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

[johnrsemtp]

I, personally didn't have a problem with it, but it was surprising how many people thought that I did wrong because I didn't do the 'correct' thing of working the patient and then calling for ok to stop working the patient.

I just put it out here to let people think about it, and that it might happen to someone else someday: and maybe they have something to go with if it does.

thank you

[arctic_myst]

Invalid DNR and being released to hospice care....I don't even load them up til they get a valid DNR. That is what hospice is for. To help them in the last moments of their life. What good does it do to transport them only for the family to panic later and call 911 when the pt. starts to go downhill. Then medics respond and have to work the code because the DNR isn't valid. Luckily ya'll were still on scene. But more often than not, the family panics and calls 911. The medics that don't know what you know will respond and work it. It is our protocol here that we do not take a hospice pt. unless they have a valid DNR. That is one of the first pieces of paperwork we check.

[firemedic37]

The correct thing in this case was to do as you did. Get a set of vitals and call on-line medical control and explain to them the situation and listen and do as they say. If they say run the code, then by all means run the code, on the other hand if they say do not run the code, do not run it. What ever they instruct you to do be sure to get their name, title, and time. Then later talk to your medical director and see what you should do the next time you transport a hospice patient. I think getting a valid DNR before transporting a hospice patient is a excellent idea and should always be done.

[JPINFV]

^

Err, what if you DON'T have online medical control at the BLS level? Not everyone has the ability to punt decesions to the nearest base hospital. It's much easier to know your county's/company's protocol regard DNRs forward and back and have a copy of it. Personally, I'll transport any patient. The DNR makes the difference between me coming back if the patient's status changes and me not coming back. If there is a DNR problem, I always inform the facility/family about what's wrong and how to fix it while checking to see if there is another DNR available (i.e. written order in the patient's chart).

[Just Plain Ruff]

If you don't have medical control then how are you operating a emergency vehicle or transport vehicle. there is always medical control.

Just call the hospital you would have taken the code to and talk to the doc there. He would be getting the patient anyway so let him make the decision.

are there really services out there who don't have any type of medical control. Maybe I've been spoiled all my ems life.

[678 Responding]

A DNR not signed by a Doctor is INVALID and hence, is not to be followed. Now, like you said, you called your doctor, explained your situation and was told to not attempt resuscitation. THAT IS valid. A verbal order from a doctor is as good as any written order. If I were the EMT in this situation, since they do not have ONLINE medical command, I would begin resuscitation efforts, and when the medics arrived, they would contact their medical command and get orders to cease efforts. So you did the right. I would have done it the same way.

[JPINFV]

EMS in California is run by the county. Each county has a medical director that sets the scope of practice and protocols for the EMS units (be it private or fire, BLS or ALS, 911 or interfacility). In the county I live in on-line medical control is only available for paramedics. To be honest, if a BLS unit has a critical emergency patient then they should either call 911 for a medic unit (i.e. fire department) or transport themselves. The patient will be in the care of ALS providers (i.e. paramedics or in the hospital) within 10 minutes. In most places they would be in the hospital and almost everyplace they would have a medic if the crew didn't transport the patient BLs. Why waste time arranging for on-line control? Why waste time having a system in place for BLS crews when the answer is going to be "transport" or "call fire" in most cases?

[Just Plain Ruff]

Fair enough JP, I don't know the california way so I wasn't sure. I've never been in a service where there was no medical control like you described.

thanks for the clarification.

Kind of makes for some sphincter tightening moments.

[NREMT-Basic]

Here it doesnt matter what med control says even if that med con should happen to be the patients doctor by some fluke. If it aint signed and on the nice IL DOPH bright orange form, it aint a DNR. That simple. You can have every doctor in the hospital say "let him go and pronounce him" and without that signature, you run a code. Worthless I agree, but thats what we are doing over here. We are even so picky over here that if its printed out on a computer and signed but not on the orange paper, its not a DNR.

[speedygodzilla]

Coming just out of class recently I would have to follow the book. If it is invalid DNR than I must work the code. However calling medical control is a great idea. I would hope I or my partner would of thought of this and than we could legally follow the pt wishes.