DOCSLIB.ORG

Do Not Resuscitate (Dnr) Order

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Do Not Resuscitate (Dnr) Order DO NOT RESUSCITATE (DNR) ORDER What it does, what it doesn’t do Do you have one?? Should you? Resuscitate: revive (someone) from unconsciousness or apparent death. What is a DNR Order? DNR order = A doctor’s order to not provide CPR Cardiopulmonary resuscitation Alerts emergency personnel that you do not want cardiopulonary resuscitation (CPR) in the event that your heart has stopped or your airway is blocked. It is a medical order only valid if signed by a doctor. If you do not have a DNR order, emergency medical personnel must use all available measures, no matter how invasive, to save your life. This is the default position. WHO IS IT FOR? DNR orders are used primarily by people who are already critically ill and feel strongly that they do not want life-prolonging treatment when close to death. When the heart stops many feel this is a natural death. Some are concerned that brain damage would occur before CPR was started. They could be resuscitated but only the brain stem would work, none, or few, cognitive functions would remain — a persistent vegetative state. If you do not have a DNR order, emergency medical personnel must use all available measures, no matter how invasive, to save your life. Another side — To be resuscitated, do nothing. Using a DNR form outside a hospital. If you are not hospitalized, you can complete a California DNR form that alerts paramedics who respond to emergencies at home, in hospice facilities, or elsewhere. It's important that you also get a MedicAlert or other bracelet, anklet, or necklace to make your wishes immediately apparent. Keep in mind that, to be valid, your DNR form must be signed by a doctor or other approved medical professional. For more information about DNR orders, talk to your doctor. Why would you have a DNR order? You are not in good health You are very old and frail You have a terminal illness You are worried that your brain would not have oxygen by the time you were resuscitated You remember these young women: Karen Quinlan Nancy Cruzan Terry Schiavo Getting a DNR order in the hospital. When you are admitted to a hospital, your doctor can add a DNR order to your medical record. Ultimately, only 5–10% of patients in cardiac arrest will survive after an attempted resuscitation. Cardiopulmonary resuscitation (CPR) = chest compressions, often with artificial ventilation, to try to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. CPR involves chest compressions for adults between 2 inches and 2.4 inches deep and at a rate of at least 100 to 120 per minute.[ CPR alone is unlikely to restart the heart. Its main purpose is to restore partial flow of oxygenated blood to the brain and heart. The objective is to delay tissue death and to extend the brief window of opportunity for a successful resuscitation without permanent brain damage. Administration of an electric shock to the subject's heart, termed defibrillation, is usually needed in order to restore a viable or "perfusing" heart rhythm. Defibrillation is effective only for certain heart rhythms, namely ventricular fibrillation or pulseless ventricular tachycardia, rather than asystole or pulseless electrical activity. Purpose: To instruct EMS personnel regarding a patient's decision to forgo resuscitative measures in the event of cardioplumonary arrest. The form does not affect the provision of life sustaining measure such as artificial nutrition or hydration or the provisions of other emergency medical care, including treatment for pain, difficulty breathing, major bleeding, or other medical conditions. The DNR must be signed by the patient or by the patient's legally recognized health care decision maker if the patient is unable to make or communicate informed health care decisions. The patient's physician must also sign the form, affirming that the patient/legally recognized health care decision maker has given informed consent to the DNR instruction. The DNR form should be clearly posted or maintained near the patient. What a DNR order does NOT do: The form does not affect the provision of life sustaining measure such as artificial nutrition or hydration or the provisions of other