If a person codes at Walmart..

tokmom, BSN, RN · Dec 17, 2013

It is so very wrong for them not to listen to the next of kin who would make decisions if I were unable to make the decisions. Why wouldn't they listen to my next of kin if we happen to not have the POLST paper or MPOA papers with me? We always listened to the next of kin whenenver they were unable to make decisions in the old days. I just can't believe they would code me if my next of kin was telling them not to. Of course my family knows not to call 911 in the first place. But say one of my hospice patients is at Walmart and the doc still has not signed the DNR. Why can't the paramedics listen to the next of kin? Its so unfair to code someone who does not want to be coded.

It is, you are right. However, it needs to be standardized. What if you were shopping with great aunt Martha who didn't exactly like you? Do you want her telling the EMS to code or not code? There are so many ethical issues involved in this scenario. Better to let the paramedics do their job and let the ED doc and hopefully the DPOA, be ones to stop the code.

wanderlust99 · Dec 17, 2013

I hope not. A lot of families lie about things like that.

EDRN62772 · Dec 17, 2013

Prior to becoming an RN I worked in EMS and unless the person possessed proper advanced directive documentation we would provide full care. As an ED RN if a person presents to the ED without advanced directives they are assumed a full code until documentation is furbished to prove otherwise. As a healthcare provider, if you with hold care on a person’s word I am quite certain you will be sued and potentially be held criminally responsible. Imagine being in court and explaining how you withheld medical care because the person’s cousin said so.

nurseprnRN, BSN, RN · Dec 17, 2013

In our state you get a signed, numbered DNR form from the state DPH from your PCP to put up on your refrigerator, have copies for local EMS and -- and this is important-- it comes with the numbered bracelet. Whether they come to your house or find you at MallWart, if you have changed your mind and removed your bracelet they treat you like anyone else they find down, which is to say that they begin ACLS. If you have the bracelet on, though, they don't.

roser13, ASN, RN · Dec 17, 2013

"Mallwart"

I love that!

Nurse Kyles, BSN, RN · Dec 17, 2013

The EMS will resuscitate if there is no Community DNR bracelet present. A DNR order is required to obtain a community DNR bracelet. This is how it works in my state.

MunoRN, RN · Dec 17, 2013

I've seen patients with a DNR tattoo, usually annoyed at waking up in an ICU since I don't know of any state that recognizes a DNR tattoo as an accepted way for EMS to withhold CPR.

As far as I know, every state recognizes a DNR bracelet although there are varying requirements. Many states have a list of approved vendors, some states requires certain terminology on the bracelet. Some states only allow you to order the bracelet through a Physician.

There are also wallet size POLST/MOLST forms available, although that relies on someone checking your wallet which is less likely than a wrist bracelet.

But no, a bystander saying they don't want CPR is never enough to allow EMS to withhold CPR.

OCNRN63, RN · Dec 18, 2013

No offense here but really:
Out of 99 included patients in whom resuscitation was attempted, 41 (41%) were successfully resuscitated and admitted to hospital. Ten (10%) patients were discharged from hospital. Seven were alive after one year and six after five years following cardiac arrest. Five of the seven patients alive one year after resuscitation presented with the same functional level as prior to cardiac arrest.
Pulseless electrical activity and successful out-of-hospital resuscitation â€" long-term survival and quality of life: an observational cohort study
After exclusion of 3,400 OHCA events that occurred after the arrival of EMS providers, bystander CPR information was analyzed for 28,289 events. In this group, whites were significantly more likely to receive CPR than blacks, Hispanics, or members of other racial/ethnic populations (p
Out-of-Hospital Cardiac Arrest Surveillance --- Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005--December 31, 2010
So really, this is kinda moot point - few people survive an out of hospital cardiac arrest unless professional (not bystander) CPR is performed.
As a pre-hospital provider, I advise CPR be started unless there is a signed IL state DNR form or obvious signs of death. Nope, I would never ever listen to a bystander.

Just because most don't survive doesn't mean significant pain and suffering isn't incurred.

I have my AD and MPOA in my purse in a zip-lock bag. Since I can no longer drive, I almost always have one of my parents with me. They know my wishes, so hopefully no one will try to jump on my chest.

Esme12, ASN, BSN, RN · Dec 18, 2013

Just because most don't survive doesn't mean significant pain and suffering isn't incurred.
I have my AD and MPOA in my purse in a zip-lock bag. Since I can no longer drive, I almost always have one of my parents with me. They know my wishes, so hopefully no one will try to jump on my chest.

Unfortunately, EMS does not follow advanced directive nor POA. Unless you have a signed/verified DNR/Comfot Care/POLST/MOLST you will be resuscitated by the EMS.

If you are serious...I would check with your state on the process for a DNR recognized by the state EMS system.

OCNRN63, RN · Dec 19, 2013

I do...I have all of my bases covered, due to my medical issues.

ThePrincessBride, MSN, RN, NP · Dec 19, 2013

Yes, if they code me and I don't happen to have my POLST Form on me, then I will sue for assault and battery!! Do Not Resuscitate me under any circumstances. I worked 13 years in ICU I do not want to me coded.

People want to sue for anything.

Sheesh.