival drops into single digits after what, five minutes, and the ambulance is a half hour from you and a half hour transport, you have somewhere barely north of a 0% chance.

Of course here in my county, if we are showing asystole in two leads, law enforcement can order us to stop CPR. (I thinkh34r: Now I must go check that one.)