emergency medical care, including treatment for pain, difficulty breathing, major bleeding, or other medical conditions. EMTs, if called, can make you comfortable but will NOT restore cardiac function or breathing, if you have a DNR order. You can let people around you NOT to call 9-1-1 if your heart stops. If you want no treatment you can spell that out in your directive AND with you health care agent. DNR applies ONLY to restoring heart function and breathing. Having DNR in your POLST or Directive is OK. But, because of time crunch the EMTs should know immediately if you want DNR. The medallion or wrist bracelet are the main ways to inform the EMTs NOT to start resuscitation. It is better to have the directive on YOU rather than your refrigerator. Unless they are absolutely certain that a qualified DNR advance directive exists for that patient, EMS personnel will proceed with CPR. Time may be too short to contact your DPOA. Unless they are absolutely certain that a qualified DNR advance directive exists for that patient, EMS personnel will proceed with resuscitative measures. Common complications due to CPR are rib fractures, sternal fractures, bleeding in the anterior mediastinum, heart contusion,hemopericardium, upper airway complications, damage to the abdominal viscera - lacerations of the liver and spleen, fat emboli, pulmonary complications - pneumothorax, hemothorax, lung contusions. The most common injuries sustained from CPR are rib fractures The brain may sustain damage after blood flow has been stopped for about four minutes and irreversible damage after about seven minutes. Typically if blood flow ceases for one to two hours, then body cells die. Therefore, in general CPR is effective only if performed within seven minutes of the stoppage of blood flow.The heart also rapidly loses the ability to maintain a normal rhythm.. Following cardiac arrest, effective CPR enables enough oxygen to reach the brain to delay brain stem death, and allows the heart to remain responsive to defibrillation attempts What about other legal documents, such as a Durable Power of Attorney for Health Care (DPAHC?) or “living wills”. Are they acceptable in place of the Pre-Hospital DNR form? While such official documents are generally respected by EMS personnel (check with your attorney and with the local EMS agency in your county), it is important to keep in mind that most EMTs or paramedics do not have the legal training needed to interpret such documents, and more importantly, do not have the time to read a lengthy document and make a life-or-death decision on the scene. If in doubt, the EMS personnel will err on the side of the patient and provide resuscitative measures. Orders for partial resuscitation (eg, "do not intubate") have evolved from DNR orders. What measures: Resusciative measures to be withheld include chest compressions (CPR), assisted ventilation (breathing), endotracheal intubation, defibrillation, and cardiotonic drugs (drugs which stimulate the heart). (DNR) Form is an official State document CAN THE STATE DNR FORM AND/OR MEDALLION BE USED IN A SKILLED NURSING FACILITY OR HOSPICE? YES. THE ADOPTION OF THE FORM FOR USE BY SUCH FACILITIES IS ENCOURAGED; HOWEVER, MANY FACILITIES DO NOT KNOW OF THE FORM, OR THEY HAVE THEIR OWN IN PLACE, WHICH MAY NOT BE RECOGNIZABLE TO THE EMT OR PARAMEDIC. THE BEST WAY TO ENSURE THAT YOUR WISHES ARE HONORED IS TO BE SURE THE FACILITY IS AWARE OF AND PROVIDED A COPY OF THE DNR OR POLST FORM AND THAT THEY ARE CLEARLY POSTED OR MAINTAINED NEAR THE PATIENT. YOUR DNR ORDERS ARE IN PLACE FOR AS LONG AS YOU WISH THEM TO BE; YOU NEED ONLY TO DESTROY THEM IF YOU WISH TO STOP THEM. YOU SHOULD ALSO CONTACT YOUR DOCTOR’S OFFICE AND FAMILY IF YOU DO SO. The medallion or bracelet can be ordered by sending a copy of the signed DNR order to the address shown (MedicAlert Foundation.) The jewelry ordered this is way IS official and will be honored. MEDICALERT FOUNDATION 5226 PIRRONE COURT SALIDA, CA 95368 1-888-633-4298 CPR may succeed in inducing a heart rhythm that may be shockable. In general, CPR is continued until the person has a return of spontaneous circulation (ROSC) or death. THESE are the only ways to make sure you are NOT given CPR. None of these are valid, they are NOT ORDERS..
