Question: Called to a nursing home for 90 year old male. On scene staff state patient has valid DNR but they are unable to produce it. The crew continues to resuscitate patient as per usual. Enroute to receiving facility, CACC advises the crew that family has phoned in and stated that they have the DNR and they do not want the patient resuscitated. The attendant phones the attending BHP and advises him of the situation. The BHP orders EMS to cease resuscitation efforts on patient. Is this right or wrong?

 The DNR Standard training bulletin addresses this question. This document can be found here: http://www.ambulancetransition.com/pdf_documents/training_bulletin_108_v1_dnr_standard.pdf

As you know, the DNR Standard is more of a MOHLTC initiative. The DNR Standard is not considered to be an Advanced Life Support Patient Care Standard which forms the core responsibility of Regional Base Hospital Programs.

With that said, this exact situation is reviewed in the Training Bulletin produced by MOHLTC in Appendix 2 named ironically Frequently Asked Questions. You should find questions 17 and 18 on page 26 of this Training Bulletin helpful.

Bottom line: If there is a delay in obtaining the fully completed DNR Confirmation Form in a patient who has suffered a cardiac arrest, CPR is to be initiated until such time as the form is produced. Alternatively, paramedics should follow local policies where they exist for termination of resuscitation. Patching to the BHP is always an option. So, in the end€¦.right.

DNR,Miscellaneous

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