question about dnrs

[emtashleyb]

I got a new partner last week after a year and a half working on a bls truck I'm now driving als in private ambo. We had a pt dnr-a (we are in maryland) new onset of seizures with multiple medical problems. New partner put the pt on the monitor on the way to the hospital and hollered for me to pull over so they could read the rhythm pt was in v-fib. New partner then proceeds to shock the pt and hollered at me to run hot.

Being as I've worked bls for the past year I've been told we do not run dnrs hot. I've searched high and low for an answer to this question but can't seem to find one and new partner has been out sick since so I couldn't ask them. If the pt is a dnr-a in a shockable rhythm are you allowed to shock? I really don't feel comfortable asking anyone else at the company since I'm pretty sure its a no-no. In the heat of everything I did make a mistake and ran us hot but I'm pretty sure this breaks some sort of protocol and want to know for sure so when my trick rolls around again I can talk to new partner about it and tell them I wont be doing that again.

 

[abckidsmom]

Not sure about Maryland's specific rules, but with a DNR that is acceptable by your state's rules, no defibrillation, cardioversion, invasive airway managment (positioning is fine), ALCS drugs (or drugs for resuscitation) should be given.

As for running with lights and sirens, in VA that's a provider discretion thing, so not covered specifically by a rule or protocol. That said, the risk/benefit ratio doesn't play out. If you were in a crash because you were running lights and sirens for whatever reason with a DNR patient, it would be approaching stupid.

For future reference, I'd say to take a deep breath and support the patient in their dying moments, make them as comfortable as possible and let them know they are not alone.

 

[emtashleyb]

Dnr in maryland has two options

Dnr-a is maximum efforts to prevent arrest
Dnr-b is comfort care

This is where my confusion comes in. I'm not an als provider so I honestly don't know what new partner was taught in class in terms of acls and dnrs. I wasn't aware of the dnr until we got to the er either. New partner had all of the paperwork, didn't tell me and the pt was non verbal no bracelet or necklace indicating they were dnr. As I said new partner and I will have a nice talk come our shift restarting about the importance of communication and following protocol. Even though I was just driving I can still get fired for whatever new partner does in the back if I don't catch their mistakes and stop them per my boss

 

[Shishkabob]

And what do your protocols state about DNRs?



And your boss is an idiot if he'd fire you for something a higher level provider does when you're not around.

 

[emtashleyb]

Protocols state exactly what I said but maximum effort to prevent arrest. I need more specification. If new partner messed up it makes me nervous for what's in store when we get that bad picu/nicu. He may of had an off day and made an honest mistake or he could have just been reckless and didn't care just didn't want to deal with death.

And linus I agree but nothing I can do about it

 

[CANMAN]

Your partner was in the right. MD DNR-A is maximum resus efforts until arrest and then no CPR. Although V-Fib is an arrest rhythm the protocol still allows for electrical therapy and intubation, just no CPR. Basically shock until they go into asystole and call it a day.

MD DNR-B is comfort care only, no CPR, no cardiac monitoring etc, Pain management is acceptable.

This year with the new protocols there will be a new DNR-A/DNI protocol to basically allow for all DNR-A interventions except for intubation and CPR.

Also you as the driver cannot and will not be held accountable on a EMT-B level for care that is taking place in the back by an EMT-P provider.

 

[emtashleyb]

Your partner was in the right. MD DNR-A is maximum resus efforts until arrest and then no CPR. Although V-Fib is an arrest rhythm the protocol still allows for electrical therapy and intubation, just no CPR. Basically shock until they go into asystole and call it a day.

MD DNR-B is comfort care only, no CPR, no cardiac monitoring etc, Pain management is acceptable.

This year with the new protocols there will be a new DNR-A/DNI protocol to basically allow for all DNR-A interventions except for intubation and CPR.

Also you as the driver cannot and will not be held accountable on a EMT-B level for care that is taking place in the back by an EMT-P provider.

Thank you for clearing that up for me I really appreciate it.

 

[AndyK]

There's an old addage that goes "Paramedics save lives, EMT's save paramedics".. it's very true! If you as an EMT think the Paramedic is making a mistake don't be frightened to challenge it... it may be the one time they've missed something! As long as it's done quietly, away from the patient, there shouldn't be a problem. OK, sometimes the paramedic won't act on your observation.. that's their call - in which case ask them later why, it's how you learn and any decent paramedic will recognise that

 

[firetender]

It's great that you asked here; that's using this place as it was intended; and look, you got your answer.

Sometimes you just don't know and that happens with all of us.

Some of us even admit it...sometimes.