Load more

Recommended publications
  • A Profile of Out-Of-Hospital Cardiac Arrests in Northern Emirates, United Arab Emirates
    A profile of out-of-hospital cardiac arrests in Northern Emirates, United Arab Emirates Alan M. Batt, MSc(c), Ahmed S. Al-Hajeri, BHSc EMHCA, Fergal H. Cummins, MB, MSc (DM). ABSTRACT Results: A total of 384 patients were enrolled in this study. Male victims of out-of-hospital cardiac arrest represented 76% of the participants. The mean age اﻷهداف: دراسة خصائص ضحايا السكتات القلبية خارج of the study population was 50.9 years. An over-all املستشفى واملخرجات في إمارات الشارقة ورأس اخليمة وأم prehospital return of spontaneous circulation rate القيوين والفجيرة وعجمان. of 3.1% was documented, as well as a 30% rate of bystander cardiopulmonary resuscitation being performed. Public access defibrillators were applied in الطريقة:هذه دراسة وصفية استباقية ملجموعة من حاﻻت of cases. Data is presented according to Utstein %0.5 سكتات القلب خارج املستشفى والتي نقلها طواقم اﻹسعاف .reporting criteria الوطني في الفترة من فبراير 2014 حتى مارس 2015. Conclusion: Baseline data for out-of-hospital النتائج: تناولت الدراسة 384 حالة.شكلت %76 من احلاﻻت cardiac arrest was established for the first time in the Northern Emirates of the United Arab Emirates. A ذكور اصيبوا بسكتات قلبية. متوسط العمر ملجموعة البحث هو low survival rate for out-of-hospital cardiac arrest, low 50.9 سنة. نسبة استعادة الدورة الدموية التلقائية التي ُوثقت rates of bystander cardiopulmonary resuscitation, and كانت %3.1 إلى جانب توثيق نسبة %30 من اﻹنعاش القلبي .low public access defibrillator use were discovered الرئوي الذي قام به حاضرون في مكان احلدث. ُاستعني بأجهزة Although low by comparison to established western إزالة الرجفان البطيني اخلارجية املتاحة للجمهور في %0.5 من systems results are similar to other systems in the احلاﻻت وعرضت البيانات وفق مقاييس أوتستاين للتقارير.
    [Show full text]
  • Do Not Resuscitate (Dnr), Physician Orders for Life-Sustaining Treatment (Polst), & End of Life Options (Aid-In-Dying Drug)
    Yolo County Emergency Medical Services Agency Policy Revised Date: September 1, 2018 DO NOT RESUSCITATE (DNR), PHYSICIAN ORDERS FOR LIFE-SUSTAINING TREATMENT (POLST), & END OF LIFE OPTIONS (AID-IN-DYING DRUG) PURPOSE To provide a mechanism to allow patients to refuse unwanted resuscitation attempts and ensure that patient's rights to control their own medical treatment are honored. AUTHORITY Health & Safety Code, Division 2.5, Chapter 4, Article 1, § 1797.220 Health & Safety Code, Division 2.5, Chapter 5, §§ 1798, 1798.2 California Code of Regulations, Title 22, Division 9 Guidelines for EMS Personnel Regarding Do Not Resuscitate (DNR) Directives, (EMSA # 111), California Emergency Medical Services Authority DEFINITIONS Advanced Health Care Directive (AHCD): A written document that allows an individual to provide healthcare instructions and/or appoint an agent to make healthcare decisions on their behalf if they are unable or if they prefer to have someone speak for them. AHCD is the legal form for healthcare proxy or durable power of attorney for healthcare and living will. Aid-in-Dying Drug: A drug (or combination of drugs) prescribed by a Physician for a qualified individual, which the qualified individual may choose to self-administer to bring about his or her death due to a terminal illness. The prescribed drug(s) may take effect within minutes to several days after self-administration. Basic Life Support (BLS) Measures: The provision of treatment designed to maintain adequate circulation and ventilation for a patient in cardiac arrest without the use of drugs or special equipment. Examples include: I. Assisted ventilation via bag-valve mask (BVM) device II.
