what would you do in this situation as a EMT-B

[johnrsemtp]

I also posted this on the ALS site.

I work both private EMS and 911 this happened on the private service

2 weeks ago my EMT-B partner (1 year experience) and I (paramedic * 2 years); were transporting a pt from a extended care facitlity to home for hospice care and to die at home.

At the ECF we found out that the DNR (Do Not Resucitate) order was invalid due to not being signed by a Doctor. Family wanted him transported and we did.

His BP in the parking lot of the ECF was 131/83. 12 minutes later as I was backing into the driveway it was 42/19.

We got him into the bed, my partner was getting signatures from the wife, and I was talking to the daughter about how to get a valid DNR; get family Dr to sign one. Also telling her what needs to happen when he dies. about 3 minutes after getting pt into his bed, a 20+ y/o grandson comes running out to say that grandpa was dead.

great, invalid DNR and we were still in the house. partner grabbed the monitor and I called there ER. pt was showing asystole in all leads. I talked to the ER doc, and explained the situation and he gave me verbal orders not to work the code. so then we stayed there and helped them to call family dr for death certificate and the funeral home for picking up the body.

what would you do and what could you do per your protocols?

I shared this at both jobs, and got all sorts of answers. also got told by more senior medics that I can't do that, and others said I did too much, and others said that I did right. Most of the Basic EMT's just stated they were glad they weren't there.

[whit72]

I would have advised the family that we would need to contact there doctor to have the DNR signed. After this was completed we could transport the pt home. Hopefully it could be done in a timely fashion.

The only issue is that if you had left, and a family member had freaked when the pt had passesd and called 911 without the DNR then the crew arriving would be obligated to work the code, without the proper signed documentation.

[emtkelley]

I will probably get lambasted for this but in the end, Grandpa died peacefully, and nice and warm in his own bed. Forget protocols and all the official crap. The situation took care of itself. Good for him he was able to die in the fashion he desired. Many aren't that lucky.

[JPINFV]

It all depends on your local procedures. In my county, I can have the patient's "attorney in fact or healthcare agent" (these are set by power of attorney and advanced directives) or immedate family sign my runsheet after requesting that the patient is a DNR. I can also accept written orders (i.e. doesn't need to be a form DNR) from the patient's chart when transporting from healthcare facilities.

http://www.ochealthinfo.com/docs/medical/e...mp;P/330.51.pdf (Section D covers physician's order in the patient's chart, section E covers verbal requests)

[MrSpykes]

I would have probably called online medical control as soon as we got the patient and informed him that we had a pt in hospice care but the DNR was incomplete. I would explain that it was just missing the doctors signature and asked him what our course of action should be if the patient does infact code. Just to be on the safe side. I want to to honor the patients wishes but I also need to do what is legally correct. I feel you handled the situation correctly. Everyhting worked out in the end he got to die peacfully at home with his family.

[AnthonyM83]

As EMTs, we would have had to call 911 while we did CPR, then explain situation to FFMedics when they arrived, then they'd call base and ask for instructions.

[Asysin2leads]

Easy. ACLS, call the doctor, pronounce, call it a day.

[Asysin2leads]

Easy. ACLS, call the doctor, pronounce, call it a day, although, really, once the doctor says its okay to pronounce, its pretty much on his head so long as you can prove you followed your protocols prior to contact. What happens and what is documented is always the same thing. Always.

[paramedicmike]

great, invalid DNR and we were still in the house. partner grabbed the monitor and I called there ER. pt was showing asystole in all leads. I talked to the ER doc, and explained the situation and he gave me verbal orders not to work the code. so then we stayed there and helped them to call family dr for death certificate and the funeral home for picking up the body.

what would you do and what could you do per your protocols?

Hmmm...so let's see here. You had an invalid DNR in your hand due to the lack of a signature. Yet presumably, by the mere presence of the paperwork, you knew that no heroic measures were wanted when grandpa died. So you called the ER, explained the situation. I hope, during the discussion, you included the part about the DNR paperwork and reasons for transport back home et cetera. The doc, hearing this, said to let the man die in peace at home.

I'm not sure where the problem lies or why so many of your coworkers had a problem with this. This is exactly what I would've done. I wouldn't have worked him at all.

Then you stayed a little while to help the family. It wasn't required of you, but I think it shows not only good faith on your part but compassion that many don't seem to have.

I say right on! Good job!

-be safe

[mobey]

I will probably get lambasted for this but in the end' date=' Grandpa died peacefully, and nice and warm in his own bed. Forget protocols and all the official crap.