EMS Policy Manual - Contra Costa Health Services
EMS Policy Manual - Contra Costa Health Services
EMS Policy Manual - Contra Costa Health Services
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<strong>Contra</strong> <strong>Costa</strong><br />
Emergency Medical <strong>Services</strong><br />
DO NOT RESUSCITATE (DNR) ORDERS AND<br />
PHYSICIAN ORDERS FOR LIFE-SUSTAINING<br />
TREATMENT (POLST) IN THE PREHOSPITAL<br />
SETTING<br />
POLICY #: 20<br />
PAGE: 1 of 2<br />
EFFECTIVE: 01/01/12<br />
REVIEWED: 10/01/11<br />
I. PURPOSE<br />
This policy identifies situations approved for withholding resuscitative measures or the treatment of<br />
patients with an advanced airway.<br />
II. DEFINITIONS<br />
Agent: An individual, eighteen years of age or older, designated in a power of attorney for health<br />
care to make health care decisions for the patient, also known as “attorney-in-fact.”<br />
Immediate Family: The spouse, domestic partner, adult child(ren) or adult sibling(s) of the patient.<br />
Conservator: Court-appointed authority to make health care decisions for a patient.<br />
Advanced <strong>Health</strong> Care Directive (AHCD): A written document that allows an individual to provide<br />
health care instructions or designate an agent to make health care decisions for that person. AHCD is<br />
the current legal format for a living will or Durable Power of Attorney for <strong>Health</strong> Care (DPAHC).<br />
Standardized Patient-Designated Directives:<br />
• Statewide Emergency Medical <strong>Services</strong> Authority (<strong>EMS</strong>A)/California Medical Association (CMA)<br />
Prehospital DNR Form<br />
• Physician Orders for Life Sustaining Treatment (POLST): A standardized, signed, designatedphysician<br />
order that addresses a patient’s wishes about a specific set of medical issues related<br />
to end-of-life care<br />
• A standard DNR medallion/bracelet (e.g. Medi-Alert).<br />
III. POLICY<br />
DNR ORDERS HONORED BY PREHOSPITAL PERSONNEL<br />
Prehospital personnel may honor the following types of DNR orders:<br />
A. A California <strong>EMS</strong>A/CMA Prehospital DNR form.<br />
B. A California <strong>EMS</strong>A POLST form where Section A – Do Not Attempt Resuscitation/DNR has<br />
been chosen.<br />
C. An Advanced <strong>Health</strong> Care Directive (living will or Durable Power of Attorney for <strong>Health</strong> Care)<br />
presented by an agent of the patient empowered to make health care decisions for the patient.<br />
D. A standard DNR medallion/bracelet (e.g. Medi-Alert)<br />
E. A DNR order in the medical record of a licensed healthcare facility (e.g., acute care hospital,<br />
skilled nursing facilities, hospices, intermediate care facilities) signed by a physician. (electronic<br />
physician’s orders are considered signed and will be honored)<br />
F. A verbal DNR order given by the patient’s physician who is present at the scene.<br />
A patient (or patient’s surrogate) may verbally rescind the DNR order at any time.<br />
IV. PROCEDURE<br />
A. COMPLYING WITH AN HONORED DNR ORDER<br />
If an approved DNR order is available:<br />
1. Verify the identity of the patient<br />
2. Perform no life saving measures<br />
3. Cancel the responding ambulance
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