Date Published

January 18, 2013

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: If a patient has a valid DNR, can they still fall under the Stroke Protocol? I realize the protocol's contraindications list a palliative patient or terminally ill but does not address DNR. DNR in my point of view only applies to a patient who is dead, and wishes to not be resuscitated. Treatment for stroke at a proper facility could restore the patient's quality of life if such is affected by the stroke, and I feel they should still be included. I just wanted to verify.


 We agree entirely. Many patients may have valid DNR forms however this would not preclude them from being considered as possible candidates for stroke bypass. The language on the DNR form speaks to withholding CPR, defib, artificial ventilations, endotracheal intubation, transcutaneous pacing, and advanced resuscitation drugs.

While one may try to argue that thrombolytics could be considered advanced resuscitation drugs, we suggest that possibly reversing a patient's profound motor weakness from an acute stroke does not represent a violation of a valid DNR confirmation form.

You do correctly point out that palliative patients or terminally ill patients do not qualify for stroke bypass, and many of these patients would have a DNR. However, many other patients in our community have valid DNR's and yet still should be considered candidates for stroke bypass if the other conditions are met. Bottom line: you are correct.

A copy of the DNR Standard can be found on our website here:



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