Date Published

March 1, 2012

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: If a DNR only comes into play once the patient has suffered respiratory or cardiac arrest, why do hospitals use DNR as an excuse to downgrade CTAS or justify putting certain patients as a code 7?


 Great question. Please see the other related question on this topic posted this week.

It is essential that you review the DNR Confirmation Form. It can be found here:

It is not entirely clear and there is some confusion that some of the procedures listed on the form may apply to the patient who is tremendously unstable but has not completely arrested. Consider pacing for example or endotracheal intubation for a patient who has not suffered a respiratory arrest but is in profound cardiogenic shock with pulmonary edema and oxygen saturation levels in the 60% range despite 100% FIO2.. The SWORBHP Medical Directors feel that if a valid DNR Confirmation Form is available, none of these "advanced cardiopulmonary resuscitation" procedures should be initiated.

To answer your specific question, we cannot comment on what a hospital does or does not do. They do not report to us. With that said, a DNR should in no way influence the CTAS scoring. It is not listed as a modifier in the latest teaching package from MOHLTC. As well, as for Code 7, if you are meaning off load delay, again, the SWORBHP cannot comment on the actions of a hospital or a triage RN, however the presence of a DNR we would suggest should not influence decision making in that regard.



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