Getting EMTs to heed DNRs

A pilot program in Seattle is giving EMTs latitude when faced with DNR situations:

Now, under Compelling Reasons, EMTs will be allowed to withhold resuscitation provided the patient is in the final stages of a terminal condition and family members request – in writing or verbally – that CPR not be performed.

(via a reader tip)

Comments

Gasman
The other half of the equasion is don’t involve EMS if you don’t want their services.
If a dying person requries transport to a hospital the call a private ambulance company. A call to EMS means that there is an emergency. There is no time to interpret a DNR document or consult with bystanders (who may or may not be authorized to act as the patient’s guardian), or physician.
Anonymous
I agree… don’t call 911 in the first place if you don’t want emergency care. Paramedics and EMTs shouldn’t have to sort through and interpret legal documents after they’ve been summoned to respond with emergency services, and legally they are in a gray area if they listen to the expressed wishes of family members. In a hospital inpatient or hospice setting, there is time to sort through this kind of thing but if you call 911, you have to be prepared for CPR.
Anonymous
You could say the same thing about going to the hospital…why go to the hospital if you are dnr? We er docs don’t have time to figure out blah blah blah…
Anonymous
why just let the emt’s off the hook…they already are immune to malpractice, now you want to let them off for this?
Anonymous
Why call anyone for help?…God forbid any of the medical profession be put out while haggling about CPR and whatnot. Just let all family member’s lay there suffocating in pain or whatever till it’s time to call the Funeral Parlor. Would that work for ya?
Anonymous
What is wrong with this country ? Why can’t we just let the 90 years old grandma die in peace, in her own bed, while we take a day off from work just to be with her ? We have to screw up everything : let grandma lie in the nursing home until the last day, see her on sundays once in a while and when she is almost dead, rush her to ER to pamper our guilty feelings. What is so outrageous about dying from old age ?
Michael Rack, MD
“why go to the hospital if you are dnr?”
For palliative care
Anonymous
Some of you Doc’s talk as though you are totally disconnected where human life is concerned.
Since when is it considered normal for family member’s not to panic when a loved one is dying? I doubt most of you have experienced losing a loved one yet. If you are with your parents and you know the end is near, I almost guarantee that impulse and emotions will lead you to try and get some help for them. You don’t want them in pain, gasping for breathe. The normal response is for someone to do something, even if that something is for comfort only.
We are NOT animals! Some of you have so much to learn yet it’s unbelivable that you are doctors.
Anonymous
Well anon 10:56/12:51 God forbid you had this conversation with your loved one ahead of time so everyone knows what their wishes are. God forbid you have shoved them off in a nursing home and haven’t seen them more than once every 6 months such that when you get the call from the hospital at 03:00 about whether to intubate your typical guilt ridden self-centered American response is “do everything” whether or not the person ever wanted “everything done”. Have you every heard of an Orange Card? My own family members have died in home hospice. Was it painful to watch…yes. But they were surrounded by family not in some nursing home box with a typical “I don’t give a shit” American family. They were NOT gasping for air. They were comfortable as possible (morphine/ativan). The idea here guys is to sit down with your family AHEAD OF TIME and make some of these decisions. I know this is an incredibly novel concept in this self-centered society. Take some responsibility for YOUR FAMILY and if you don’t, don’t bitch about it when you get a frantic 03:00 phone call from the hospital with a stranger on the other end of the phone asking how aggressive to be with YOUR LOVED ONE.
Anonymous
You know it would be nice if you had even one clue as to what the hell you are talking about. Unfortunately you don’t.
I don’t shove my family off to the nursing homes. I took care o fmy mother for 13 years in my home prior to her death. Yes, she did have a DNR. I knew exactly what her wishes were but, there was no agreement any where that said. “I wish to die in extreme pain with no medication whatsoever to help said pain.”
You really are a wacko..
Anonymous
Also, I really don’t know what an “orange card” is…I hope you don’t know what a “green card” is..
Who in hell do you think you are to make assumptions about an entire country that you most likely dont know shit about?
Anonymous
Anon 2:28… your argument is so off the path of the original article. No one is talking about witholding pain medication!
