DNR, POST and Advance Directives

 

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 on the DNR form. A living will or other legal document that identifies the patient’s desire to withhold CPR or other medical care may be honored with the approval of Medical Control. This should be done when possible in consultation with the patient’s family and personal physician.

 

Purpose:

 

  • To honor the terminal wishes of the patient and to prevent the initiation of unwanted resuscitation.

 

Procedure:

 

  • 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:

 

    • The form(s) must be a South Carolina DNR form – or – DNR box is checked in section A of the POST form.
    • The effective date and expiration date must be completed and current.
    • The DNR form must be signed by a physician, physician’s assistant, or nurse practitioner.
    • A valid DNR form may be overridden by the request of the patient, the guardian of the patient or an on-scene physician.
    • If the patient or anyone associated with the patient requests that a SC DNR form not be honored, EMS personnel should contact Medical Control to obtain assistance and direction.

 

  • 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:

 

    • Full Scope of Treatment box is checked:

 

    • Use all appropriate measures included in Greenville County EMS system protocols to stabilize/resuscitate the patient.

 

  • 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.

 

  • 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.
    • If family members are present and ask that resuscitative efforts be withheld in the absence of an advanced directive, determine their relationship to the patient and the patient’s history. If the patient has an obvious life-limiting illness (terminal cancer, advanced neurological disease, advanced age, etc.), resuscitative efforts may be withheld. If there is no obvious life-limiting illness, begin resuscitation based on appropriate protocol(s) and contact Medical Control for further guidance.
    • Living wills or other documents indicating the patient’s desire to withhold CPR or other medical care may be honored only in consultation with the patient’s family and Medical Control.
    • When in doubt – contact Medical Control immediately.
  • Resuscitative Measures to be withheld:
    • CPR
    • Advanced airway management to include intubation
    • artificial ventilations
    • defibrillation
    • Cardiac resuscitation medications (Atropine, Epinephrine)
    • Cardiac diagnostic monitoring (12-Lead)

 

  • Approved procedures include:
    • Suction
    • Basic cardiac monitoring
    • Oxygen and basic airway (OPA, NPA)
    • CPAP
    • Control of bleeding
    • Comfort care
    • Non-cardiac resuscitation medications (examples include Aspirin, Nitroglycerin, Adenosine (Adenecard), Diltiazem (Cardizem), and Amiodarone (Cordarone) for wide complex tachycardia with a pulse)
    • Pain mediation