Advance Directive DNR for EMS
Frequently Asked Questions and Answers - Reprinted from California Emergency Medical Services Authority
- What is a DNR Form?
A DNR (Do Not Resuscitate) Form (actual title: "Emergency Medical Services Prehospital Do Not Resuscitate (DNR) Form) is an official State document developed by the California EMS Authority and the California Medical Association which, when completed correctly, allows a patient with a life threatening illness or injury to forgo specific resuscitative measures that may keep them alive. These measures include: chest compressions (CPR), assisted ventilation (breathing), endotracheal intubation, defibrillation, and cardiotonic drugs (drugs which stimulate the heart). The form does not affect the provision of other emergency medical care, including treatment for pain (also known as "comfort measures"), difficulty breathing, major bleeding, or other medical conditions. Many patients make their DNR wishes officially known because they do not want to be placed on life-assisting equipment in the event that their heart or breathing ceases.
- Are there State guidelines covering the use of the DNR Form?
Yes, you may download the EMS Authority's "Guidelines for EMS Personnel Regarding Do Not Resuscitate Directives" via our website at www.emsa.ca.gov (access Publications # 111). You may also wish to contact the local EMS agency for your county to obtain a copy of their local DNR policies, which will be based on the State Guidelines, but may have additional specifications.
- How can I ensure that the EMT or paramedic responding to my emergency needs will honor my DNR wish?
The best way to ensure that your wishes are honored is to complete the official State Prehospital DNR form and have it signed by your physician and readily accessible when EMS help arrives. If you are concerned about the form being available at all times, you would be well-advised to obtain and wear a MedicAlert bracelet or neck medallion engraved with your DNR requirements.
- How can I obtain a DNR form?
The Advanced Directive DNR for EMS can be downloaded at the top of this page. The wording on these forms are not to be modified in any way except to include the required information of patient name, date signed by patient, surrogate's relationship to patient, physician date signed, physician printed name and physician phone number.
- How can I obtain a MedicAlert bracelet?
Bracelets may be ordered through the MedicAlert Website. The Medic Alert organization has a 24-hour toll-free line: 1-888-755-1448. Please note that MedicAlert is a registered trademark, and substitute identifier bracelets may not be recognized by the EMT or paramedic.
- What if the EMT cannot find the DNR form or evidence of a MedicAlert medallion? Will they withhold resuscitative measures if my family asks them to?
No. EMS personnel are taught to proceed with CPR when needed, unless they are absolutely certain that a qualified DNR advance directive exists for that patient. If, after spending a reasonable (short) amount of time looking for the form or medallion, they do not see it, they will proceed with lifesaving measures.
- What if I change my mind? Can I reverse my DNR orders?
Absolutely. Your DNR orders are in place for as long as you wish them to be; you need only to destroy them if you wish to stop them. You should also contact your doctor's office and family if you do so.
- Can the State DNR form and/or Medic Alert medallion be used in a skilled nursing facility or hospice?
Yes. We encourage the adoption of the form for use by such facilities; however, many facilities do not know of the form, or they have their own in place, which may not be recognizable to the EMT or paramedic. If you have any concerns about the ability of the responding EMS personnel to be able to follow your DNR wishes, you would be well advised to obtain and wear a MedicAlert bracelet or medallion.
- What about other legal documents, such as a Durable Power of Attorney for Health Care (DPAHC?) or "living wills". Are they acceptable in place of the Prehospital DNR form?
While such official documents are generally respected by EMS personnel (check with your attorney and with the local EMS agency in your county), it is important to keep in mind that most EMTs or paramedics do not have the legal training needed to interpret such documents, and more importantly, do not have the time to read a lengthy document and make a life-or-death decision on the scene. They have been taught to err on the side of the patient, if they are in doubt (in other words, to provide life support). If you are at all concerned about their ability to follow your DNR wishes, you will want to follow the advice given in the answer to question number three, above.
- Where can I get other information about end-of-life care in California.
One such organization is the California Coalition for Compassionate Care. The Coalition is a statewide partnership of over 50 regional and statewide organizations dedicated to the advancement of palliative medicine and end-of-life care in California.
- Is this form and the MedicAlert medallion used in other states?
Each state has its own DNR policies and procedures and accompanying paperwork. Some states are more specific than California, some less. Only about thirteen states currently use the MedicAlert brand of ID bracelets, and some use wallet cards instead. If you are traveling out of state, you may wish to contact that state's EMS office or public health department to determine what you will need to do to ensure that your DNR wishes will be followed.