If you were to find yourself in a situation in which the person you are caring for stops breathing or their heart stops beating, do you know what their wishes would be? Would they want to be revived or would they want the episode to take them? It is difficult to know these desires inside the trauma of an emergency situation. A Do Not Resuscitate Order will help take some of the stress off because everyone is clear when the moment arises.
Do Not Resuscitate: An Overview
A Do Not Resuscitate Order (DNR) is an advanced directive and legal document that instructs medical personnel to forgo resuscitation attempts in the event of a patient’s cardiopulmonary arrest or if they were to stop breathing. Resuscitative measures to be withheld include:
- Chest compressions
- Assisted ventilation
- Endotracheal intubation (a tube is placed into the windpipe)
- Defibrillation (a device that delivers a therapeutic dose of electrical energy to the heart)
- Cardiotonic drugs
A DNR does not affect whether other emergency medical care is provided, including palliative treatment for pain, dyspnea, major hemorrhage, or other medical conditions. Some DNR orders only apply to resuscitation attempts made by EMS providers in pre-hospital settings, for example:
- a patient’s home
- a long-term care facility
- during transport to or from a health care facility
- locations outside of acute care hospitals
It is important to note that DNR instructions made in one state may or may not be honored in other states or jurisdictions. So if you cross state lines you want to check that your legal documents are still valid.
Do Not Resuscitate: How do I create one?
If the person you are caring for wants to have a DNR order, you should talk with their primary physician. Most states require the physician’s signature on a DNR advanced directive and she will often be the one to obtain and prepare the necessary paperwork. If she does not have the required form or information, you can obtain it from your own state Health Department. Here is an example of the form through Florida’s Department of Health.
What should I do with the DNR after it’s signed?
You should keep a signed original copy of your care recipient’s DNR in a safe, accessible location; emergency personnel may initiate resuscitation attempts until the form is presented and the patient’s identity is confirmed. It is important for everyone who assists your loved one to know the location of the DNR; you may wish to put information regarding the location of the DNR in a prominent location on the outside of the care recipient’s refrigerator.
The care recipient’s physician should keep a copy of the DNR in the permanent medical record.
If desired, a third copy of the DNR can be used to order an optional wrist or neck medallion inscribed with the words “DO NOT RESUSCITATE”. Most states have an approved supplier of the medallions, which will be issued only upon receipt of a properly completed DNR order, enrollment form, and the appropriate fee. Although use of a wrist or neck medallion is optional, it provides quick identification of the patient and notification of the DNR, and is strongly encouraged.
Do Not Resuscitate: What happens in an emergency?
If your loved ones heart or breathing has stopped, and the paramedics or EMTs are presented with a valid DNR, they will not attempt to restart his heart or breathing. They will not be placed on life support, such as a ventilator or a breathing machine. They will still receive “comfort care”, which consists of full treatment for conditions like:
- shortness of breath
If the patient is awake, they will be treated for any airway obstruction or blockage. If your loved one has both breath and a heartbeat, and does not require resuscitation, the DNR will not affect his care.
What happens if the Do Not Resuscitate order is lost?
If paramedics or EMTs begin resuscitation and are notified by the care recipient or a caregiver that the patient has a DNR but cannot find it, the paramedics will continue CPR while they contact the base hospital physician. After consultation, the base hospital physician can give orders to the paramedics to stop CPR, or may choose to continue resuscitation measures until the situation becomes clearer. If CPR is started and then the DNR is found, the paramedics will stop CPR and all other procedures to artificially support life. This can obviously turn into a sticky legal situation quickly! Make sure to keep this order on hand and available.
Do Not Resuscitate: Changing Your Mind
If your care recipient decides at any time that they want to receive full treatment, such as CPR or defibrillation, he can simply indicate to the paramedics or EMTs that he does wish resuscitative efforts and that they should ignore the DNR order.
If your care recipient changes his mind about the DNR order, it’s important that his doctor and family are informed of his specific wishes, and that all copies of the DNR order are destroyed. If he has a DNR bracelet or medallion, you should remove it and contact the issuing company to update his records.
Remember if there is any question about someones wishes the emergency medics will do all they can to revive someone. I understand there have been many complicated scenarios arrive in this situation. If you have had experienced this first hand please share your story here ….