armymedic571 Posted January 22, 2010 Posted January 22, 2010 (edited) This is a very complex issue. Mostly because laws are so various between states. Also, because it is an emotional issue. I believe it was AK that said , you need to keep your emotions and feelings out of the equation. Regardless of what you believe, everyone owes a death. PERIOD. I find that the issue is more of patient education and advocacy by the pt's family and family physician. In the state of PA we have two types of DNR's (IN-hospital and Out of Hospital) By law, EMS is not legally bound to honor in hospital DNR's, Living wills and the like. As a matter of fact, we can be found negligent if we do. Now, if we arrive on scene and the family has the paperwork and is insisting, do the right thing. Start BLS and call Medical Command. Ultimitely, the ER Doc can honor those wishes. The second is that many families and patients don't ever know about the Out of Hospital DNR. This is one that must be requested from the Department of Health, and has the Department seal on it. It must be filled out in its entirety, have all original signatures, and be physically present upon EMS arrival. Now, how often do you think that actaully happens. At the end of the day, you have to ask yourself, are you a patient advocate? Sometimes, it is just time to let them go. Just know the rules surrounding DNR's and Living wills in your area! Remember, don't mourn death, celebrate life. Edited January 22, 2010 by armymedic571
tcripp Posted January 22, 2010 Posted January 22, 2010 When I was working EMS in Michigan, the EMT-B could not honor a DNR order. For those patients that we encountered with a valid DNR order, we were instructed by protocol to begin resuscitative measures after calling for an ALS unit, (Paramedics were the only ones that were allowed to make that kind of call in the field). Interesting approach. Was their any reason for this protocol? Was there ever any backlash? Is this a statewide protocol or service specific? I see one of three scenarios taking place. One would be a distraught family who is trying to convince the BLS team NOT to proceed. Another is the distraught family who's okay with the rescue attempt and is now being told by an ALS unit that the DNR should be honored and then watching efforts cease. Or, worse yet IMHO, the BLS does just enough to bring the patient back to life which is against his/her wishes in the first place.
itku2er Posted January 22, 2010 Posted January 22, 2010 I tend to agree with the ones that say keep your emotions out of it, when you emotionally involved then the outcome is usually isnt pretty. We should as health care providers keep it on a professional level go in do the job honor the DNR and drop them off at the hospital, morgue, or where ever your protocol tells you to do so. Then forget it and move on to the next call. It is the persons wishes that they be a DNR and who I or anyone one else to say thier wishes do not mean crap and go against them. Its that cut and dry leave the emotion at the door, do the job and get the hell on to the next call.
ccmedoc Posted January 22, 2010 Posted January 22, 2010 When I was working EMS in Michigan, the EMT-B could not honor a DNR order. For those patients that we encountered with a valid DNR order, we were instructed by protocol to begin resuscitative measures after calling for an ALS unit, (Paramedics were the only ones that were allowed to make that kind of call in the field). I dont recall this protocol, it must be a regional thing..Basics can, indeed, honor the DNR if it is present and valid. Contact of MC may be prudent though.. Some examples.. Kent.. Another..Here LCA and Genesee County is attached as PDF..they all say that the protocol applies to all EMS providers..The Basic EMT not honoring the DNR is an exception rather than the rule, I believe.. If any family wants the resuscitation started, I believe the DNR is revoked..as far as I know. The papers must be filled out, signed, and presented to the EMS personnel.. GCDNR.pdf
itku2er Posted January 22, 2010 Posted January 22, 2010 (edited) I don't see how a DNR can not be honored. Its a legal doucement and who is the county government to say that a EMT B can not honor it that is just stupid! Edited January 22, 2010 by itku2er
armymedic571 Posted January 22, 2010 Posted January 22, 2010 I don't see how a DNR can not be honored. Its a legal doucement and who is the county government to say that a EMT B can not honor it that is just stupid! As I had previously stated, in some locales, there are specific protocols and types of DNR's that EMS can/cannot accept. Also, there are rules, like the document must be signed and that it must be present. Furthermore, one can always call Medical Command and run the situation past him/her as to the patients current status, Hx and family wishes. I see your point, but it is not stupid. Its the law.
JakeEMTP Posted January 22, 2010 Posted January 22, 2010 I see your point, but it is not stupid. Its the law. Sort of an oxymoron don't you think? Almost like Army Intelligence.
armymedic571 Posted January 22, 2010 Posted January 22, 2010 OK Jake, you got me.......Especially since I amin the Army, and I know how true that is...........hahahaha. 1
JakeEMTP Posted January 22, 2010 Posted January 22, 2010 OK Jake, you got me.......Especially since I amin the Army, and I know how true that is...........hahahaha. Ha! Yeah Jeff, I knew you'd take it in the spirit it was intended!
Richard B the EMT Posted January 23, 2010 Posted January 23, 2010 I see your point, but it is not stupid. Its the law. "The Law is a Ass" Mr Micawber (?) from the writings of Charles Dickens.
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