Dnr

[Scriptor]

I was wondering where I can get very specific answers for very specific questions about CC/DNR orders. There are probably plenty of Q and A on this site, but to be completely honest I didn't bother searching because I've been searching everywhere else all night. Let me know, thanks!

 

[Mountain Res-Q]

I was wondering where I can get very specific answers for very specific questions about CC/DNR orders.

Your local MSA or Medical Dirrector...

or: http://www.emtlife.com/search.php

 

[EMTim]

The policies for your county should hold all the answers.

 

[medicdan]

Your employer should have educated you on this when you were hired. See below for some information:
http://www.mass.gov/?pageID=eohhs2s...+(DNR)+Order+Verification+Program&sid=Eeohhs2

Also check out this presentation
http://docs.google.com/present/view?id=dcjvjpfg_13235c3tm345&interval=5&autoStart=true&loop=true

MA's system is different from that of other states, so read carefully. ALso consider checking out the appendices of the state protocols.. they detail procedure very well.

Good Luck!

Dan

 

[mycrofft]

Ask your attorney and or MD.

tencharacters

 

[VCEMT]

The policies for your county should hold all the answers.

Mhmmm.

 

[JPINFV]

The policies for your county should hold all the answers.

...only in California.

 

[mycrofft]

My Califorina County's don't.

Was that........... sarcasm?

 

[JCampbell]

.........................

 

[emtfarva]

What do you want to know? It is different in every state. MA has it own sets of protocols, and some of them are not written or explained. Like what exactly is a valid CC. List your questions and we can better answer you.

 

[JPINFV]

What do you want to know? It is different in every state. MA has it own sets of protocols, and some of them are not written or explained. Like what exactly is a valid CC. List your questions and we can better answer you.

Isn't Massachusetts Comfort Care/DNR pretty simple? Either the patient has the EMS DNR verification form filled out completely or doesn't and the only valid DNR form is the EMS form? Restrictive? Yes. Difficult? No.

 

[medicdan]

You wouldn't imagine all the creative ways people find to fill them out incorrectly.... especially not circling the section about whether it expires or not... or not having an MD signature...

 

[JPINFV]

Oh, I'm not arguing that people manage to screw them up. I'm always surprised that somehow hospice services seems to be the worse with not getting a physician's signature. Of course the hospital/hospice/physician failing to fill it out properly doesn't make it difficult for EMT. Not properly filled out means that the patient is a full code. Furthermore, the protocol essentially clearly states that online control can't override it for basics (basics are explicitly mentioned that they can't cease resuscitation in the field outside of obvious signs of death). There are ways to make a more robust DNR protocol that can handle these situations. Massachusetts just decided to not include those options.

 

[medicdan]

In states other then MA, consider looking up your state's flavor of the POLST. Physician Order for Life Sustaining Treatment. It is a universal DNR, with caveats to allow for DNI/DNH, etc. Cities/Counties and States all treat this differently, as do different medical directors. If you are working in MA, your company may ask you to call for an ALS truck when you have a pulseless/apnic patient with a valid DNR.

The moral of this story is, DO YOUR OWN RESEARCH.

 

[EMSLaw]

Isn't Massachusetts Comfort Care/DNR pretty simple? Either the patient has the EMS DNR verification form filled out completely or doesn't and the only valid DNR form is the EMS form? Restrictive? Yes. Difficult? No.

New Jersey's is the same. Either there is a pre-hospital DNR signed by a physician, or there isn't. In the latter case, we work the code absent obvious signs of death. So, in the 95% of cases where there's no signed DNR put in our hands when we walk in, we're starting CPR.

Then the medics come and pronounce, but that's not my "problem." Which is to say, it doesn't change what I have to do.

I believe in patient choice, and so I'm not entirely comfortable with NJ's system, but it does have the benefit of being easy to understand.

 

[emtfarva]

There is a lot that can not filled out that would make it invalid.
In order for MA CC to be valid it needs to have:
Pt's full name
Pt's address
Signature of Pt or Pt's health care proxy
Pt's proxy's name
Doctor's printed name
effective date
expiration date
doctor's name
doctor's address
doctors signature

It also doesn't explain in detail that if you are called to a house and find a person that has coded has a signed DNR but family wants you to work them up, you work them up. Same as if you are called to a SNF.

 

[emtfarva]

oh, before I forget, you do not need the orignal. You can have a copy or the old style bracelet. But you need to see it. It can't be on file some where it has to be in hand. And you should keep a copy for the report also.

 

[JPINFV]

It also doesn't explain in detail that if you are called to a house and find a person that has coded has a signed DNR but family wants you to work them up, you work them up. Same as if you are called to a SNF.

It does in two specific ways.

1.

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.

Note: No where does it require the responder to verify that the person is a health care agent or guardian. S/he just needs to identify him/herself as one.

2.

If EMS personnel have any question regarding the applicability of the CC/DNR Order
Verification with regard to any specific individual, the EMS personnel shall:

* verify with the patient, if the patient is able to respond;
* provide full treatment; or,
* contact Medical Control for further orders.

Any family member revoking a DNR immediately makes the DNR questionable and applicable to that section. I think the bigger issue is that few EMS providers ever actually read the official protocol and instead rely on what their service, FTO, partner, or friend tells them to do.

 

[vquintessence]

It does in two specific ways.

1. (Referring to above DNR comment)

Note: No where does it require the responder to verify that the person is a health care agent or guardian. S/he just needs to identify him/herself as one.

Yep. How often have the wishes of pts and families been denied because of one supposed witness who heard the pts dying words be "I want them to do everything".

Difficult situations... and I can say with a degree of certainty from experience that majority of the time these people are typically family who have not been around the pt during their decline the past few months/years.