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

[ittybitty1313]

It was so cool to find this, my instructor gave us almost the exact same scenario. According to the protocol here if there is not a valid DNR we are to start CPR and call for ALS. We were also taught that even if med control tells us to discontinue CPR our scope of practice tells us we are NOT allowed, only ALS can make that decision. (It's our butt that can fry regardless of what the doc tells us) So legally we have to do CPR even if morally we want to just let him go in peace.

[medic001918]

It was so cool to find this, my instructor gave us almost the exact same scenario. According to the protocol here if there is not a valid DNR we are to start CPR and call for ALS. We were also taught that even if med control tells us to discontinue CPR our scope of practice tells us we are NOT allowed, only ALS can make that decision. (It's our butt that can fry regardless of what the doc tells us) So legally we have to do CPR even if morally we want to just let him go in peace.

So you have to disregard an order from a doctor to withhold resuccitation and wait for a paramedic to make the determiniation? It seems to me that medical control would be a higher authority then an ALS provider in the first place. In a case like this, it's not like medical control is giving an incorrect order that's "harmful" to the patient that you would need to disregard. That just sounds like a totally strange protocol. I don't know as though I'd want to deal with disregarding a physician's order and wait for one from a paramedic. It just sounds like a strange system to me.

Shane

NREMT-P

[Lone Star]

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.

Per my state and local protocols, I have no choice but to work the code. As an EMT-B in Michigan, I cannot honor a DNR order, whether valid or invalid.

Since the DNR order was not valid (missing the physician's signature), legally, one would think that it's as good as not having one at all.

Would I have felt bad for Grandpa? Of course! But at the end of the day, I either follow protocols or lose my license. I'm sorry, but its no contest. Granpa gets worked.

[katbemeEMT-B]

So you have to disregard an order from a doctor to withhold resuccitation and wait for a paramedic to make the determiniation? It seems to me that medical control would be a higher authority then an ALS provider in the first place. In a case like this, it's not like medical control is giving an incorrect order that's "harmful" to the patient that you would need to disregard. That just sounds like a totally strange protocol. I don't know as though I'd want to deal with disregarding a physician's order and wait for one from a paramedic. It just sounds like a strange system to me.

Shane

NREMT-P

I agree with Shane that the doctor would have more authority over the medic. Let's not forget that whether we are basics or medics we are an extension of the doctors license so in reality if it is well documented that he ordered you to discontinue CPR your butt is just fine and his butt is on the line. Maybe it's better said that no doctor in your area will give the order unless there is a medic on scene.

[ittybitty1313]

Well like Lone Star, my state requires us to run the code unless the DNR is in proper order. If not it's me loosing my job. So in that situation, I feel bad for the old man, but I have to run with the code until ALS shows up then they can make that determination to stop the code. My instructor hounded on the fact that YES, he is a doctor but if we are directed to do something that conflicts with our scope of practice, when it hits the fan it's our job NOT his. So it's sad but I have to run the code. No choice without the proper DNR.

Josie

[paramedicmike]

If you can't call medical command and consult with a doc regarding the validity of a DNR, regardless if you're a basic or medic, then your system sucks.

If there exists a DNR even without a doctor's signature, a phone call with your command doc would go a long way to ease your decision making process. The intent is there to indicate they don't want to be worked. So call your doc and ask.

I recently had an interesting discussion with a doc who's a medical command physician in PA. (I didn't read through all the pages of this thread to see if this has been discussed so if I'm repeating someone forgive me.) It seems that in PA, though not widely known, field providers can't accept an "in-hospital" DNR. This would be the common DNR paperwork with a patient's chart from a nursing home or on their fridge or where-ever. PA has what they call a "pre-hospital" DNR that consists of separate paperwork and a wrist band that people have to wear if they don't want measures taken while they're not in the hospital.

It seems that not a single family practice or internal medicine doc in the state has handed these out or brought them up with their patients. In the five or six years they've been out not a single provider I know in PA has ever seen one. The command doc I was speaking to said simply, "If you see they have an "in-hospital" DNR order, completed or not, call me and I'll make the call."

But, back to the more recent turn of this thread, if you can't call command to determine whether or not you can cease efforts, regardless of the circumstances, then your system sucks and I hope you start making waves to address those issues.

-be safe

[AnthonyM83]

Riverside County is well worth the drive.

The women is hott there! 8)

Dust, Dust...you must visit Hollywod and Santa Monica....Woahwa

[ittybitty1313]

I'm just simply stating what my instructor drilled into our heads over and over again. He is and has been a medic for 30 yrs in this state. He said without a proper DNR we have got to start CPR. It may be that we are told to stop but we must, without question, start CPR if the family cannot provide a proper DNR.

Josie

[medic001918]

I'm just simply stating what my instructor drilled into our heads over and over again. He is and has been a medic for 30 yrs in this state. He said without a proper DNR we have got to start CPR. It may be that we are told to stop but we must, without question, start CPR if the family cannot provide a proper DNR.

Josie

That's not what you said though. Without a valid DNR, you must begin efforts. But what you said was this:

We were also taught that even if med control tells us to discontinue CPR our scope of practice tells us we are NOT allowed, only ALS can make that decision.

The common interpretation of that statement is that even if you call medical control, and they tell you NOT to work the code...you're going to work it anyway and violate a physicians order which would be higher than that of a paramedic.

Shane

NREMT-P

[CBEMT]

If you can't call medical command and consult with a doc regarding the validity of a DNR, regardless if you're a basic or medic, then your system sucks.

Even moreso, if the patient HAS a valid DNR, and you aren't allowed to honor your patient's wishes because you're a Basic and not a medic, your system sucks even more.

I once heard a working code described as the most violent thing you can do to a person legally. There's simply no excuse for the government (via protocol) forcing it on someone who clearly doesn't want it, and went so far as to sign a document to that effect.

I recently had an interesting discussion with a doc who's a medical command physician in PA. (I didn't read through all the pages of this thread to see if this has been discussed so if I'm repeating someone forgive me.) It seems that in PA, though not widely known, field providers can't accept an "in-hospital" DNR. This would be the common DNR paperwork with a patient's chart from a nursing home or on their fridge or where-ever. PA has what they call a "pre-hospital" DNR that consists of separate paperwork and a wrist band that people have to wear if they don't want measures taken while they're not in the hospital.

It seems that not a single family practice or internal medicine doc in the state has handed these out or brought them up with their patients. In the five or six years they've been out not a single provider I know in PA has ever seen one. The command doc I was speaking to said simply, "If you see they have an "in-hospital" DNR order, completed or not, call me and I'll make the call."

We have a similiar system here, but they ARE out there. The only people I've ever seen with the bracelet are those on home Hospice care- and frequently the family has the form but the bracelet's on the nightstand. Picked up a patient like that once to go to the hospice inpatient unit, and I just asked the family to put the bracelet on for me so as to prevent a problem during transport.

The saving grace to the protocol is that it ALSO stipulates that "a Do Not Resuscitate order signed by the patient's physician and recorded in the patient's medical record" is also valid. So for all those thousands of nursing home patients who are DNRs but don't have the bracelet (because they aren't actually dying) but DO have the nursing home's own DNR form signed, we aren't forced to go full-court press on them. You may want to look into getting such language added to your protocol.