EMS..LTC..DNR orders

  1. So say I have a resident in LTC who I'm sending to the hospital for possible urinary sepsis...I do all the paper work stuff, report, etc. The Pt is a DNR. Maybe has a high temp, low output, foul urine, little dehydration. Doc wants pt sent for IV ABT, hydration and labs.

    Or I had a resident fall, maybe hit their head or c/o arm pain. Sending them off for Xrays, etc they are DNR.

    When EMS takes them....do they become a full code by EMS?

    I'm in PA if this matters. DNR papers, advanced directives are signed and sent with pt.


    I was told that when EMS accept them, they would be considered full code if say they would code on the bus and when they got to the hospital then the docs etc would stop it???
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  2. 6 Comments

  3. by   shadowflightnurse
    Depends on the state's EMS regs. When I was in Arizona, there was a specific pre-hospital DNR form that had to be filled out and given to the EMS providers. It was bright orange, had to be the original. People who were DNR's and lived at home had to have them filled out by their doc and available to EMS or they would be treated like a full-code. I would check with your state' EMS agency to determine their policy.

    Just went to the PA Dept of Health site (http://www.dsf.health.state.pa.us/he...a=170&q=231878) and it says there is a specific out-of hospital DNR form (PA OOH DNR)and if it is an original it shall be honored.
    Last edit by shadowflightnurse on Nov 14, '05
  4. by   RoxanRN
    In any place I've worked EMS (KS, MS, OK), a copy of the DNR suffices as long as I've laid eyes on the original, but I must have the copy in hand during transfer or I'm bound by my protocol should they arrest.

    If the patient were ultimately admitted to the hospital after the transfer, the doc would still have to write another DNR anyway - even if one was sent from the NH.

    As far as CYA goes when dealing with EMS.... There's never such a thing as too much info. Give them copies of the current MARS, an accurate description and timetable of events leading up to, PMHx information, any kind of DNR (no intubation, chemical only, etc), a current copy of insurance information and/or facility face sheet, and DPOA information. None of this information sharing is contrary to HIPPA. They need the information to continue care until delivered to the hospital.
  5. by   CoffeeRTC
    Roxanne....that is what I thought/ already do. When I give report, etc to the medics I try to give it in their format for assessment. Years ago I took an EMT cert class and saved a few forms. Helps when giving report to them...got the questions aswered before they ask.
  6. by   Talino
    Quote from michelle126
    Roxanne....that is what I thought/ already do. When I give report, etc to the medics I try to give it in their format for assessment. Years ago I took an EMT cert class and saved a few forms. Helps when giving report to them...got the questions aswered before they ask.
    This is state-specific. PA EMS do require an "out-of-hospital DNR" form to withhold CPR. It would be best to have one for each DNR resident in the facility to honor their wishes (or that of their surrogates) regardless the setting.

    see sample here...
    http://www.dsf.health.state.pa.us/he...ampleorder.pdf

    EMS General Provisions (PA)
    http://www.pacode.com/secure/data/02...ap1051toc.html
  7. by   CoffeeRTC
    I will read those links better to try to understand them, but ins't what we have already good enough. We (ltc) facility have a signed form indicating yes or no to cpr. Some residents may or may not have advanced directives that get into more detail...ie intubation, blood, antibiotics, meds et. I give them that paper work with every transport out. I also verbally remind them, it is also on our transfer papers.
  8. by   Daytonite
    In general, whenever a person codes when they are out in public, or in the scenario you suggest, in a public conveyance (the ambulance), CPR must be administered if there is a qualified heathcare giver present. Now, some states have passed law to deal with the DNR's. I know that in one state you sign paperwork that you are DNR and have to have some kind of identification on you showing this. You should check your local fire department paramedics as they will know the specific answer to your question as it pertains to your state.

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