Understanding the Rules of Do Not Resuscitate (DNR) Orders in Emergency Situations
Understanding the Rules of Do Not Resuscitate (DNR) Orders in Emergency Situations
When a patient does not have a Do Not Resuscitate (DNR) order in place and paramedics are called, it can lead to a complex and sometimes sticky situation. Ensuring paramedics understand a patient’s wishes without a DNR order can be challenging. This article outlines the legal and practical procedures to follow in such situations and provides insights into the roles of various medical authorities.
Legal Requirements and Procedures for Paramedics
First and foremost, paramedics are legally required to attempt resuscitation if there is no DNR order or any other directive from a Medical Power of Attorney (MPOA) or a healthcare provider. Here's a breakdown of the steps paramedics should follow:
No DNR Order Present: If there is no DNR order available for the paramedics to examine, they must use all appropriate measures to attempt resuscitation. This is mandated by law.
Family Members' Wishes: Family members may have concerns about their loved one's resuscitation status. However, the paramedics do not follow family members' wishes directly. The family can provide evidence of a Medical Power of Attorney (MPOA) to potentially override the need for resuscitation.
Physician’s Order: If a patient is under active medical care and the attending physician is contacted, the physician can order a DNR.
Paramedic's Authority: In rare cases, a paramedic may have the authority to declare the patient dead upon examination, thus ending resuscitation efforts. However, this is an exception and is not commonly practiced.
Advanced Medical Care Directive and Override Considerations
While paramedics are legally bound to follow DNR orders or the directives of those with legal authority, there are ways to ensure that paramedics do not attempt resuscitation without the necessary permission. An Advanced Medical Care Directive is a key document that can outline specific circumstances where resuscitation should or should not be attempted:
Specified Circumstances: The directive can specify conditions under which life-saving measures should or should not be taken. For instance, a patient may want resuscitation in the case of trauma but not in the event of cardiac failure.
Procedures Allowed/Denied: The directive can specify which procedures are allowed or denied. For example, the patient may permit manual CPR but not the use of defibrillation.
Religious Considerations: Certain religious groups may choose not to use specific medical interventions, such as drug injections, but may still allow CPR and oxygen.
Ensuring Compliance and State-Specific Variations
The rules governing DNR orders, Advanced Medical Care Directives, and Medical Powers of Attorney can vary significantly from one state to another. Therefore, it is crucial to obtain and adhere to the correct legal documents based on the patient's residency:
Revising Documents: It is not uncommon for documents to become invalid or non-applicable in different states. For instance, after moving from Ohio to Arizona, we discovered that our Ohio Advanced Directives were no longer valid. We had to create new documents.
State-Specific Requirements: Each state has its own set of regulations and procedures. Familiarizing oneself with the state-specific requirements can help ensure that the correct documents are in place.
Conclusion
Ensuring that paramedics and medical professionals understand a patient's wishes can be a nuanced process. An Advanced Medical Care Directive is a powerful tool in this regard, offering specific guidelines for resuscitation and other medical interventions. However, it is crucial to have these documents in the correct legal form and to ensure they are valid in the current jurisdiction. By understanding these procedures and their state-specific variations, patients and their families can better advocate for the patient's medical wishes.