1-7 DO NOT RESUSCITATE (DNR)

Purpose: To accurately identify patients who may not want life sustaining treatment initiated, and delineate the appropriate treatments to provide in this setting.

Indications: A valid pre-hospital DNR order in the Brown County EMS system is limited to the following:

1. A valid state DNR Bracelet or Necklace (Plastic or Metal)
2. A signed standardized state DNR form (Nursing homes, CBRF, Hospice)
3. Direct verbal order from the patient’s primary care physician (in person or via phone)
4. A written, signed notation by the patient’s primary care physician on the patient’s record in a nursing home or extended care facility

Contra-indications: The following conditions invalidate a DNR order:

1. The patient expresses to any First Responder, EMT, Paramedic or health care provider the desire to be resuscitated. If this is done, the provider shall remove the DNR Bracelet.
2. The patient defaces, burns, cuts or otherwise destroys the DNR Bracelet.
3. The patient (or another individual at the patient’s request) removes the DNR Bracelet.
4. The DNR bracelet appears to have been tampered with or removed.
5. Any Healthcare provider knows the patient to be pregnant.

Procedure:

1. Assess the patient.
2. If the patient is pulseless and non-breathing, check the patient’s wrist for a DNR bracelet.  If patient has no wrist/arms, check for a neck chain for possible do-not-resuscitate band attached.
3. If NO DNR bracelet is found on the patient’s wrist or neck chain, provide usual care.
   1. If a DNR bracelet is found on the patient’s wrist and the bracelet is NOT defaced, do not undertake life support measures and instead provide comfort care measures, such as clearing the airway, providing oxygen, positioning for comfort, control of bleeding, provision of emotional support and provision of pain medication
4. Contact Medical Control for further orders.
5. Document the patient contact on the Emergency Medical Record Ambulance Run Record, including details of type of DNR order present and any therapeutic measures provided.
6. Copies of all documentation of patient DNR status should accompany the patient to the hospital if the patient is transported.

Additional Information:

1. The patient’s desire not to be resuscitated is controlling. In the event that a friend, or member of the patient’s family requests that resuscitative measures be taken, that person’s request does not supersede a valid DNR order.
2. If there is any question about the presence, validity or meaning of a DNR order (including “chemical code”,  “ventilate only” or evidence of revocation) EMS personnel shall initiate full resuscitate measures and immediately contact the online medical control physician for clarification and further orders.
3. The Wisconsin Declaration to Physicians (DOH 0060) Rev 5/86 or “Living Will” and Durable Power of Attorney are not valid for pre-hospital situations. If presented with these documents as evidence of DNR status, initiate resuscitation and contact medical control for clarification and further orders.