Emergency Medical Services Do Not Resuscitate Order

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Emergency Medical ServicesDo Not Resuscitate
Order

• July 2006

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THE LAW

• Definitions
• To Whom It Applies
• Duties of EMS Personnel
• Required Format
• Liability
• Revocation
• Promulgate Regulations

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Definitions

• Do Not Resuscitate Order
• EMS Personnel
• Health Care Provider

• Palliative Treatment
• Resuscitative Treatment
• Terminal Condition

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Who?

• Patient with DIAGNOSED Terminal Condition
• Over 18 Years of Age
• Health Care Providers
• EMS Personnel

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Duties of EMS Personnel

• EMS personnel must not use any resuscitative
  treatment if the patient has a do not
  resuscitate order for emergency services.
• EMS personnel must provide that degree of
  palliative care called for under the
  circumstances which exist at the time treatment
  is rendered.

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Required Format
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Liability

• Issuing a DNR
• Operating under good faith
• Treatment withheld or initiated
• Best medical judgement

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Revocation

• Oral Statement
• Mutilating
• Obliterating
• Destroying

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REGULATIONS

• Further define law

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So whats in Regs that isnt in Law?

• More Definitions
• Location and Distribution of EMS DNR Form
• Patient Assessment and Intervention
• Specific Resuscitative Measures to be Withheld or
  Withdrawn
• Procedures for Palliative Treatment
• Roles and Responsibilities

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More Definitions

• Agent or Surrogate
• Cardiac Arrest
• Cardiopulmonary Resuscitation

• The Department
• Respiratory Arrest
• EMS DNR Marker

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Location and Distribution

• Patient
• Visible
• Secure
• Marker

• DHEC EMS
• Distribution
• Instructions
• Provide Guidance
• Enforcement

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Patient Assessment and Intervention
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Measures to be Withheld/Withdrawn

• CPR
• INTUBATION / OTHER ADVANCED AIRWAY
• ARTIFICIAL VENTILATION
• DEFIBRILLATION
• CARDIAC RESUSCITATION MEDICATION
• CARDIAC DIAGNOSTIC MONITORING

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Palliative Treatment

• SUCTION
• OXYGEN
• PAIN MEDICATION
• NON-CARDIAC RESUSCITATION MEDICATION
• ASSISTANCE IN MAINTAINING AN OPEN AIRWAY
• CONTROL OF BLEEDING
• COMFORT CARE
• FAMILY/PATIENT SUPPORT

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Roles and ResponsibilitiesPatient/Agent

• Make all care givers aware of location of EMS DNR
  form
• Be aware of the consequences of refusing
  resuscitative measures
• Be aware that if the form is altered in any
  manner resuscitative measures will be initiated
• Understand that in all cases, supportive care
  will be provided to the patient

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Roles and ResponsibilitiesHealth Care Provider
(Physician)

• Has determined that the patient has a terminal
  condition and is at least 18 years old
• Has completed the patients EMS DNR form
• Has explained to the patient and family the
  consequences of withholding resuscitative care,
  the medical procedures that will be withheld, and
  supportive care that will be administered to the
  patient

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Roles and ResponsibilitiesEMS Personnel

• Will confirm the presence of the EMS DNR form and
  the identity of the patient
• Will withhold or withdraw resuscitative measures
  upon finding an unaltered EMS DNR form
• Will provide palliative and supportive treatment
  to the patient and family
• Must have in his/her possession either the
  original or a copy of the EMS DNR form during
  transport of the patient

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So what does this all mean in the real world?

• When in doubt - contact medical control
• Err on the side of the patients wishes
• If it doesnt say Emergency Medical Services Do
  Not Resuscitate Order it does NOT apply to EMS
  personnel
• Take the time to look for a marker during the
  initial assessment

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QUESTIONS?

• Jennifer Paddock
• SC DHEC - Division of EMS
• 803-545-4569
• PADDOCJL_at_dhec.sc.gov