    [Show full text]
  • International Differences in End-Of-Life Attitudes in the Intensive Care Unit Results of a Survey
    ORIGINAL INVESTIGATION International Differences in End-of-Life Attitudes in the Intensive Care Unit Results of a Survey Arino Yaguchi, MD; Robert D. Truog, MD; J. Randall Curtis, MD; John M. Luce, MD; Mitchell M. Levy, MD; Christian Mélot, MD; Jean-Louis Vincent, MD, PhD Background: Important international differences ex- tral Europe, whereas oral orders took preference in South- ist in attitudes toward end-of-life issues in the intensive ern Europe, Turkey, and Brazil. One third of Japanese care unit. physicians said that they would not apply do-not- resuscitate orders. Most participants from Japan, Tur- Methods: A simple questionnaire survey was sent by key, the United States, Southern Europe, and Brazil chose e-mail to participants at an international meeting on in- to treat the hypothetical patient with antibiotics if he/ tensive care medicine. Respondents were asked to choose she developed septic shock, whereas in Northern Eu- 1 of 3 to 5 possible answers for each of 4 questions re- rope, Central Europe, Canada, and Australia, terminal lated to the treatment of a hypothetical patient in a veg- withdrawal of mechanical ventilation and extubation were etative state due to anoxic encephalopathy after cardiac the more commonly chosen responses. arrest with no family and no advance directives. Conclusions: In countries where intensive care medi- Results: From 3494 valid addresses, 1961 complete ques- cine is relatively well developed, considerable differ- tionnaires (56%) were received from 21 countries. Sixty- ences remain in physicians’ attitudes toward end-of-life two percent of physicians from Northern and Central Eu- rope said they involved nurses in end-of-life discussions care in the intensive care unit.
    [Show full text]
  • (DNR) Argumentative Essay
    iochem l B ist a ry ic : Burghal and Maryyan, Clin Med Biochem 2017, 3:2 d O e p e DOI: 10.4172/2471-2663.1000136 M n & A l c a c c i e n s i l s C Clinical & Medical Biochemistry ISSN: 2471-2663 Opinion Open Access Do Not Resuscitate (DNR) Argumentative Essay Muhand Burghal H1* and Majd Maryyan2 1Senior Nurse in University of Jordan Hospital, Amman, Jordan 2Faculty of Nursing, The Hashemite University, Zarqa, Jordan *Corresponding author: Muhand Burghal H, MSN, RN, Senior Nurse in University of Jordan Hospital, Amman, Jordan, Tel: 00971565888449; E-mail: [email protected] Rec date: November 06, 2017; Acc date: November 11, 2017; Pub date: November 18, 2017 Copyright: © 2017 Burghal M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Patients with terminal cancer suffering from many physiological and psychological signs and symptoms that affected on quality of life. When the cancer patient could not be cured, the objective of treatment is to enhance human dignity and prevent needless suffering from unnecessary treatments. As result, DNR orders have become an integral part of the care of the terminally ill patient. Although DNR increased over decades but still DNR concept considering one of most common ethical and legal dilemma. The purpose of this argumentative essay to identify literature and to support current researcher’s opinion about proppant to DNR; also taking into consideration the legal and ethical points of view of opponents and proponents.
    [Show full text]
  • Understanding Advance Directives
    Understanding Advance Directives What are advance directives? “Advance directives” are legal documents that allow you to plan and make your own end-of- life wishes known in the event that you are unable to communicate. Advance directives consist of (1) a living will and (2) a medical (healthcare) power of attorney. A living will describes your wishes regarding medical care. With a medical power of attorney you can appoint a person to make healthcare decisions for you in case you are unable to speak for yourself. What is a living will? A living will is an advance directive that guides your family and healthcare team through the medical treatment you wish to receive if you are unable to communicate your wishes. According to your state’s living will law, this document is considered legal as soon as you sign it and a witness signs it, if that’s required. A living will goes into effect when you are no longer able to make your own decisions. What is a medical power of attorney? A medical power of attorney is the advance directive that allows you to select a person you trust to make decisions about your medical care if you are temporarily or permanently unable to communicate and make decisions for yourself. This includes not only decisions at the end of your life, but also in other medical situations. This document is also known as a “healthcare proxy,” “appointment of healthcare agent” or “durable power of attorney for healthcare.” This document goes into effect when your physician declares that you are unable to make your own medical decisions.
