Can you assist ventilations when a patient has a DNR? I had a call recently where a patient had a DNR, she was GCS 6, breathing spontaneously at a rate of 20 but there was very little air movement and an O2 sat in the low 80's after we put her on a high concentration mask. I decided it was appropriate to assist her ventilations with a BVM to try to push oxygen deeper in her lungs. This did seem to help because when we arrived at the hospital she was now opening her eyes spontaneously, had a GCS of 10 and her O2 sats got to low 90's. I just want to clarify the difference between assisted ventilations and using a BVM for resuscitation when it comes to DNR's.
Please see the MOHLTC Training Bulletin on the Do Not Resuscitate (DNR) Standard (here). Within this training bulletin, it describes the definition of Do Not Resuscitate as it relates to the DNR Standard. Here it also highlights the list of specific examples of interventions, written on the form, that are considered a part of cardiopulmonary resuscitation and as such, are not to be initiated by paramedics for a patient with a valid DNR Confirmation Form. This list includes Artificial Ventilation. Therefore, if a patient has a valid DNR, assisted ventilations via BVM should not be initiated.
Please note that this Bulletin outlines the importance of the specific use of the language will not initiate. If a treatment would normally be considered a resuscitative measure was initiated as part of the patients ongoing plan of treatment prior to the arrival of the paramedic crew, the treatment is to be maintained. An example of this type of situation would be if a patient normally breathes with the assistance of a ventilator due to their underlying medical condition. Paramedics would be expected to maintain positive pressure ventilation as it is part of the patients ongoing treatment plan. However, if this same patient were to suffer a cardiac arrest while in the care of the paramedics, no further resuscitation interventions would be initiated, as these interventions would not be considered part of the previously on-going treatment.