EMS ignoring DNR orders

[Foxbat]

Something I read in Wikipedia's DNR article:

In many jurisdictions, medical professionals are ordered not to acknowledge DNR orders. This is especially common with paramedics, who are often employed by private companies unwilling to fight a potential lawsuit.

Is it really common for a company to instruct its employees to ignore DNRs? I'm pretty sure you can be sued for not honoring a DNR odrer.

 

[MMiz]

Something I read in Wikipedia's DNR article:

In many jurisdictions, medical professionals are ordered not to acknowledge DNR orders. This is especially common with paramedics, who are often employed by private companies unwilling to fight a potential lawsuit.

Is it really common for a company to instruct its employees to ignore DNRs? I'm pretty sure you can be sued for not honoring a DNR odrer.

No. It's Wikipedia, what do you expect?

 

[Sasha]

Something I read in Wikipedia's DNR article:

In many jurisdictions, medical professionals are ordered not to acknowledge DNR orders. This is especially common with paramedics, who are often employed by private companies unwilling to fight a potential lawsuit.

Is it really common for a company to instruct its employees to ignore DNRs? I'm pretty sure you can be sued for not honoring a DNR odrer.

Yeah.. I don't think they'd have a leg to stand on "Well.. we had the DNR order.. but we revived her anyway."

I wouldn't take Wiki as factual. Anyone can edit it.

 

[mikeN]

first, you pulled this off wikipedia.
second, take a look at some of the DNR's. Half the time they aren't filled out properly, not signed by a doctor and family/staff is trying to tell you it is valid or the patient signed it and its dated a week or two earlier and the person has late stages dementia/alzheimer's.

 

[exodus]

If you're unsure just do BLS CPR and contact BH and just have the death confirmed... They'll put you in front of line unless they're taking a Full Code online..

 

[NEMed2]

It seems like someone should be reviewing the information people edit in Wikipedia & not post something that may be interpreted as defamation. But that obviously doesn't happen.

 

[Mountain Res-Q]

Wiki...

Define "ignore". Define "DNR".

Were I worked IFT it was common to pick up a pt. from Hospital XX for a transfer to SNF XX and have the nurse tell us that the pt. was a DNR. "Do you have a copy of that paperwork handy?" The nurse points to the transfer orders that are handed to us. Somewhere on the chart were the three letters rubber stamped in red: DNR. Somewhere on the chart would also be a Doctors signature. The question alays came up: Is that a valid DNR? Depends on the state you are in, the EMSA you work in, and the company you work for. I know of many Medics and EMTs that would not acknowledge that as a valid DNR, because it was not an actual copy of a legally binding DNR, just a doctor acknowledging that the pt. had a DNR somewhere. But if an actual DNR is produced, I can not believe that any company would tell their people to violiate the signed pts. wishes and a Doctor's orders... it seems that there would be more lawsuits that way...

 

[Dominion]

I am thinking every state has a legal DNR form and in Kentucky we have two. Hospital DNR and EMS DNR, I've been on a run where the family gave me a hospital DNR but not an EMS DNR. Usually I call the facility nearest and say we're coming in with a hospital DNR and doing BLS CPR to arrival. They can call it there but a paramedic can't honor a DNR in the field unless it's EMS DNR.

Also someone above was right, many times these are filled in improperly, my policy on DNR is if it seems fishy or looks like it's not a legit DNR I'll call med control and get their opinion. Usually the doc tells us to BLS CPR to the hospital where he assumes responsibility, looks at the DNR and makes his decision.

 

[WuLabsWuTecH]

If there is uncertainty, you treat as if there was no DNR. A lot of times we get ones that aren't filled out, aren't signed, etc. Fortunately I've never had to make a call so I've given up talling nursing homes that the DNR is not vaild before taking off as usually nothing will happen anyway, but if I don't see ink on the page everywhere there needs to be ink (and I do mean ink, I believe copies are still not acceptable here) then I treat as if there were no DNR shuold the stuff hit the fan.

And it is your judgment. If there is uncertainty, then you treat. Who can tell you you wern't uncertain? Unless you tell the family, I KNOW the DNR is valid and I'm going to ignore it, then no one can really prove that you did it deliberately (which I assume you wouldn't be doing deliberately anyway)

 

[medic417]

Any EMS provider that ignores a patients wishes and revives them and makes them suffer longer should me made to suffer. It is cruel and it is wrong. Be a professional and respect your patients wishes.

 

[Dominion]

Any EMS provider that ignores a patients wishes and revives them and makes them suffer longer should me made to suffer. It is cruel and it is wrong. Be a professional and respect your patients wishes.

You have to think about this though. If I go to a persons home and I'm handed a DNR that was signed by the patient in late-stage illness then I'm going to call med control. If it's missing a signature, if it's not filled out properly, etc. I'm going to work it and transport. I can't tell if that improperly filled out form is a mistake or what.

