Controversy: 80 y/o woman in Iowa w/ "DNR" Tattoo

[brentoli]

It might not have any legal standing, but seeing the tattoo would certainly prompt a call to my medical command to verify what are otherwise clearly stated wishes.

You just used criticial thinking, and rationalization skills.

I hope the EMS in her town, are as fortunate to have these.

[Ridryder 911]

It might be better if she would wear a tube containing her written DNR, as well as instructions to freinds and family not to notify EMS in the event of an arrest.

R/r 911

[Cookie]

Below is a copy of Iowa's Out of Hospital DNR Order. What people fail to realize that this has to be physician signed, that you cannot just state you do not want to be resuciatated. Many people also feel that their Living Will will take the place of the DNR Order. Not so.

They do address the fact of wearing a Medic Alert Tag for the DNR Order and that is addressed in this as well.

OOH DNR order Page 1 of 2 September, 2003

“Promoting and Protecting the Health of Iowans”

Iowa Department of Public Health

OUT-OF-HOSPITAL DO-NOT-RESUSCITATE ORDER

(Please type or print)

Date of Order: ____/_____/______

Patient Information:

Name: (Last)__________________________(First)____________________(Middle)_____________

___

Address: __________________________________(City)____________________________(Zip)______

Date of Birth: ____/_____/_____ Gender (Circle): M or F

Name of Hospice or Care Facility (if applicable): _____________________________________________

Attending Physician Order

As the attending physician for the above-named patient, I certify that this individual is over 18 years of

age and has a terminal diagnosis. After consultation with this patient (or the patient’s legal

representative), I hereby direct any and all health care providers, including qualified emergency medical

services (EMS) personnel, to withhold or withdraw the following life-sustaining procedures in accordance

with Iowa law (Iowa Code Chapter 142A):

• Cardiopulmonary Resuscitation/Cardiac Compression (Chest Compressions).

• Endotracheal Intubation/Artificial or Mechanical Ventilation (Advance Airway Management).

• Defibrillation and related procedures.

• Use of Resuscitation Drugs.

This directive does NOT apply to other medical interventions for comfort care.

______________________________________________ ______/______/______

Signature of Attending Physician (MD, DO) Date

______________________________________________ (_____)_____-_______

Printed Name of Attending Physician Physician’s Telephone (Emergency)

To the extent that it is possible, a person designated by the patient may revoke this order on the

patient’s behalf. If the patient wishes to authorize any other person(s) to revoke this order, the

p atient MUST list those persons’ names below:

Name: ___________________________________________________________________

Name: ___________________________________________________________________

Name: ___________________________________________________________________

Name: ___________________________________________________________________

Patients please note: Directions for obtaining a uniform identifier are listed on the back of this form.

The uniform identifier is the key way the health care provider and/or EMS personnel can quickly

recognize that you have an Out-Of-Hospital Do-Not-Resuscitate order. If you are not wearing an

identifier, the health care provider and/or EMS personnel may not realize that you do not want to be

resuscitated.

Physicians please note: Information regarding the completion of an Out-of-Hospital Do-Not-Resuscitate

Order is on the back of this form.

OOH DNR order Page 2 of 2 September, 2003

Directions for obtaining a uniform identifier:

The uniform identifier may be obtained through MedicAlert®1, which requires:

1. A completed MedicAlert® application, which is available in physician offices or through

MedicAlert® by phoning (800) 432-5378 or their Web site www.medicalert.org, and

a new membership fee of $35.00.

2. A copy of this completed OOH DNR order, which must accompany the MedicAlert®

application or be sent to MedicAlert® prior to the identifier’s being mailed.

1MedicAlert® is a nonprofit 501C membership organization.

Suggested Guidelines for physicians:

1. Please review the Iowa Out-of-Hospital Do-Not-Resuscitate order and related protocol with

the patient/patient’s legal representative(s). The following points may be helpful:

• Patient/patient’s legal representative(s) listed on this order must understand the significance of

this order, that in the event the patient’s heart or breathing stops or malfunctions, the anticipated

result of this order is death.

• Patient/patient’s legal representative(s) listed on this order may revoke this directive at any

time. However, the desire to revoke must be communicated to the EMS or other health care

professionals at the scene.

