Applications of the Out-Of-Hospital Do-Not-Resuscitate (DNR) Order
Out-of-hospital do-not-resuscitate orders are now recognized by a recent law to empower TERMINALLY ILL PATIENTS to make personal decisions regarding resuscitation. These are known as “DNR Orders” and can be in the form a written order, bracelet, or necklace, the contents of which are described in the statute. The Orders are available from the patient’s physician. The Orders are primarily intended to direct Emergency Medical Service Providers to comply with the patient’s wishes when a patient is experiencing cardiac or respiratory arrest. The patient through their DNR Order empowers EMS personnel to withhold cardiopulmonary resuscitation (CPR) in the out-of-hospital setting without contacting a physician.
AN OUT-OF-HOSPITAL DNR ORDER APPLIES TO ALL SETTINGS when providing emergency medical services to a DNR patient (including personal care facilities and all other health care facilities). Under the DNR Act, the EMS provider can withhold CPR upon observing an out-of-hospital order, bracelet, or necklace displayed by the patient. The EMS provider is not required to contact a medical command physician to secure approval and can follow the patient’s wishes when they are experiencing cardiac or respiratory arrest.
IF THE PATIENT HAS DISPLAYED A DNR ORDER, EMS PERSONNEL SHOULD NOT PROVIDE CPR, intubation, bag-and-mask ventilation, defibrillation, or medications intended to resuscitate according to guidelines set forth by the Pennsylvania Department of Health in their website at www.DSF.health.state.pa.us.
The out-of-hospital DNR order is a written order that is issued by an attending physician, where a terminally ill patient may have more than one attending physicians, directed towards EMS personnel and providers who are defined as pre-hospital personnel and individuals, medical command physicians, advance life support service medical directors, medical command facility medical directors, ambulance service, and quick response service personnel. THEY ARE DIRECTED TO WITHHOLD CPR AND OTHER LIFE-SUSTAINING TREATMENT FROM THE PATIENT IN THE EVENT OF CARDIAC OR RESPIRATORY ARREST. However, they may provide oxygen, suctioning, medications for comfort or to alleviate pain per local medical commands (unless refused by the patient).
In that an Advance Health Care Directive (Living Will) is not in the form of a Do Not Resuscitate Order, patients are advised to have both a Living Will and an Out-Of-Hospital DNR Order prepared. Only their physician may issue a DNR Order. A Living Will is different in that it encompasses resuscitation criteria and other measures (i.e., feeding tubes, ventilators, etc.