DNR Order
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JPINFV
Gadfly
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Since you list your location as San Fransisco,
http://www.sfdem.org/Modules/ShowDocument.aspx?documentid=224
http://www.sfdem.org/Modules/ShowDocument.aspx?documentid=224
JPINFV
Gadfly
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Really? 814 eh? There is no policy 814 in Orange County. Orange County LEMSA's DNR policy can be found under 330.51. The OP is no where close to LA, hence why I quoted and provided the link for San Fransisco's LEMSA's DNR policy. The San Fransisco DNR policy is policy number 4051 and listed above.
firecoins
IFT Puppet
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Reguardless of what state your in, you start CPR. THe DNR has become invalid.
JPINFV - my apologies. I blindly referenced LA County policy as his own. After studying policies all day I am going to pardon myself here. Hope you will do the same. I enjoy reading your posts.
If my "correct answer" offended at all apologies as well. It was meant to read as "on a test the answer would be".
Sorry again.
In Texas, it depends on who enacted the DNR. If the pt. enacted the DNR, it can only be revoked by the pt. or a physician. The family cannot revoke a DNR enacted by the pt. Unfortunately this is an area where many providers are lacking education (regarding their state regulations on DNRs).
JPINFV
Gadfly
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The problem is you worded it as if LA LEMA's policy was statewide policy, which isn't the case. This is a huge issue when you consider, for example, that San Fransisco's policy doesn't allow a verbal request to withhold resuscitation from immediate family members, whereas OC LEMSA and LA LEMSA does.
Shishkabob
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Mmm, no.
Medical poa, family, and the patient can revoke at anytime.
It's up to your med control if they want you to work it or not.
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Santa Clara County's Policy for the OP's situation is part of Policy 604:
Sacramento County Policy 2085.11 simply states:
The "supportive care" does not include resuscitation measures such as compressions...
Sacramento County Policy 2085.11 simply states:
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HelpmeHelpyou
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This is almost on par to what questions I was going to ask in class when this subject was brought up in CH.2 of my textbook.
This is when policy seems to out weigh logic in some states, I am glad this was brought up.
This is when policy seems to out weigh logic in some states, I am glad this was brought up.
Can you provide TDSHS regulations or state law to verify this? The medicolegal class I took and my medical director both teach that only the person who enacted the DNR or a physician can revoke it. I'm sure we'd be facing a lot of heat with this policy if it wasn't permissible under state law.
Shishkabob
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I guess it comes down more to semantics, because like I said, the final determination of if you work the code is up to your MC, but it's still the family "revoking" it.
AlphaButch
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In Texas, the wife would be a qualified family member and is able to revoke the DNR. (It's on the DNR form)
Publications No. EF01-11421 TEXAS DEPARTMENT OF STATE HEALTH SERVICES STANDARD OUT-OF-HOSPITAL DO-NOT-RESUSCITATE ORDER 25 TAC §157.25 (h)(2)
"REVOCATION:
The Out-of-Hospital Do-Not-Resuscitate Order may be revoked at ANY time by the patient OR the patient’s Legal Guardian/Agent/Managing Conservator/
Qualified Relative, Parent (if a minor), or physician who executed the order. The revocation may involve the communication of wishes to
responding health care professionals, destruction of the form, or removal of all or any Do-Not-Resuscitate identification devices the patient may possess."
"Qualified Relatives: Those persons authorized to execute or issue an out-of-hospital DNR order on behalf of a person who is comatose, incompetent,
or otherwise mentally or physically incapable of communication under Section 166.088 H&SC Section 166.088 refers to 166.039; “One person, if
available, from one of the following categories, in the following priority...: (1) The patient’s spouse; (2) the patient’s reasonably available adult children;
(3) the patient’s parents; or (4) the patient’s nearest living relative.”
Publications No. EF01-11421 TEXAS DEPARTMENT OF STATE HEALTH SERVICES STANDARD OUT-OF-HOSPITAL DO-NOT-RESUSCITATE ORDER 25 TAC §157.25 (h)(2)
"REVOCATION:
The Out-of-Hospital Do-Not-Resuscitate Order may be revoked at ANY time by the patient OR the patient’s Legal Guardian/Agent/Managing Conservator/
Qualified Relative, Parent (if a minor), or physician who executed the order. The revocation may involve the communication of wishes to
responding health care professionals, destruction of the form, or removal of all or any Do-Not-Resuscitate identification devices the patient may possess."
"Qualified Relatives: Those persons authorized to execute or issue an out-of-hospital DNR order on behalf of a person who is comatose, incompetent,
or otherwise mentally or physically incapable of communication under Section 166.088 H&SC Section 166.088 refers to 166.039; “One person, if
available, from one of the following categories, in the following priority...: (1) The patient’s spouse; (2) the patient’s reasonably available adult children;
(3) the patient’s parents; or (4) the patient’s nearest living relative.”
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It just goes to show "you" that knowledge of DNR matters, matters. Make sure you know who may legally revoke a DNR/No Code/Advanced Directive in your state. It may just save your bacon someday!
Thanks for posting the regs! It's appreciated. Got a question - does this person have to be listed on the DNR, kinda like a power-of-attorney, or just any of those people present themselves (following the order of priority)? I'd think that besides the spouse there'd be a problem with proving you're one of those people.
Shishkabob
Forum Chief
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They don't need to be listed on the DNR.
However, if you question it, do CPR while you call med control.
However, if you question it, do CPR while you call med control.
AlphaButch
Forum Lieutenant
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As Linuss stated. They don't have to be listed.
If in doubt, do cpr and contact med control. It's easier to cease resuscitation, than it is to try to resuscitate someone after they've been down for the time it takes for med control. It's also easier to defend should you end up in court.
On the other side - If there is any reason to suspect that a DNR is not valid, resuscitation efforts should be started and med control contacted. (as per TSDHS regs as well).
Note* I don't know any other state regs other than TX.
If in doubt, do cpr and contact med control. It's easier to cease resuscitation, than it is to try to resuscitate someone after they've been down for the time it takes for med control. It's also easier to defend should you end up in court.
On the other side - If there is any reason to suspect that a DNR is not valid, resuscitation efforts should be started and med control contacted. (as per TSDHS regs as well).
Note* I don't know any other state regs other than TX.
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It is indeed far easier to cease efforts after confirming a DNR order is valid than it is to raise the dead after a prolonged down-time. After all, at some point, you'd be more successful trying to resuscitate a rock...
Know what is considered a valid DNR, who can order you to stop, and who can countermand a valid DNR. Always have the paperwork OR someone who can legally request that you start, or stop, efforts. I've had to work patients that I (and everyone else) "knew" were DNR, but nobody could find their paperwork and nobody present had legal authority to order that I stop...
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