Policy:

 

  • Any patient presenting to any component of the EMS system with a completed South Carolina Do Not Resuscitate (DNR) form shall have the form honored. Treatment will be limited as documented in the palliative care section of the SC CODE of Laws Section 44-78-10 amended 1994. . A living will or other legal document that identifies the patient’s desire to withhold CPR or other medical care may be honored other than the POST form currently under pilot in South Carolina.  If the patient has a Do Not Resuscitate bracelet, it must be from the official vendor "Sticky J Medical ID Company".

 

Purpose:

 

  • To honor the terminal wishes of the patient and to prevent the initiation of unwanted resuscitation in accordance with South Carolina law under the Death with Dignity Act.

 

Procedure:

 

  1. When confronted with a cardiac arrest patient, the following conditions must be present in order to honor the DNR request and withhold CPR and ALS therapy:

 

    1. The form(s) must be a South Carolina DNR form – or – DNR box is checked in section A of the POST form, or an approved South Carolina DNR Bracelet must be present on the patient.
    2. The effective date and all required information provided.
    3. Must be signed or approved by a SC licensed physician.

 

  • A valid DNR form may ONLY be revoked by VERBAL/IMPLIED request, by mutilating, obliterating or destroying the document, or by removal or destruction of an approved bracelet in any manner by the PATIENT ONLY.

 

  1. If the patient or anyone associated with the patient requests that a SC DNR form not be honored, EMS personnel should contact their supervisor to obtain assistance
  2. When confronted with a seriously ill patient who is not in cardiac arrest and has a POST form, the POST form Section B shall be utilized as follows:

 

    1. Full Scope of Treatment box is checked: Use all appropriate measures included in Greenville County EMS system protocols to stabilize/resuscitate the patient.
    2. Limited Scope of Treatment box is checked: The maximum airway intervention is non-rebreather mask and airway suctioning. All appropriate IV medications may be utilized. No electrical therapies are to be provided.
    3. Comfort Measures box is checked: The maximum airway intervention is non-rebreather mask and airway suctioning. IV pain medications may be administered. Medical Control may be contacted to reference appropriate treatment.
  1. Living wills or other documents indicating the patient's desire to withhold CPR or other medical care may not be honored by SC paramedics.
  2. EMS providers can accept a copy of an original DNR form valid for that transport only after visually verifying that the properly formatted, completed SC DNR exists, and documenting that on the copy of the form.
  3. The copy of original form should be scanned and attached to the ePCR if execute.
  4. Any SC DNR form that is transported with the patient and is NOT executed must be returned to the patient or patient surrogate agent (POA).
  5. If specific parameters of this policy are not met or there is doubt, contact Medical Control for questions and clarity.

 

  • Resuscitative Measures to be withheld:
    • CPR
    • Advanced airway management to include intubation
    • defibrillation
    • Cardiac resuscitation medications (Atropine, Epinephrine)

 

  • Approved procedures include:
    • Assist Ventilation
    • Suction
    • Basic cardiac monitoring
    • Oxygen and basic airway (OPA, NPA)
    • CPAP
    • Control of bleeding
    • Comfort care
    • Pain Management

 

Non-cardiac resuscitation medications:

Aspirin, Nitroglycerin, Adenosine (Adenecard), Diltiazem (Cardizem), and Amiodarone (Cordarone) (for wide complex tachycardia with a pulse)

DNR, POST and

Advance Directives