DNR question

[Lone Star]

I dont recall this protocol, it must be a regional thing..Basics can, indeed, honor the DNR if it is present and valid. Contact of MC may be prudent though..

It's actually amusing that you would just happen to throw Genesee County in there, because that's where I took my EMS training!

Keep in mind, that since I took my training more than 10 years ago, things may have changed since then. Further, if I remember correctly, Oakland and Wayne Counties also had that at the time.

This doesn't mean that I'm wrong, it just means that I was unaware of any policy changes since the time I worked in those counties.

You are correct in stating that contacting Medical Control would be the 'prudent thing to do'. When there's doubt, let Medical Control make the call!

[sportygirl]

so if i remember right there different levels of the DNR. Are there? Do they very for each person?

[armymedic571]

so if i remember right there different levels of the DNR. Are there? Do they very for each person?

Not different levels. Just different types. BUT, this depends on the state.

In the end, what is important, is that depending on pt status, presentation and wishes (or family wishes). Call Medical Command, and let them make the decision. Most reasonable ER Docs will see your case and grant the patients, or families wishes.

[Kiwiology]

Not different levels. Just different types. BUT, this depends on the state.

In the end, what is important, is that depending on pt status, presentation and wishes (or family wishes). Call Medical Command, and let them make the decision. Most reasonable ER Docs will see your case and grant the patients, or families wishes.

Are you not allowed to think for yourself? While laws may vary by jurisdiction I think that this is totally unnecessary. I am a very strong advocate for patient rights, if somebody does not want something done then they do not have to be subject to it; whether its taking a blood pressure or resuscitation from cardiac arrest.

Whilst our legal system is more flexible and we have no "online medical command" to speak of, let alone call up, here is how we are directed

Resuscitation should begin unless there is a clear reason not to. Clear reasons not to include:

• Signs of rigor mortis or lividity.

• A clearly described advanced directive (or living will) not to receive resuscitation for cardiac arrest. Advanced directives do not have to be in writing and include clearly described verbal directives.

• Clinical scenarios where resuscitation is either futile or not in the best interests of the patient e.g. unwitnessed cardiac arrest with asystole as initial rhythm, patients who are dying from cancer, and patients with severe end stage chronic medical conditions (e.g. end stage heart failure or end stage COAD) who are house bound.

Competent patients have the right to decline treatment, including resuscitation. Family members do not have the right to either demand or decline resuscitation, but their opinion must be taken into consideration

[armymedic571]

Are you not allowed to think for yourself? While laws may vary by jurisdiction I think that this is totally unnecessary. I am a very strong advocate for patient rights, if somebody does not want something done then they do not have to be subject to it; whether its taking a blood pressure or resuscitation from cardiac arrest.

Whilst our legal system is more flexible and we have no "online medical command" to speak of, let alone call up, here is how we are directed

Quite the contrary, Kiwi.

We are able to think, which is why we can call Medical Command. The point here is that we have several types of DNR's, advanced directives and Living wills. But, as EMS providers we are only "Legally" able to accept a specific type. In which it must be filled out exactly as prescribed with original signatures.

Because we very seldom come across patients that actually have this, I was trying to say that based off of Patient/Family wishes, presentation and pt status. You should call Medical Command, paint your picture (argue your case) and allow the MD to allow you to Cease efforts if that is what has been decided.

This is about not only knowing our protocols and standing orders, but having good assessment and history taking skills, and the mannerisms to communicat effectively with Medical command to do what is in the patients best interests when our protocols would otherwise not allow it.

Sorry for the confusion.

[JPINFV]

Are you not allowed to think for yourself?

In large parts of the country, that answer is a resounding "No!"

[Richard B the EMT]

OK, folks, we all know and understand (or at least I hope we do), every jurisdiction has different numbers of "Standing Orders" available before contact to their On Line Medical Control is mandated. Somewhere they all end up in a "Mother/Father, May I?" scenario.

OLMC is a nice thing, and is there to be utilized.

I also understand, some jurisdictions do not have an OLMC, and field personnel are trained to higher levels to make up for that. Army Medics and Navy Corpsmen (and presuming that the word exists, Corpswomen) fall under that classification.

[JPINFV]

The problem is that then you have the exact opposite. Places where all of the standing orders can be fit on a single page or two with mandated online medical control for everything pasted a stubbed toe.

[armymedic571]

In large parts of the country, that answer is a resounding "No!"

Isn't that kind of pessemistic?

OK, folks, we all know and understand (or at least I hope we do), every jurisdiction has different numbers of "Standing Orders" available before contact to their On Line Medical Control is mandated. Somewhere they all end up in a "Mother/Father, May I?" scenario.

OLMC is a nice thing, and is there to be utilized.

I also understand, some jurisdictions do not have an OLMC, and field personnel are trained to higher levels to make up for that. Army Medics and Navy Corpsmen (and presuming that the word exists, Corpswomen) fall under that classification.

I am not following your point? Isn't that what we've been saying?

The problem is that then you have the exact opposite. Places where all of the standing orders can be fit on a single page or two with mandated online medical control for everything pasted a stubbed toe.

Still......a little extreme. I hope there aren't any systems really like that.

[JPINFV]

Isn't that kind of pessemistic?

I am not following your point? Isn't that what we've been saying?

Still......a little extreme. I hope there aren't any systems really like that.

Orange County, CA

Los Angeles County, CA.