Dnr

Airamis

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Hello everyone, Been lurking for awhile, and finally decided to register.

I'm a new EMT-B student, only a couple weeks in. And I've come upon a question I was hoping you all could help me out with. My Teacher told me that if someone has a DNR but the family is requesting you to do whatever it takes to save the pt, then you have to attempt to save them.

Is this true? I didn't think about it much in class but when I got home and started to review It struck me as odd so now I'm questioning myself on weather or not I heard him correctly.

And if so, then what is the point of a DNR if your family can override your wishes?

Thanks in advance :)
 

MMiz

I put the M in EMTLife
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Welcome to the forum!

DNRs are sticky situations. Usually your local medical control will have a protol that you follow.

If the patient had a valid DNR, the actual document that was filled out properly, I would follow the advance directive and not work the patient.

In our county we have DNR orders and also Comfort Care.

Under comfort care I'd:
  • Provide O2 (via NC or NRB )
  • Suction
  • Place patient in position of comfort
  • Control bleeding
  • Provide pain meds per online med control (ALS unit, not me)
There have been times where a patient or family has said they have a DNR but I cannot confirm it. I'd then work the call as a full code and contact online med control for further instruction.

If I've worked a code, and somehow they find the correct documentation, I would then stop working the code, stop CPR / BVM / airways / but I'd keep the airway and/or IV in place.

If I see a DNR but don't believe it, or someone says they have a DNR but can't provide it, I'd work a full code. When in doubt I'd work the patient as a full code, but I would not work a patient just because a family wanted me to.

I rambled a bit, but I hope that helps!
 

ffemt8978

Forum Vice-Principal
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Welcome to our own little corner of dysfunction.

As MMiz pointed out, your local protocls should specify what you are to do in this situation. Ours states that we are not to work the code unless family members on scene insist. Then we work the code until we can get the patient in the ambulance and contact medical control for a decision.
 

Stevo

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Welcome Airamis.

imho, DNR should stand for 'Don't Need a Rig' , whereas if one is called all legalities pursuant to such an order should be legally moot

i say this because it's unfair for the legal community to hold ems to a 10 second decision involving what may be extranious legalities while someone may be turning blue

the states differ on DNR's, note published materials....

DNR state by state booklet

the medico-ethical contingent further expands here....

Do Not Resuscitate Orders

~S~
 

MMiz

I put the M in EMTLife
Community Leader
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I should also add that I came at this from the BLS / transport perspective. Before we even transport a patient we have most of this stuff filled out, and all questions have been asked and referenced in the chart / records.

If I arrived at a home for an emergency call and the patient's family wanted me to work the code, I'd most likely work it, get the patient in the ambulance, and have my partner contact online med control.

There are just some times when I think the code should be worked. It's kind of like the situation where you arrive on a clearly dead patient. Even if they meet all of your conditions to declare the patient on scene, sometimes it's best to "work" the patient until you get them in the ambulance, and then call it.

There are lots of shade of gray in EMS :)
 

Wingnut

EMS Junkie
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:) :) :) Welcome! :) :) :)

I agree with what was said above, maybe take your instructor aside and ask. Protocols in your area might be different than ours.
 

FFEMT1764

Devil's Advocate
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Well I know here in SC if the DNR for is filled out corectly and has not been altered in any way then it MUST be honored, or you run the risk of prosecution...if the form has been altered though, scribble marks, tears in the papers, etc...it becomes invaild as it has been "mutilated" per the state law governing the DNR's. Hope that gives you some insight.

Also welcome to our little family!
 

coloradoemt

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I would have to see the original copy of the DNR before I can stop any life saving measures. My partner and I ran a core about a month ago where the DNR was not produced until we had already given the first round of drugs and then we had to stop.
 

firegal920

Forum Probie
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You think that was bad, try this one. Arrived at a full code with SNF stating the pt has a DNR but they don't know where it is. Sister on scene states that the pt would not have done such a thing and to work her. Get pt worked and arrive at hospital with a pt who has a Blood pressure and pulse to find out she does have a DNR and the daughter is mad (to say it lightly) that we worked the pt. Apparently the sister has Alzhimers and keeps throwing away the DNR. We have yet to live that down ... You worked a DNR with orders from an Alzhimers pt. :p :wacko:

Here the protocol for DNR's that the family wants worked is to load the pt, alert Med Control so that they can get the counselors in the ER and transport to be called at the hospital. We don't do CPR, or airway, or IV's. It's a load and go slow call.
 
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ffemt8978

Forum Vice-Principal
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DNR not in my hands on scene = No valid DNR...I don't care how many people say she has one.
 

i_drive_code3

Forum Crew Member
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oh the joys of a dnr!

hiya and welcome aboard! dnr's can be a tricky thing and i LOVE it when you get on scene the family says that they have a dnr, ok so we need to see it...and its where? in the bank vault (after 5 on a friday night!) ARGHHH!
tape it to the bed frame folks! :unsure:

or get on scene, start working it bls cuz the housemate says they have a dnr, your medic "reads" the dnr, calls it, you pack up everything, start with some decon (it was a bit messy) and suddenly your medic calls you back in & quietly tells you that the dnr is not for the patient but the roomie! lug all the equipment back in, resume cpr (luckily it was some newbie fireguys so they get some "practice" in)...and 10 minutes later you get to quit again when the CORRECT dnr is located. :rolleyes:

heh heh...ya gotta laugh folks

take it easy!
kate
 

Stevo

Forum Asst. Chief
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maybe we should instigate legislation to have DNR tattooed on sternums?

~S~
 

i_drive_code3

Forum Crew Member
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target practice?

Stevo said:
maybe we should instigate legislation to have DNR tattooed on sternums?

~S~

on that line of thinking: how about a bullseye on the vein for either a blood draw or iv??


kate
 

emtbass

Forum Lieutenant
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I would call med control... let him take some of the heat.
 
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