DNR Question for a new emt!

[62_derick]

I have never faced and DNR but I have treated a patient who had one (she just had a cold) but however if I would be ever faced with a situation that resulted in this type of scenario witch I am thinking of what would you do?

This is what I am thinking of and not sure how to over come this.

Scenario:

You get called out to a 50 yr old in resp failure. PT has a DNR and deffinitly does not want and measures to keep him alive. How ever his family wants you to revive him and ignore the DNR. Do you still need to fallow that DNR or follow the family's wishes? Could you be held responsible for anything wither its from the PT or Family?

I am in Pa and I know that some of the protocols and laws are different in different states. I hope this makes any sense if not I will try to clear it up.

Thanks

 

[Dominion]

I have never faced and DNR but I have treated a patient who had one (she just had a cold) but however if I would be ever faced with a situation that resulted in this type of scenario witch I am thinking of what would you do?

This is what I am thinking of and not sure how to over come this.

Scenario:

You get called out to a 50 yr old in resp failure. PT has a DNR and deffinitly does not want and measures to keep him alive. How ever his family wants you to revive him and ignore the DNR. Do you still need to fallow that DNR or follow the family's wishes? Could you be held responsible for anything wither its from the PT or Family?

I am in Pa and I know that some of the protocols and laws are different in different states. I hope this makes any sense if not I will try to clear it up.

Thanks

Read your protocols and follow them. Only people who know the PA protocols can tell you that situation. Some states that might let you null the DNR, other states only the Power of Attorney or the patient can nullify the DNR. Any more questions search for DNR, there are hundreds of threads on it.

 

[Shishkabob]

Best thing to do is ask your supervisor or someone at your agency what you policy is, BUT,in some (if not all) places, if someone has MPA over a pt, they can override a DNR

 

[NBfire841]

I have never faced and DNR but I have treated a patient who had one (she just had a cold) but however if I would be ever faced with a situation that resulted in this type of scenario witch I am thinking of what would you do?

This is what I am thinking of and not sure how to over come this.

Scenario:

You get called out to a 50 yr old in resp failure. PT has a DNR and deffinitly does not want and measures to keep him alive. How ever his family wants you to revive him and ignore the DNR. Do you still need to fallow that DNR or follow the family's wishes? Could you be held responsible for anything wither its from the PT or Family?

I am in Pa and I know that some of the protocols and laws are different in different states. I hope this makes any sense if not I will try to clear it up.

Thanks

It depends on what type of DNR it is too. Technically, we are not supposed to honor in-hospital DNRs, only PA-issued DNR orders which are the size of a credit card (at least this is the case per my protocols). Try to read up on your protocols, and ask your medical director if you are still unsure. If you come across something you and your partner are unsure about, don't hesitate to contact Med-Comm.

 

[HotelCo]

Best thing to do is ask your supervisor or someone at your agency what you policy is, BUT,in some (if not all) places, if someone has MPA over a pt, they can override a DNR

If they can't produce a document saying the have power of attorney... then you follow the DNR. REMEMBER: DNR doesn't mean Do not treat. Just because someone has a DNR doesn't mean you can't provide supportive care. (Assuming that the DNR doesn't say you can't)

 

[Pudge40]

PA Statewide DNR Protocol

OUT-OF-HOSPITAL DO NOT RESUSCITATE
STATEWIDE BLS PROTOCOL
Criteria:
A. Patient displaying an Out-of-Hospital Do Not Resuscitate (OOH-DNR) original order, bracelet, or
necklace who is in cardiac or respiratory arrest.1
Exclusion Criteria:
A. Patient does not display, and patient surrogate does not produce, an OOH-DNR original order,
bracelet, or necklace.
B. An OOH-DNR order may be revoked by a patient or their surrogate at any time. If the patient or
surrogate communicates to an EMS practitioner their intent to revoke the order, the EMS
practitioner shall provide CPR if the individual is in cardiac or respiratory arrest.
C. Advance directives, living wills, and other DNR forms that are not valid Pennsylvania Department
of Health OOH-DNR orders may not be followed by EMS personnel unless validated by a medical
command physician. When presented with these documents, CPR / resuscitation should be
initiated and medical command should be contacted as soon as possible.
D. Patient is not in cardiac or respiratory arrest.
Treatment:
A. All patients in cardiac or respiratory arrest: 2
1. Follow Scene Safety protocol #102 and BSI precautions.
2. Verify the presence of a valid PA DOH OOH-DNR original order, bracelet, or necklace.
a. If there is any question of whether the OOH-DNR order is valid, the patient or their
surrogate has revoked the order, or whether the patient is pregnant 3 , the EMS
practitioner shall:
1) Initiate resuscitation using appropriate protocol(s), and
2) Contact medical command as soon as possible
3. Verify pulselessness or apnea.
4. If a bystander has already initiated CPR:
a. Assist with CPR and contact medical command immediately.
5. If CPR has not been initiated before the arrival of EMS personnel:
a. The OOH-DNR shall be honored and CPR shall be withheld or discontinued.
b. Contact the local coroner or medical examiner.
Possible Medical Command Orders:
A. The medical command physician may order termination of resuscitation efforts if CPR was not
initiated by EMS personnel.
Note:
1. EMS personnel shall follow this protocol and, when appropriate, shall honor an OOH-DNR within
a hospital.
2. An OOH-DNR order, bracelet or necklace is of no consequence unless the patient is in cardiac or
respiratory arrest, if vital signs are present, the EMS practitioner shall provide medical
interventions necessary and appropriate to provide comfort to the patient and alleviate pain
unless otherwise directed by the patient or a medical command physician. Follow appropriate
treatment protocols.
3. For pregnant patients, the EMS personnel shall examine the original signed OOH-DNR to ensure
completion of Section 2B “Physicians for Pregnant Patients Only” by the patient’s attending
physician in order to honor the OOH-DNR and withhold or discontinue CPR.
Performance Parameters:
A. Review all cases for documentation of presence of a PA DOH recognized OOH-DNR order,
bracelet, or necklace..Pennsylvania Department of Health Resuscitation 331 – BLS – Adult/Peds
Effective 11/01/08 331-1 of 3

Go here to download the BLS protocols for PA: http://www.dsf.health.state.pa.us/health/lib/health/ems/pa_bls_protocols_effective_11-01-08.pdf

 

[EMTinNEPA]

Cardiac or respiratory arrest, or unless they refuse treatment. Do Not Resuscitate doesn't mean Do Not Treat.

 

[WuLabsWuTecH]

wow i just read some of that protocol. PA has a good med control system. We basically only have standing orders now. not counting pediatric for verification of numbers and such, I've only heard one call for medical control ever and that was an out of county ambulance transporting who had reached the limit of a drug but since it have been hours, they wanted to give more. The hospital was so unsure of what medical control meant, the doctor stayed by the radio the whole time asking for updates every 5 minutes since he thought that once he established med control he had to stay!

 

[Aidey]

Someone posted WA states version of the DNR up when this topic was discussed awhile ago. Their DNR (which has a different name) not only specifies DNR status, but also what level of treatment they want.

Im not sure if any other states have similar set ups, but just keep in mind that in some cases that paper you are handed is a do not treat form, not just a DNR.

 

[KillTank]

Contact medical directive

 

[wyoskibum]

I have never faced and DNR but I have treated a patient who had one (she just had a cold) but however if I would be ever faced with a situation that resulted in this type of scenario witch I am thinking of what would you do?

You can always contact your online medical control when in doubt