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Do-Not-Resuscitate Orders: Where Are They in the Prehospital Setting?

Published online by Cambridge University Press:  28 June 2012

Kristi L. Koenig  and
Gary W. Tamkin
Kristi L. Koenig*
Affiliation:
Emergency Department, Highland General Hospital, Oakland, Calif.
Gary W. Tamkin
Affiliation:
Emergency Department, Highland General Hospital, Oakland, Calif.
*
Emergency Department, Highland General Hospital, 1411 East 31st Street, Oakland, CA 94602USA
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Abstract

Without a well-functioning, prehospital, do-not-resuscitate (DNR) system in place, emergency medical service (EMS) providers must resuscitate all patients who access the system, regardless of the patients' wishes and regardless of what makes ethical or economic sense. In lieu of valid documentation, it is not appropriate to withhold resuscitative measures in this critical, time-dependent situation. In order to help EMS systems implement functional prehospital DNR protocols, this paper reviews the state-of-the-art of prehospital DNR including the issues to consider when designing such a system and a discussion of the features of some of the existing systems. This review includes: 1) the basis and requirements of a DNR system; 2) legal and physical forms for DNR orders; 3) eligibility for DNR status; 4) reversal of DNR orders; and 5) inappropriate use of EMS systems for DNR patients. Finally, a more general discussion of overall resource utilization in prehospital resuscitations is presented to emphasize that implementing prehospital DNR systems is only one piece of a larger issue.

Keywords

advance directivescost-containmentdo-not-resuscitate ordersemergency medical servicesethicsprehospitalresource utilizationresuscitationterminal illness
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 8 , Issue 1 , March 1993 , pp. 51 - 54
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1993

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