• It is important to emphasize that this order does not apply to medical interventions to make the

patient more comfortable.

• The importance of wearing the uniform identifier for those qualified patients who would benefit

from the mobility this offers should be stressed. It is also helpful to walk patients through the

process they must follow to acquire the identifier.

2. Provide a copy of this order to the patient/patient’s legal representative(s) listed on this order

and place the original in the patient’s medical records.

The OOH DNR Order form is available through the Iowa Department of Public Health, Bureau of EMS, Lucas State

Office Building, Des Moines, Iowa 50319-0075, or through the Bureau of EMS’s Web site www.idph.state.ia.us/ems.

[Just Plain Ruff]

Cookie stated

Below is a copy of Iowa's Out of Hospital DNR Order. What people fail to realize that this has to be physician signed, that you cannot just state you do not want to be resuciatated. Many people also feel that their Living Will will take the place of the DNR Order. Not so

So I cannot tell a medic crew if I am conscious that I do not want to be resuscitated. I then code and they go against my stated wishes. If a patient told me that they did not want to be resuscitated and then the patient codes, do you resuscitate them? Against their expressly stated wishes?

[Cookie]

Cookie stated

So I cannot tell a medic crew if I am conscious that I do not want to be resuscitated. I then code and they go against my stated wishes. If a patient told me that they did not want to be resuscitated and then the patient codes, do you resuscitate them? Against their expressly stated wishes?

Is this not a refusal of care? In which case there would be a refusal form to sign and document, document, document, and be sure all the t's are crossed and i's dotted and witnessed.

Refusal of Service and or Care:

• Competent individuals have the right to refuse medical care

• “Release of Liability” or “Refusal of Transport” form should be signed

• Patient must fully understand the risk and consequences of refusal of medical care

Consent:

• Expressed Consent

• Verbal or non-verbal

• Generally the act of calling an ambulance is considered consent

• Implied Consent

• Unconscious patients are assumed to desire life-saving treatment

• Children without a responsible adult are treated by implied consent

• Involuntary Consent

• Used if the individual is a threat to the community

• Often involves law enforcement

[Just Plain Ruff]

Actually what I was commenting to was you saying that a patient just cannot come out and say they do not want to be resuscitated that it has to be signed by a doc.

I say that they can. If a patient tells me they do not want to be resuscitated and they do that in direct terms, then they go ahead and die on ya, do you resuscitate them or not? I for one am going to be calling my medical control and discussing this with them.

What do you do?

[Cookie]

In reviewing what I wrote, I realize I did not put what I was thinking. You cannot say you have a DNR "Order" emphasis on order. If you do not want resuscitation that is a personal choice. But to imply you have a DNR "Order" when none exists is another story, and that is basically what I was saying, only I left out some words.

Now if you tell me you do not want to be resuscitated then I would have it documented as to your wishes, and you will sign it after I have contacted Medical Control or in our area the Medical Director under whose license I operate. But it will be documented and witnessed and the ramifications of such actions or lack of there of explained in detail. I would then, after all is documented and the Medical Control or Director notified, and all bases covered, honor your wishes, but not until then.

[VaREMS1]

Very good question.

Personally, if a patient told me they didn't want resucitation & ALS intervention, and then proceeded to code, I'm going to begin resucitation. If there's a 3rd party with me that can contact medical control and ask, then by all means. If the patient does not have an actually DNR, then there's many variables in play.

Does my patient suffer from a mental disorder? Can I call it implied consent and begin CPR?

Is my patient under the influence of ETOH or controlled substance(s)?

Did anyone else besides me hear my patient state this?

Does this fall under "dying declaration"?

Unless presented with a really good reason not to resucitate, I'm going to do so. The doctor can make that call when I get to the ER. All it cost me is a little bit of deisel fuel, a combitube, and some EKG tape. What's a life worth?

Luckily, Virginia's pretty clear about DNR. If the original DNR order isn't presented, with proper signatures...then you resucitate, unless medical control states otherwise. No tattoos, bracelets, sky-writing, jumbotrons, morse code, or braille apply.