The DNR/the durable DNR

Many of you, by your choosing, find yourselves being caregivers to loved ones. This is also a place that many more will find themselves as our loved ones get older and are either unable to care for themselves or simply need assistance getting around. One thing that comes with this responsibility is knowing the wishes of your loved one when it comes to resuscitative efforts, in the event of respiratory or cardiac arrest. For the person that wants everything possible done, then this is a mute point concerning what I am about to say. However, for the person that wants no heroic measures or, in other words, does not want CPR or other advanced means of resuscitation, then this is a discussion that needs to be had long before the event. Many believe that as long as they have an advanced directive from their doctor or a living will that fire and EMS personnel will honor that. The fact was, and I believe still is, that the only official documentation that can be accepted by prehospital providers is a Do Not Resuscitate (DNR) order that is up to date, or a Durable Do Not Resuscitate order. This is a distinctive colored form that has the patient’s information and their doctor’s signature. Again, I say, this is something that needs to be taken care of well in advance of a medical event, which is in keeping with the explicit wishes of your loved one.

So now that the paperwork is in order, what does all of this mean? First of all, if your loved one requires supportive care or pain management, then they will receive it. What a properly documented DNR provides for is the person that chooses to die in their home or in your home. If 9-1-1 is called, immediately following that moment, then pre-hospital personnel will honor the wish of your loved one. Without this documentation, pre-hospital providers will be mandated by a standard of care and a duty to act to provide any and all means of resuscitative care. You cannot decide this at the moment that an event occurs. You must work this out with the patient’s doctor ahead of time. I was asked the other day, what if I am not at home when something happens and I have a Durable DNR at home? There is a part of the form that can be carried on your person, when you are out and about.

Here is another part of this that we must talk about. What if, after your loved one has passed, you change your mind and want everything done, and you are the primary caregiver with medical power of attorney? Though someone will take you aside and insure that you want to go against your loved ones express wishes, other crew members will work to provide care, in light of this change.

You may ask, what are the steps to take when my loved one passes in my presence? If 9-1-1 is called, pre-hospital personnel and police will respond. Police will conduct a natural death investigation, while pre-hospital providers will insure that proper documentation exists, and then supportive care to the family will occur, if necessary. In a hospice situation, hospice will instruct families on how to handle this moment. What I tell people is do what your loved one would want. You must be able to live with the decisions that you make, and I will tell you that pre-hospital providers are as trained in how to handle these situations as they are in how to work through a cardiac or trauma scenario. God bless you as you care for your loved one, and try to honor their wishes concerning their death.   

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