    [Show full text]
  • Recognition of Death and Termination of Cardiac Resuscitation Attempts by UK Ambulance Personnel a S Lockey
    345 PREHOSPITAL CARE Emerg Med J: first published as 10.1136/emj.19.4.345 on 1 July 2002. Downloaded from Recognition of death and termination of cardiac resuscitation attempts by UK ambulance personnel A S Lockey ............................................................................................................................. Emerg Med J 2002;19:345–347 ....................... A S Lockey, Accident and Objectives: To identify whether the practice of the UK ambulance trusts comply with national recom- Emergency Department, mendations with respect to when ambulance personnel are allowed to recognise death and/or termi- York District Hospital, York, nate resuscitation attempts in the adult, normothermic, non-traumatic cardiac arrest. UK Methods: Questionnaire study of 39 ambulance trusts. Correspondence to: Results: At the time of the study (summer 2000), 23 trusts operated separate policies for recognition Dr A S Lockey, Accident of death and termination of resuscitation, two had policies for recognition of death alone, two had and Emergency policies for termination of resuscitation alone, five operated a policy purely for termination of resusci- Department, Calderdale tation attempts after a limited period of CPR, and seven had no protocols other than “the presence of Royal Hospital, Salterhebble, Halifax, rigor mortis, postmortem staining or injuries incompatible with life”. Only eight trusts conformed to the Yorkshire, UK; protocols for both recognition of death and termination of resuscitation attempts recommended by the [email protected] Joint Royal Colleges Ambulance Liaison Committee (JRCALC). Accepted for publication Conclusion: The JRCALC has proposed guidelines for recognition of death and terminating resuscita- 9 November 2001 tion attempts in the adult normothermic non-traumatic cardiac arrest. Despite this, there was still consid- ......................
    [Show full text]
  • Do Not Resuscitate (DNR) Orders Among Terminally Ill Patients: an Argumentative Essay
    Journal of Biology, Agriculture and Healthcare www.iiste.org ISSN 2224-3208 (Paper) ISSN 2225-093X (Online) Vol.6, No.20, 2016 Do Not Resuscitate (DNR) Orders among Terminally Ill Patients: An Argumentative Essay Aseel Aljundi School of Nursing, Hashemite University, PO box 330127 Zarqa, Jordan Abstract Do Not Resuscitate orders among terminally ill patients starts to be one of the most common argumentative issues within health care institutions agreed this type of orders. In the last quarter of twentieth century Do Not Resuscitate (DNR) statement starts to emerge in different health care centers. Cardiopulmonary Resuscitation (CPR) that attempt to restart patient’s heartbeats or natural breathing is the base line when dealing with any patient regardless any circumstances. Reviewing much of articles, research papers, guidelines and different policies regarding the DNR statement actually brought us into the stake. Ethical as well as legal Proponent and opponent opinions were confront for this debatable issue in order to argue the supportive and giving up points of views. DNR orders should be discussed and explained seriously with the patient (his or her surrogates) and their families to reach the suitable and preferable situation as well as allowing natural death process. In addition, the concept of futility regarding to health status possess high contribution when deciding the patients as DNR coded. However, integrating DNR orders within health care institutions eases in a way or in another the burden of activating CPR, while in advance; the end result is already known and unsatisfied based on clinical picture for the patient known as terminally ill.
