DNR/Advance Directives

Standard: 

In the event any provider of the EMS System is presented with a completed Out of Hospital Do Not Resuscitate (OOH-DNR) form and/or OOH-DNR ID device, the provider shall withhold CPR and the listed therapies in the event of cardiac arrest. The form and device may be from any (US) State. 

Purpose: 

To honor the terminal wishes of the patient and to prevent the initiation of unwanted resuscitation. 

If you are unsure whether the patient meets criteria, then resuscitate. 

Exceptions: 

  • The provider shall begin resuscitation efforts until such time as a physician or OLMC directs otherwise when: 
    • The patient is known to be pregnant. 
    • If there are any indications of unnatural or suspicious circumstances. 
    • If the Provider is unsure of the existence or validity of the DNR. 
    • An advanced directive does not imply that a patient refused supportive or palliative care. 

 Application: 

  1. When confronted with a cardiac arrest patient, one of the following conditions must be present to honor the DNR request and withhold CPR and ALS therapy: 
  2. Out-of-Hospital Do Not Resuscitate (OOH-DNR) or OOH-DNR ID device, original or copy. 
    1. Valid original or copy of OOH-DNR written order or OOH-DNR ID device from any US state. 
    2. A licensed physician on scene or in contact by telephone orders that no resuscitation efforts are to take place. 
  3.  A DNR request may be overridden by: 
    1. The patient or person who executed the order destroying or directing someone in their presence to destroy the form and/or remove the identification device. 
    2. The patient or person who executed the order telling EMS providers or attending physician that it is their intent to revoke the order. 
    3. The attending physician or physician’s designee if present at the time of revocation records in the patient’s medical rector the time, date, and place of the revocation and enters “VOID” on each page of the OOH-DNR. 
  4. In the event here is a question regarding whether to honor or not honor an OOH-DNR or Advanced Directive, then initiate resuscitation and contact OLMC.