Eydawn Posted April 9, 2008 Posted April 9, 2008 Not any parent... a custodial parent for a minor or dependent adult. Those with legal guardianship. The divorced dad who doesn't have legal custody? I don't believe so... that's kind of like an aunt or uncle stepping in saying "do CPR!" when the parent says no... Think it also applies to anyone with legal guardianship/medical power of attorney who signed the DNR for the person they are responsible for and then changed their mind... you were responsible for saying "NO" and now you say "YES" so the most current order stands... Wendy CO EMT-B
JPINFV Posted April 9, 2008 Posted April 9, 2008 I can't pull up the protocol right now, but I'm 95% sure that any disagreement on scene results in the start of resuscitation and a call to med control. This goes hand in hand, though, with immediate family being able to verbally decline resuscitation, even if there is no written DNR.
AZCEP Posted April 9, 2008 Posted April 9, 2008 In AZ anyone can rescind a prehospital DNR order. Only a physician, or a patient can allow for one. If there is a conflict of any kind with carrying out the order as written, call medical control.
spenac Posted April 9, 2008 Posted April 9, 2008 It opens and you are greeted by the pt`s mother, who orders you to stop CPR immediately, as her child has suffered enough, holding in your face a valid DNR signed by both parents. Both parents are the pt`s natural parents and both have legal custody of the child. What would you do? IBEMT31 Continue CPR. Father nullified DNR by telling you to save his child. He is a legal guardian and he and his wife will have to work out their disagreement later. I feel bad for the kid because my heart would say let him go so he quits suffering.
Scaramedic Posted April 9, 2008 Posted April 9, 2008 Continue with BLS (BVM/Chest Compressions) and call medical control. In my system odds are you are going to transport C3 w/ BLS procedures and let the hospital Docs, Lawyers and Ethics people figure it out. I had the same situation with an adult female terminal from ovarian cancer. Family wanted no resuscitation, husband wanted her worked. He actually tore up the DNR in front of me. I elected BLS only and transported to the hospital. ER Doc and our Med control Doc stood behind my decision.
Richard B the EMT Posted April 9, 2008 Posted April 9, 2008 I went back and looked in the original posting several times, looking for any indication that the original parent, specifically, the father, was divorced or separated from the second parent, the mother. Did I still miss such indication? Father requested the crew to save his child, and CPR was started. Mother, whom I will speculate was not originally on the scene, arrived following commencement of CPR, and presents the crew with a DNR order. This is definitely in the posting. I admit I now speak from emotion, not "the book". I'd continue CPR, and try, quick, for On Line Medical Control to sort it out, while transporting, CPR in progress. Of course, if the OLMC tells my crew to discontinue CPR, I would have to, otherwise, the decision to stop (or not) would come from the ED MD on our arrival.
ccmedoc Posted April 9, 2008 Posted April 9, 2008 Here is food for thought I think you do CPR.. chance is it is futile anyhow. The DNR is in place in the event of ROSC and vegetative state. That is when the battle begins... Let the doc determine resuscitation is futile. You shouldn't bust fanny to the hospital though..depends on the exact orders also. Is it no resuscitation period, or all but CPR? Many variables in all this debauchery. I don't envy the person put in this situation...
mitchb Posted April 10, 2008 Posted April 10, 2008 Bag mask and compressions only smacks of "social CPR" ie. doing it for apperances only. In my opinion, you either follow the full proceedure or you don't start. In this case, I would not start. DNR or not, this seems to me to be a case were CPR is futile.
akroeze Posted April 10, 2008 Posted April 10, 2008 Yeah, to me it's all or nothing. How do you justify going to the hospital with CPR only? They are dead.... but I'm deciding that I'll only do CPR cuz that's all they should get even though they have a better chance with defib/drugs. All or nothing.
aryan51 Posted April 10, 2008 Posted April 10, 2008 There is also the matter of whether the child's respiratory arrest was caused by his terminal illness. If it was something totally unrelated I would say consult medical direction and attempt to explain this to the mother, in the mean time continue to work him up. This may not be the case in this situation, but it's something to think about.
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