Dnr

[mikeylikesit]

i think that some people got DNR tattoo's after the song came out and they thought it would be like DNR "don't try and save me...i'm already dead" just examining the possibilities here.

 

[AJemt]

no OOH-DNR - work it. unless you can find paperwork in which case i'm still not going to waste any time looking for paperwork at the expense of providing pt care - if its just me (qrs) i'll be working till someone shows up to help and then either they or i can look quickly to see if there's anything on her - otherwise we keep working. if we actually do find anything i'm calling med command to stop IF all paperwork/whatever is in order, then of course document the bejeebers out of the call.....

 

[BossyCow]

I think the whole tattoo idea started with a nurse in Oregon. She had the red circle with a line through it over the letters CPR tattooed on her chest. But that was some years back. We have been through the evolutions of having to document that we examined the no-code bracelet and determined that it did not appear that the pt had attempted to remove it, thus showing they had changed their minds about their status.

Currently the POLST used in my state covers all the options. It has to be continually updated and covers not just do you start CPR but what methods and interventions you do and don't want. I can't count the number of times I've been on calls where the family swears they have a DNR but just can't find it right now, and it turns out never to have been signed. I personally don't want to put my house and future financial security on the line for a disagreement between family members over who loved mom more.

I've also been to a pt where I know there was a signed POLST because I'd seen it, but her husband denied that it existed. He just wasn't ready to let go yet. So, in the field, we brought his wife in with CPR in progress. Her POLST was never made a part of her hospital record so she spent about a week in CCU before she died.

Birth and death are highly personal processes. It's impossible to say how a family should deal with the end of life. We all have our opinions on the matter, but those are based on our emotional, spiritual and financial preferences. The blame stage of the grief process is where the family looks for someone to blame for Grandma's being gone from their life. I personally will make sure that my butt is legally covered when they turn the attorney's binoculars on me.

 

[emtd29]

No PAPER DNR = I'm working it

 

[newbie]

Is the Pt salvageable? And do you have a DOA protocol that this Pt. fits? Failing that Med control Dr.'s make more $ than me and I figure that is because they get to make decisions like that. I figure a Pt. w/ a DNR tattoo doesn't want to be worked. Now I just gotta make sure don't get jammed up for not working them.
J

 

[mikie]

interesting a great solutions...

Now just to ask a question

A day later you find out that the patient was indeed DNR (a family member gave proof to the authorities)...could they sue or take any other action?

 

[JPINFV]

Now just to ask a question

A day later you find out that the patient was indeed DNR (a family member gave proof to the authorities)...could they sue or take any other action?

I don't see how they could. Assuming that the local protocol requires a paper DNR to be present and properly filled out (most, but not all, do), then I don't see any way to hold a prehospital medical team 'accountable' for attempting to revive a patient. There are zero proper medical orders against treatment as there would be if a proper DNR was present.

 

[JPINFV]

Is the Pt salvageable? And do you have a DOA protocol that this Pt. fits?
J

Salvageable has nothing to do with a DNR. A patient that fits into a DOA/don't start/end resuscitation protocol should fall under that protocol. A patient with a full DNR should fall under a DNR. A patient with obvious signs of death shouldn't be worked regardless of DNR status. A DNR patient should not have resuscitation (resuscitation!=treatment) attempted regardless of if they are salvageable.

 

[MRE]

The only thing a tattoo like that will make me do is look twice to try and find the DNR paperwork. No paperwork, then they are getting worked.

 

[karaya]

29 posts so far about a DNR tattooed on someone's chest? Incredible. I wish there was this much concern about how medics can improve their intubation success rate.

 

[Jon]

With that, it is now 30...I'll make it 31
In PA, they have to have an official state-approved bracelet. A DNR tattoo would make me take another look for the braclet, and perhaps check their wallet/purse for paperwork... but no bracelet, then my medic would call command and discuss the situation. Until command calls the code, we work it.

 

[BossyCow]

29 posts so far about a DNR tattooed on someone's chest? Incredible. I wish there was this much concern about how medics can improve their intubation success rate.

Isn't part of intubation knowing whether or not to intubate (i.e. DNR protocols?)

And regarding the question by another poster about 'can they sue'. Anyone can always sue, even over silly things, but will they end up with anything other than bills from their lawyer is the real question. If you did CPR on someone who later turned out to have a DNR that wasn't presented to you, they most likely wouldn't be able to show you did something wrong which is part of the process for determining fault, resulting in damage, paid for by fat settlement

 

[karaya]

Isn't part of intubation knowing whether or not to intubate (i.e. DNR protocols?)

Wasn't the same frame of comparison I was talking about. The answer to the question about what to do if one sees DNR tattooed on someone's chest is rather simplistic.

 

[Robby1974]

In Nevada the documens for DNR must be reapplied for once a year and require a dr's signature. In our course our instructor indicated that DNR's are very rare in Las Vegas because there are very few physicians that are willing to sign off on them. In the case of a tattoo we would need to have the appropriate form signed off by the county, physician, and not expired. In the 8 years that our instructor ran paramedic calls here in the valley he never saw even 1 "valid" DNR order.

So no go on the DNR tattoo....resuscitate.

 

[KEVD18]

yet another topic that cant be allowed to rest in peace. somebody just has to keep digging it up.

jon said it much better than i did. a dnr tattoo would make me take another look for the paperwork, but at the end of the day, no paperwork=full resuscitation measures until relieved by a higher level of licensure. be it the medic or the doc. no questions, comments or concerns.

 

[SCFD8REZ]

This is so clear cut, if she doesnt have a signed and notarized DNR order present then as a care provider it is negligence if you dont try to revive based on her tatoo, this is just silly. for all you know the tatoo could stand for Dan Noel Ramos who was her husband or something like that.

 

[YouthCorps1]

call medical control ... see what they say...and recesitate

 

[KEVD18]

wow.....you brought up a deceased thread to add that????????????????????