Category Archives: Do Not Resuscitate (DNR)

Question: When the Ministry of Health's DNR forms are filled out, can the section where the patient's name goes have a sticker from the hospital with the patients name/health card #/DOB, etc. instead of having the name printed or does that make the form invalid. The form specifically states the patient’s name should be printed clearly. I wasn't sure if the ID sticker was something we could accept instead or if that section can only be filled out by hand.

Question: In a setting where you arrive on scene and you are presented with a patient who is unconscious and is hypotensive, the patient has a valid DNR. Can you still administer fluids to this patient or does that fall under the same category as inserting an OPA/NPA and BVM to a patient with a DNR?

Question: How is the DNR standard in the BLS PCS reconciled with this statement in the ALS PCS: "if a paramedic is aware or is made aware that the person has a prior capable wish with respect to treatment, they must respect that wish (for example, if the person does not wish to be resuscitated)."

Obviously the ideal situation is that the patient has the DNR confirmation form and there are no issues. The issue comes up with regards to verbal DNRs issued by a capable patient or SDM (that are reasonable), or in such cases where the patient has a DNR, living will or other advanced directive that specifies the patients wishes, but no prehospital DNR form. Is this form not redundant provided there is a reasonable indication that the patient does not wish to be resuscitated or have aggressive life sustaining therapies delivered?

How can the BLS PCS DNR standard be reconciled with the ALS PCS regarding honouring a prior capable wish when the provider is made aware of such wish (provided its reasonable)? Especially given that in nearly ever other case, a directive in the ALS PCS over-rides the BLS-PCS. Given that this issue is not nearly as cut and dry in reality, or in any other healthcare setting, as it seems to be made out to be in EMS in this province what is the situation with regards to this? Especially given that end-of-life issues are increasingly common, the issue is not going to disappear. There are many other provinces that use a similar wording or philosophy to that mentioned in the ALS-PCS under consent and capacity.

Question: Are we allowed to accept photocopied DNR? I have heard several discrepancies on this question.

Question: I have been to a few calls where the patient does not have a DNR, but the death is expected and family does not want CPR or other interventions. The family will make statements like "we don't want CPR" or “they wouldn't want CPR", etc. Do we initiate the CPR and Defibrillation protocols until we can get hold of the BHP or do we run the call and transport regardless of family request?

Question: There is some confusion about patients that have a valid DNR, and are very sick requiring transport. It makes sense that many of the ACP skills might not be utilized on these patients, and CPAP would be a PCP skill. There are cases where the family changes their mind on a DNR, and cases where the status is not clear. There are also other cases where a patient may be a trauma and have a valid DNR where they may need a needle decompression, but not necessarily cardiac arrest needing CPR or intubation. Is it OK for ACPs not to attend valid DNR patients?

Question: I was told by a physician that a DNR becomes void with a suicide attempt. I was wondering how we should approach this situation.

Question: We had our recert this week and I have a question about DNR patients. In the pocket book it says that a patient will get epi IM if they have a history of asthma and BVM ventilation is required. So I am wondering, if a DNR patient does not receive a BVM under any circumstance and an asthma patient with a valid DNR who started off just slightly SOB became severe and required a BVM would they still be eligible for epi? In other words does "required" mean that yes it is required due to the severity of SOB, but due to the fact they have a DNR they don't actually get the BVM, can they still receive the epi, which is not contraindicated on the DNR validity form? Thanks in advance.

Question: I was just wondering if we have a patient with a valid DNR are we still allowed to Bolus if they fit our protocol or is this considered an advanced life saving technique?

Question: I had a call today to a nursing home where the patient had a valid DNR. The patient was in agonal respirations. The staff stated the patient HAD to be transported to ER as per direct orders from the doctor on call for the nursing home. She kept saying the patient was a level 3 and he had to go to ER. My partner and I told the staff we cannot do anything for him and with a valid DNR the patient does not need to be transported. The staff argued with us more saying the patient had to go and that they already called ER. Instead of getting into it further with staff my partner and I loaded the patient and went to ER. We transported Code 3 as the patient expired as soon and we left for ER. Were we right in doing so? I pre alerted ER about the situation and they were accommodating when we got there.

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