    [Show full text]
  • Do Not Resuscitate (DNR) Order Among Terminally Ill Patients with Cancer: a Position Statement
    Journal of Biology, Agriculture and Healthcare www.iiste.org ISSN 2224-3208 (Paper) ISSN 2225-093X (Online) Vol.6, No.6, 2016 Do Not Resuscitate (DNR) Order among Terminally Ill Patients with Cancer: A Position Statement Batool Al-Masri 1 Majd Mrayyan 2 1. Master of Oncology Nursing, Hashemite University, Faculty of Nursing, AL-Zarqa, Jordan 2.Dean of Scientific Research, Consultant of Nursing, Hashemite University, P.O. Box 150459, AL-Zarqa 13115, Jordan Abstract End-of-life (EOL) care takes an important place in critical care settings. Of it, one of the most serious and arguable decision is the Do Not Resuscitate (DNR) order. The DNR is a legal order written by a licensed physician in consultation with the patients or their surrogate decision makers, in which the cardiopulmonary resuscitation (CPR) is withhold at the time of cardiac or respiratory arrest. Many studies reported that many inpatient deaths had a DNR order. The purpose of this position statement paper is to present proponents and opponents’ viewpoints regarding the DNR orders for terminally ill patients with cancer. Proponents of the DNR order reported that it is a form of treatment that protects patients’ rights, and allows the terminally ill cancer patients to die peacefully without undergoing futile resuscitation attempts. Opponents of the DNR order are concerned with the protection and preservation of life of the terminally ill cancer patients. The current author is against the DNR order based on the patients’ right for sanctity of life, and the Islamic views of human life. Keywords: Do Not Resuscitate, Do Not Resuscitate Order, DNR, Cancer, Position Statement, Proponents, Opponents.
    [Show full text]
  • The Status Ofthe Do-Not-Resuscitate Order in Chinese Clinical Trial
    Journal ofMedical Ethics 1999;25:309-314 J Med Ethics: first published as 10.1136/jme.25.4.309 on 1 August 1999. Downloaded from The status of the do-not-resuscitate order in Chinese clinical trial patients in a cancer centre Jacqueline Ming Liu, Wei Chun Lin, Yuh Min Chen, Hsiao Wei Wu, Nai Shun Yao, Li Tzong Chen and Jacqueline Whang-Peng National Health Research Institutes, Veterans General Hospital, Taipei and National Yang Ming University, Taipei, Taiwan, Republic of China Abstract encing cessation in cardiac function.' Cardiopul- Objective-To report and analyse the pattern of monary resuscitation has since then been auto- end-of-life decision makingfor terminal Chinese matically administered to any individual who has cancer patients. experienced abrupt cessation in cardiac or respira- Design-Retrospective descriptive study. tory function,2 3 unless otherwise prohibited. Setting-A cancer clinical trials unit in a large In the 1980s in the USA, CPR was performed in teaching hospital. about a third of all hospitalised persons before Patients-From April 1992 to August 1997, 177 dying.4 After the first CPR, pulse and blood consecutive deaths of cancer clinical trial patients pressure could be established in 30-40% of were studied. patients,4 although vital signs had to be restored to be 6 10-40% Main measurement-Basic demographic data, within 30 minutes effective,5 copyright. patient status at the time ofsigning a DNR consent, survived 24 hours,5 7 but only 14-17% lived to hos- or at the moment of returning home to die are pital discharge,7 10 and 11% of patients actually documented, and circumstances surrounding these required a second CPR whilst still in hospital.8 For- events evaluated.
    [Show full text]
  • Resuscitation Initiation and Termination
    Resuscitation Initiation and 8.17 Termination RESUSCITATION EFFORTS SHOULD BE WITHHELD UNDER THE FOLLOWING CIRCUMSTANCES: • Valid Do Not Resuscitate: Refer to Do Not Resuscitate (DNR) & Clinician Orders (COLST) Protocol 8.9. • Scene Safety: The physical environment is not safe for providers. • Dead on Arrival (DOA): A person is presumed dead on arrival when all five “Signs of Death” are present AND at least one associated “Factor of Death” is present. Signs of Death (All five signs of death must be present) ➢ Unresponsiveness. ➢ Apnea. ➢ Absence of palpable pulses at carotid, radial, and femoral sites. ➢ Unresponsive pupils. ➢ Absence of heart sounds. Factors of Death (At least one associated factor of death E must be present) 8.17 Medical Policy / ➢ Damage or destruction of the body incompatible with life, such A as, but not limited to: / ✓ Decapitation. P ✓ Decomposition. ✓ Deforming brain injury. ✓ Incineration or extensive full thickness burns. ➢ Lividity/Rigor mortis of any degree. ➢ Major blunt or penetrating trauma. ➢ Body frozen solid—unable to perform chest compressions. SUDDEN UNEXPLAINED INFANT DEATH (SUID) • An infant <12 months who is apneic, asystolic (no heartbeat or umbilical cord pulse), and exhibiting lividity and/or rigor mortis may be presumed dead. NEONATE • A neonate who is apneic, asystolic, and exhibits either neonatal maceration (softening or degeneration of the tissues after death in utero) or anencephaly (absence of a major portion of the brain, skull, and scalp) may be presumed dead. • Contact Medical Direction if gestational age is less than 22 weeks and neonate shows signs of obvious immaturity (translucent and gelatinous skin, lack of fingernails, fused eyelids).