Additionally in my state if you don't work a patient who has a hospital DNR but not an EMS DNR you could lose your license.

I personally am not going to ignore a properly filled out legal DNR. But I will at the very least contact med control or the director for additional direction (on a recorded line) if something is off.

 

[Sasha]

You have to think about this though. If I go to a persons home and I'm handed a DNR that was signed by the patient in late-stage illness then I'm going to call med control. If it's missing a signature, if it's not filled out properly, etc. I'm going to work it and transport. I can't tell if that improperly filled out form is a mistake or what.

Additionally in my state if you don't work a patient who has a hospital DNR but not an EMS DNR you could lose your license.

I personally am not going to ignore a properly filled out legal DNR. But I will at the very least contact med control or the director for additional direction (on a recorded line) if something is off.

If it's properly filled out, it's properly filled out and if you ignore it you should go to jail.

 

[Dominion]

If it's properly filled out, it's properly filled out and if you ignore it you should go to jail.

Partially agree, I don't think you should be going to jail but you should lose your license. I stand by my stance that if something is off on the DNR I'm going to contact my medical control and get orders, I have to call before I can pronounce anyways.

There are two ways to sign a DNR here: Patient/POA sign + Notarized OR Patient/POA sign + 2 UNRELATED witnesses. A doctor does not have to sign or authorize or even know there is an EMS DNR. If a family can't give me a DNR, it's not the original (hard to tell sometiems if it's not notarized), I can't confirm the ID of the patient, or a signature is missing or a section not filled out I can legally begin resuscitation. If the person who signed it (poa) destroys it or says "I've changed my mind" we work it.

If the patient is pronounced dead and there was a DNR I have to take the original with me. Which is why I have to be shown an original.

 

[emtjack02]

In the Illinois EMS act there is actually a section that says "A person currently licensed as an EMT‑B, EMT‑I, or EMT‑P may honor Do Not Resuscitate (DNR) orders and powers of attorney for health care only in accordance with rules adopted by the Department pursuant to this Act and protocols of the EMS System in which he or she practices."
So many people think there is a choice...I am not a lawyer but I would be willing to bet that may in this case really is not a choice but a fancy way of saying do it. Any lawyers here?

 

[JPINFV]

Wiki...

Define "ignore". Define "DNR".

Were I worked IFT it was common to pick up a pt. from Hospital XX for a transfer to SNF XX and have the nurse tell us that the pt. was a DNR. "Do you have a copy of that paperwork handy?" The nurse points to the transfer orders that are handed to us. Somewhere on the chart were the three letters rubber stamped in red: DNR. Somewhere on the chart would also be a Doctors signature. The question alays came up: Is that a valid DNR? Depends on the state you are in, the EMSA you work in, and the company you work for. I know of many Medics and EMTs that would not acknowledge that as a valid DNR, because it was not an actual copy of a legally binding DNR, just a doctor acknowledging that the pt. had a DNR somewhere. But if an actual DNR is produced, I can not believe that any company would tell their people to violiate the signed pts. wishes and a Doctor's orders... it seems that there would be more lawsuits that way...

I hope to God that those providers actually know what their (in this case county) protocol says. In Orange County, the DNR protocol specifically addresses written and signed physician orders in the patients chart like that at licensed health care facility as valid. Saying, "well, I didn't accept it as valid because I'm quesy" isn't going to work when that scenario is specifically addressed.

 

[JPINFV]

No. It's Wikipedia, what do you expect?

People who know the truth to remove junk like that. Guess what, that little bit isn't there any more. I'd also expect people to use good judgment. Check out the Emergency Medical Technician article and the EMS Provider by US State article for good, well referenced, articles (albeit I do need to take a run through the provider/US State article to clean up a few lines and add stuff about the new levels).

 

[VFFforpeople]

I was taught if the spouse is present and she say work the code, that I should do what she says. Even with DNR intact.

 

[JPINFV]

Again, varying areas will have varying protocols. In Orange County, CA, any person present can request resuscitation and the crew is mandated to work the code pending base hospital contact. If a friend asks the crew to work it and the spouse says not to, then the crew is still supposed to work it.

In Massachusetts, how ever, the patient (either verbally or by destroying the DNR. Precode, of course) or any person "identifying" themselves (no provesion to require the crew to verify the ID) as DPAC:HC can request resuscitation and override a DNR.

 

[Sasha]

I was taught if the spouse is present and she say work the code, that I should do what she says. Even with DNR intact.

Only if that spouse is POA and can prove they are.

 

[JPINFV]

^
again, depending on local protocols on both counts (whether they have to be POA and whether they have to prove it). I can provide references and quotes to online protocols for both accounts. Now, I'm not arguing about whether or not it is true in Florida as I do not know Florida specific protocols, but as a blanket statement, it is wrong.