The issue is with emergency services- when they are summonned through a phone call to 911, the assumption has to be that the family wants emergency medical help for their loved one. Time is of the essence is these situations, and paramedics/EMTs are trained to act quickly and immediately. They are trained to save lives, not sit by and watch people die. They do not have time to sort through a stack of legal documents, trying to determine if they are appropriately executed and not expired. In the time it takes to do that, the patient could have gotten worse or died. They certainly can’t just take the word of the nearest family member (legally) because what if a.) they are mistaken, or b.) they aren’t authorized to act as power of attorney.
Anon 9:01, no, you could not say the same thing about going to the hospital. At a hospital one could receive palliative care that would not have been available at home or through emergency services. Assuming a patient has been stablized, there would be sufficient time (as well as trained staff) available to read any living wills or DNR orders and interpret them.
Anonymous
Hospital should not be used for palliative care. Hospice is more appropriate for that.
Actually, let’s wait until medicare goes belly up and then we’ll see how many will be willing to pay 1000$ daily for palliative care in the hospital, when some morphine and the presence of the family around would do much better for the mental and physical pain of a terminal patient.
Anonymous
“Some of you Doc’s talk as though you are totally disconnected where human life is concerned. “
Some of them are.
Anonymous
Anon 7:25..You are looking at this only from a Drs. perspective. If you are alone with an elderly parent whose time you know is limited and all of a sudden they are gasping for breathe and crying out in unexpected pain, you cannot just “not do anything.” Even though you know there is a DNR and that they are going to die. You want to get them help to make it easier. Im not talking about people who are on hospice. I’m talking about patients who have been cared for completely by family members. The choices then become, ignore them, they are dying anyway, the pain won’t last long, or, call an ambulance for help. It doesn’t take alot of sense to figure this out. Most people are not physicians and I don’t care who you are, when your parent is dying, there are strong emotions there. You are not going to let them suffer.
Anonymous
“Most people are not physicians and I don’t care who you are, when your parent is dying, there are strong emotions there. You are not going to let them suffer.”
Suffer is exactly what they will do if you call 911 !!!!
Plan ahead. Check into hospice. Establish an understanding with the primary care doctor. I am tired of breaking ribs doing CPR and poking large needles deep into the body of 90lb 90 year old granny because family did not want to see her die. This society has such an ignorant disconnect with death and dying
Anonymous
One is arguing based on reason, the other based on emotion. Neither, in my opinion,is wrong. Physicians have an advantage of having seen the situation from different angles. If the world were a stage and we are all just actors, doctors have been through the routine and played the roles and know the script. And for all those involved, this is one of the most difficult scenes in life to be part of. The details of the scene is imprinted permanently and clearly in one’s memory for the rest of his/her life. “Don’t hit the panic button” is easier said than done in time of crisis.
-amd
Anonymous
Anon 10:15, I don’t disagree with anything you said. I understand why someone would freak out and call 911, but the point that was made was that you can’t turn around and not expect the paramedics that arrive to do what they are trained to do (CPR, etc).
Interesting that you stated the option as “calling for an ambulance”. There is a difference between calling 911 and calling an ambulance company. One implies that there is an emergency (and hence emergency life-saving care needs to be given) and the other just implies that skilled transport is needed. In the situation you described, it would have been wise to have planned ahead for such an inevitable event and to know the number of an ambulance company you could call to get your relative to the hospital.
Anonymous
I should add to the last sentence: that is, IF you (or the patient, if you know this to be true) did NOT want CPR and other interventions like the lady in the article. If you do, then by all means call 911 and that’s what you’ll get.
jerry
“I doubt most of you have experienced losing a loved one yet.”
Yeah, doctors family members, parents, grandparents, children never die. They are immortal and live forever. Very very silly statement.
Seeing the end of life played out every day I do know that I do not want my end to be with a 911 call, tubes in every orofice, and ICU torture for the sake of “having everything done” and a chance of a few more weeks or months of misery.
Michael Rack, MD
“Hospital should not be used for palliative care. Hospice is more appropriate for that.” I agree that hospice is the most appropriate location for palliative care. However, it is sometimes necessary to initiate palliative care in the hospital and then transfer the patient to hospice care.

Getting EMTs to heed DNRs

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