DNR question

[Icecuban]

Hey I'm a new student in EMT-B and I just got done with the chapter about DNR's. Is the DNR in effect once the person passes away or does the DNR go in effect as soon as we arrive? and we do nothing at all?

[BEorP]

Hey I'm a new student in EMT-B and I just got done with the chapter about DNR's. Is the DNR in effect once the person passes away or does the DNR go in effect as soon as we arrive? and we do nothing at all?

"Do Not Resuscitate" generally does not mean "Do Not Treat."

[EMT007]

The question is a bit awkwardly worded, but I think what you're asking can be answered like this: DNR's do not apply unless the pt is in arrest - period. If the patient still has a pulse and resps, you treat them like any other patient (assessment, treatment, bagging, O2, etc.). Once they are in arrest, however, you must cease all resuscitative measures (BVM, defib, CPR, etc.). Like beorp said, it is a do not resuscitate order, not a do not treat.

Here is LA County's Policy on the matter

http://ladhs.org/ems/manuals/policies/Ref800/815.pdf

[scparamedic98]

I agree with the previous poster. DNR standards vary from state to state. However, I have never heard of any standards where you don't treat. For example you respond to a DNR patient with an obstructed airway, you can fix that and not violate the DNR order as long as it doesn't include any treatment that would extend life beyond a natural death. (If that makes sense)

Here is South Carolina's DNR law

lSC DNR Law (Local Copy on our website)

[VentMedic]

One of the reasons you see so many 90+ y/o ill patients who are full codes is the families and physicians are afraid a DNR order will be interpreted by some healthcare providers as "Do Not Treat".

The DNR order also needs to read carefully especially at extended care facilities or nursing homes. It will contain specific instructions as to what parts of the resuscitation can or cannot be done. For some, no intubation but everythng else or intubation and nothing else. Others, they want drugs and intubation but no chest compressions. And some may just want the code drugs which if an arrhythmia occurs while on a monitor, that may be effective or NOT.

[JPINFV]

C. “Do-Not-Resuscitate (DNR)” means no chest compressions, no defibrillation, no assisted ventilation, no basic airway adjuncts, no advanced airway adjuncts (endotracheal tube, Combitube), no cardiotonic medications or other medications or means intended to initiate a heartbeat or to treat a non-perfusing rhythm.

http://www.ochealthinfo.com/docs/medical/e...mp;P/330.51.pdf

The fact is DNR validity and orders is going to be different from place to place. A perfect example would be asking who can request a DNR order. In Orange County, CA, for example, any immediate family member [parents, siblings, adult children, spouse or domestic partner] can request that EMS personal withhold or withdrawl resuscitation. [Part V, section E, subsection 3 of the above link] The issue gets even muddier when you have patients that have partial DNRs. The ultimate question is, though, are you willing to respect your patient's wishes or are you going to simply pass the buck?

[AnthonyM83]

JP,

That's how it works in Los Angeles County as well. Of course, I don't think most EMTs know that. Partially, because most have never even glanced over protocols. Those who have probably have their computers freeze trying to load each individual PDF file from the county site for each sub protocol.

[riskynremtp]

Yep! Basically the same protocols in South Carolina.