Question: I have been to a few calls where the patient does not have a DNR, but the death is expected and family does not want CPR or other interventions. The family will make statements like "we don't want CPR" or they wouldn't want CPR", etc. Do we initiate the CPR and Defibrillation protocols until we can get hold of the BHP or do we run the call and transport regardless of family request?

Thanks for the question. This is very similar to another ASKMAC question from 2012. The process for a paramedic to withhold initiating resuscitation is clearly outlined in the Do Not Resuscitate (DNR) Standard training bulletin.

This document can be found here: http://www.lhsc.on.ca/About_Us/Base_Hospital_Program/No.108V.1.0DNRStandard.pdf

This exact situation is reviewed in the Training Bulletin produced by MOHLTC in Appendix 2 named ironically Frequently Asked Questions.

Question 17 on page 26 states: "For the paramedic or firefighter to not perform CPR on a patient who is in respiratory or cardiorespiratory arrest, he/she MUST receive a fully completed DNR Confirmation Form. This Form is the only directive that gives permission to paramedics and firefighters to not perform CPR on patients who have a DNR order and have experienced respiratory or cardiorespiratory arrest".

DNR,Miscellaneous

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