    [Show full text]
  • Operational Policies Guidelines for EMS Personnel Regarding Do Not
    San Benito County EMS Agency Section 600: Operational Policies Guidelines for EMS Personnel Regarding Do Not Resuscitate Policy 614 Rev: 2/18 (DNR) Orders/Directives and The End of Life Options Act I. Authority: A. California Health and Safety Code, Division 1, Part 1.8, Section 442 – 443 B. California Health and Safety Code, Division 2.5, Section 1797.220 and 1798 C. California Probate Code, Division 4.7 (Health Care Decisions Law) II. Purpose: A. To allow EMS personnel to honor valid Do Not Resuscitate (DNR) orders or Physician Orders for Life- Sustaining Treatment (POLST) and other patient designated end-of-life directives in the field and act in accordance with the patient’s wishes when death appears imminent. III. Definitions: A. Advance Health Care Directive (AHCD): A written document that allows an individual to provide healthcare instructions and/or appoint an agent to make healthcare decisions when unable or prefer to have someone speak for them. AHCD is the legal format for healthcare proxy or durable power of attorney for healthcare and living will. B. Absent Vital Signs: Absence of respirations, absence of carotid pulse. When available, a capnography reading of less than 10 mmHg. C. Basic Life Support (BLS) measures: The provision of treatment designed to maintain adequate circulation and ventilation for a patient in cardiac arrest without the use of drugs or special equipment. Examples include: D. Assisted ventilation via a bag-valve-mask device E. Manual or automated chest compressions F. Automated External Defibrillator (AED) – only if an EMT is on scene prior to the arrival of paramedics G.
    [Show full text]
  • Do Not Resuscitate (Dnr) Form
    INFORMATION ON DO-NOT-RESUSCITATE (DNR) REQUESTS IN EMERGENCY MEDICAL SERVICES This summary provides information about the types of Do-Not-Resuscitate (DNR) requests that will be honored in the field by paramedics, and emergency medical technicians ( EMTs) on fire engines and ambulances. This information will also be helpful to physicians in the hospital if you do not want resuscitative efforts. The best resource for obtaining information is your own physician. Once you have read this summary sheet, you may want to write down any questions and discuss them with your family and physician. For general information, call Orange County Emergency Medical Services at (714) 834-3500. 1. What does DNR mean? · DNR means, “Do Not Resuscitate,” or, do not attempt to restart a heart or breathing once they have stopped. · Generally, for paramedics and EMTs to honor a patient’s wishes not to have CPR or other resuscitative efforts, a properly completed field DNR form must be present. 2. What happens when paramedics or EMTs respond to a person with a DNR order? · If the person’s heart or breathing has stopped and there is a valid DNR order, paramedics and EMTs will not try to restart the heart or breathing. · The types of treatments that a patient with a DNR order WOULD NOT receive include cardiopulmonary resuscitation (chest compressions and mouth-to-mouth breathing, or CPR), electric shocks to the heart, assisted breathing with mechanical devices, or the use of medications which are intended to artificially start the heart again. A person will not be placed on life support, such as a ventilator or a breathing machine.
    [Show full text]