The new statewide "Do Not Resuscitate" law is now in effect. The new law has several provisions that each and every prehospital provider needs to be acquainted with. Briefly l will highlight specific areas which will impact you in the very near future. -Ron Grout

Q: Why is there a statewide DNR law?
A: The intent of the law is to allow for standardized application of a statewide DNR plan within all areas of healthcare.

Q: How will I know if the patient is a DNR/ComfortCare Patient?
A: The patient has a variety of ways that they can be identified; which include the actual form itself, ID bracelet, necklace or wallet card.

Q: How do I ensure that this is the actual patient that has the DNR?
A: The law allows for several means of identification verification, they include verification of identity by family, friend or caregiver and personal knowledge of the patient in a health facility utilizing I.D. bracelet or photo identification.

Q: I was told that the new law has two different types of DNRs, is this true?
A: Yes, the two types are as follows: (1) DNR/ComfortCare (2) DNR/ComfortCare-Arrest. The first form of DNR, which is called DNR/ComfortCare is the patient who has elected to only receive palliative care. In other words we are going to do things that are limited to making the patient comfortable. The second form of DNR which is called DNR/ComfortCare-Arrest. This form of DNR allows for maximal care. In other words this patient will be treated like any other patient that you would care for up to the point when the patient stops breathing an/or heart stops beating then we will not intervene. The patient will be able to expire naturally.

Q: If I recognize that my patient is a DNR/ComfortCare patient what am I permitted to do?
A: First and foremost you will not find this in your training manuals. Be a caring person, listen and be understanding. While being kind and caring you are also permitted to suction the airway, administer oxygen, position the patient for comfort, splint/immobilize, control bleeding, provide pain medication, provide emotional support and contact appropriate health care providers.

Q: Are there things that I am prohibited from doing when caring for a DNR/ComfortCare patient?
A: Yes, basically when dealing with a DNR/ComfortCare patient you are not permitted to administer CPR, insert artificial airways, defibrillate/cardiovert, provide respiratory assistance, initiate an 1. V, or initiate cardiac monitoring. When dealing with a DNR/ComfortCare-Arrest you are permitted to treat this patient like any other patient and/or as written physician's orders permit, up to the point of the patient expiring. Then you will follow the above "will not".

Q: Do we, as EMS personnel have to recognize this DNR law?
A: Yes, in fact EMS personnel shall comply with either a written or an oral Do Not Resuscitate order. If an oral order is issued, the EMS personnel shall verify the order is from a physician or CNP. Acceptable forms of verification include personal knowledge of physician, a list identifying the named physician or a return telephone call to verify information.

Q: Are we, as EMS providers at risk for being sued if we carry out these orders?
A: No, in fact as long as you adhere to the DNR/ComfortCare protocol you will be given immunity from civil, criminal and professional liability. The law is very clear and concise, follow it and you will be free of any actions.

Q: In the past we utilized local DNRS. From time to time we would be given the DNR form and then a family member would show up and say "do everything". Has this changed?
A: Yes, if you have proper recognition of a DNR/ComfortCare patient and have verified their identity, you will follow the patient's wishes and disregard the wishes of the family. The wishes of the patient prevail. The only people who have the ability to cancel the DNR is the patient themselves or a physician. The patient can destroy the document, tear up their wallet card and/or bracelet. This then allow the patient to be treated like any other patient you might respond to.

Q: Above you stated that EMS personnel are immune from liability, does this apply to any other healthcare workers?
A: Yes, virtually all healthcare workers are included. Some specific individuals identified include health care facilities, administrators and persons in health care facilities, clinical nurse specialist and physicians.