CPR on DNR?

[ADyingBreed]

Hey guys

So, in EMT class we were going over DNR's and the such


Our instructor told us that "Even if the patient has a valid DNR, but the family wants you to do CPR, you do it" (i double checked that's what was said)

So, my question is.. Does anybody else do this? I feel like the patient had an advanced directive for a reason... :huh:

 

[wanderingmedic]

dead people don't sue....it's the alive ones to watch out for.

The family would get what they want in this situation. I would call med control and inform them and "request direction" so I pass the liability buck onto a doc. I will do whatever the doc i'm talking to wants.

However, most families cant stand to watch CPR being performed on their loved one. If you bring them in to watch....they will usually ask you to stop just as quick. Be blunt and explain their loved one is dead.

 

[ffemt8978]

Hey guys

So, in EMT class we were going over DNR's and the such


Our instructor told us that "Even if the patient has a valid DNR, but the family wants you to do CPR, you do it" (i double checked that's what was said)

So, my question is.. Does anybody else do this? I feel like the patient had an advanced directive for a reason... :huh:

And how do you know that they didn't revoke it just before you were called? What about if one of the family members has Power of Attorney for the patient and wants you to do CPR?

Short answer is your instructor is correct. You have no way of knowing if it is still a valid DNR in the field...let the hospital deal with it by contacting medical control.

 

[ADyingBreed]

I would call med control and inform them and "request direction" so I pass the liability buck onto a doc.

So would you wait until med control has directions to start CPR, or would you go ahead and start it before that?

 

[ADyingBreed]

And how do you know that they didn't revoke it just before you were called? What about if one of the family members has Power of Attorney for the patient and wants you to do CPR?

Short answer is your instructor is correct. You have no way of knowing if it is still a valid DNR in the field...let the hospital deal with it by contacting medical control.

Should i wait until i contact med control to start CPR?

 

[DesertMedic66]

And how do you know that they didn't revoke it just before you were called? What about if one of the family members has Power of Attorney for the patient and wants you to do CPR?

Short answer is your instructor is correct. You have no way of knowing if it is still a valid DNR in the field...let the hospital deal with it by contacting medical control.

Depends on your area. For us even if family wants us to do CPR and the patient has a valid DNR we follow the DNR. However you can make the argument about questioning the validity of the DNR in which case we would start CPR and contact medical control.

 

[ffemt8978]

Should i wait until i contact med control to start CPR?

Start it first...then call. Unless you're dealing with obvious death criteria.

 

[Aprz]

Depends on your area. For us even if family wants us to do CPR and the patient has a valid DNR we follow the DNR. However you can make the argument about questioning the validity of the DNR in which case we would start CPR and contact medical control.

Same here. Valid DNR, won't start CPR even if family demands it.

Every
effort shall be made to honor the wishes of the patient even if
the patient’s family requests the DNR or POLST be ignored

Santa Clara County EMS - Policy 604 - Do Not Resuscitate

Like Desert said, depends on location. In the adjacent county (Alameda County), family can request to ignore the DNR, and CPR will be initiated.

 

[Akulahawk]

In the presence of a DNR, I'm going to ask who has durable power of attorney for healthcare decisions. If that person happens to be the patient, or is not present, I will generally honor the DNR, unless the county protocols or custom require me to start CPR at the request of immediate family.

I'm going to certainly try to honor the DNR order because it's a document that's signed by the patient (or DPAHC) and the patient's physician. If I come across a POLST, I'll certainly honor that because it's directions are even more specific about what level care the patient is to have.

 

[ffemt8978]

Depends on your area. For us even if family wants us to do CPR and the patient has a valid DNR we follow the DNR. However you can make the argument about questioning the validity of the DNR in which case we would start CPR and contact medical control.

Yes, it does depend upon the area but I'm willing to give the instructor the benefit of the doubt in the belief he knows what the criteria is for the area he is teaching in.

 

[TheLocalMedic]

A DNR is pretty explicit. I've only had it happen once where a couple family members on scene were requesting that we resuscitate a patient with a DNR in place... I just explained to them what the document meant (and that it referred to this exact scenario) and that the patient did not want us to help them once they had reached this point.

I also explained exactly what our whole process was, chest compressions, IVs, drugs, "breathing tube", electricity... Also that it probably wouldn't help him, or just prolong his suffering if it did... After I explained, they agreed that it was better to just let him be.

Now, if someone has durable power of attorney and they want you to do it... I would start BLS CPR while I tried to first explain to them why we should honor the DNR, and then if that didn't work contact medical control to let them have a whack at talking them out of a full resuscitation.

Not a common occurrence though, in my experience.

 

[lisha]

Hey guys

So, in EMT class we were going over DNR's and the such


Our instructor told us that "Even if the patient has a valid DNR, but the family wants you to do CPR, you do it" (i double checked that's what was said)

So, my question is.. Does anybody else do this? I feel like the patient had an advanced directive for a reason... :huh:

My instructor told us that if a DNR is present, you do not perform CPR! If the family states there is a DNR and does not physically have it handy, begin CPR!

 

[Medic Tim]

It will depend on your state. Where I work a DNR isn't worth the parr it is written on. If there is a a DNR in place and family wants us to run it we BLS for 5 cycles then call it. If there is no DNR but the family wants us to not do anything we follow the family wishes as long as it sounds reasonable. Like I said though , the answer depends on your state and where you work.

 

[unleashedfury]

I have ran into this situation a few times more than I wanted to. On one hand you have the family who wants CPR. on the other hand you have a valid DNR order signed by the patient when he/she was apparently still had the capacity to validate the order.

Easy way if the patient has a valid DNR and family wants it revoked, Then initiate CPR, contact medical command. These are the times where I use my cell phone and speak to the doc via landline. This way I can have them talk to the family and explain the situation. Most docs in my region will do this. and we call it from there.

Most patients that have a DNR order and are hospice or terminally ill family is notified not to dial 911 in the event of their death.

 

[Handsome Robb]

Know your local and state laws regarding DNR/DNIs...there is no cut and dry answer to this.

If they have a valid prehospital DNR and a family member screams at me to do something ill quickly walk to them and comfort them.

The patient has a DNR for a reason. Respect their wishes. Some of the responses in here scare me.

Just like the CHFer I had the other day that was circling, but was A&O and refused treatment and directly told myself and the doctor "please just let me die." That's exactly what we did.