Witnessed Cardiac Arrest & Verbal DNR

[JacobJohnson, BSN, RN]

This is a hypothetical situation and wondering if anyone has experience in it. It's a thought I've had before.

Scenario:

The trained RN is in public and not on duty. He or She witnesses a man collapse and determines he is in cardiac arrest. The RN starts CPR. A family member directs the RN to with-hold CPR, stating that the man has a DNR/POLST stating no CPR. However, the order is not present.

What do you do?

What are potential repercussions?

Do any laws protect the professional here?

[Been there,done that, ASN, RN]

I would not administer CPR in the field.You may or may not be covered under the Good Samaritan law. I don't care if a lawyer is present waving the DNR in my face. Once you have started CPR.. you must keep on pumpin'... until the real first responders arrive.

[canoehead, BSN, RN]

If I've started CPR I'm not in a position to examine anyone's paperwork, or verify the family member's identity. Frankly, I wouldn't start CPR off duty unless the person looked like they had an excellent chance at survival, so the patient is unlikely to be a palliative patient. I'd advise the protesting family member to call the EHS, and they could look at the paperwork, and then direct me to stop.

[AnnieOaklyRN, BSN, RN, EMT-P]

I would continue CPR if there is no proof on paper or bracelet that the patient wants to be a DNR, especially if you are not working on someones clock! If you are in public start CPR and then let the first responders go from there, as the chance of getting someone back from CPR only is slim anyway.

If I was on the ambulance and this occurred we would be starting resuscitation efforts and call medical control for orders to stop or continue, which ever the physician felt was appropriate. I have had this happen a couple times when they could not find the DNR and we just called the physician to get the OK to stop, especially if its obvious the patient is ill or elderly.

Just always remember you can stop CPR, but you can't decide to start after the patents been dead for ten minutes while you argue with the family about it. What if another family member steps into the picture and says they want CPR done. To many gray areas when there is no DNR in writing, to much risk to take.

You are protected by the good samaritan law, but only in 32 states so it depends on where you live, when offering help off duty as long as you are not getting paid or any other compensation, that includes receiving any thank you gifts etc from the patient or family.

Could the family member try and sue you for starting CPR, absolutely, but anyone can sue you for anything at anytime. They would have to prove damages and in this case that would be minimal since you were trying to help the patient. If you do not start CPR and another family member who argues the patient was not a DRN or that the patent would have wanted everything done and you didn't initiate CPR they can easily prove damages and that you acted negligently because you did not initiate resuscitation efforts, which in this case would be the standard of care since no DRN was present, and the patient died.

Hope that helps,

Annie

[AnnieOaklyRN, BSN, RN, EMT-P]

I honestly think its terrible that some of the other posters have said that they would not start CPR at all in public! What if it was your family member or YOU?! You want people to just walk on by while your brain cells die? Unbelievable!

Annie