Location of a DNR

  I responded to a cardiac arrest at 3:40 am i get there the 89 year old patient is DOA so i immediatly start doing compressions. I succesfully resuscitate him. We get him loaded and get him to the ER about 20 min later his son comes in with the DNR and they unplugg the guy imediatly. 1. if you have a DNR keep it close to you so the EMT's know. 2. as the EMT never get your hopes up when you recusitate a patient. Needless to say i learn that leason the hard way.

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Permalink Reply by Andrew Dalgarno on January 30, 2011 at 10:59am
Exactly...it's no different than going to a barn fire and some says "It's my barn. I don't use it. Let it burn." Do we let it burn??? NO!! We put it out...we don't know that the guy is the owner...even if he is, maybe he's going to phone his insurance company tomorrow and tell them there was a fire and the firefighters wouldn't put it out...he'd own your favorite pumper truck by the week-end!

Andrew
Permalink Reply by BREMAR on January 30, 2011 at 11:11am
In what region are you in where an emt can hook them up to the moniter with out als on scene.
Permalink Reply by Michael Meadows on January 30, 2011 at 12:33pm
Suprised he could talk after that kind of extubation LOL. It's a wonder he didn't do a lot of damage before AND after he took his "pills".
Permalink Reply by Fireyladd - Retired Chief Sharp on January 30, 2011 at 2:16pm
Without showing the DNR you have an obligation to provide CPR. Them saying the person has DNR orders dosnt work either. In the absence of actual DNR orders its a Paramedic or Doctor call. Tough to be in those situations.BZY an Ralph are right on.
Permalink Reply by BREMAR on January 30, 2011 at 3:38pm
I WORK THE MAJORITY OF THE TIME ON AN PARAMEDIC RIG TOO. I USUALLY SET UP THE STUFF FOR THE IV'S, SPIKE THE BAGS, HOOK THEM UP TO THE MONITER, IVE EVEN DRAWED UP MEDS WHILE THE MEDIC WAS GETTING A LINE STARTED. MY QUESTION THOUGH WAS IF YOUR ON A BLS RIG WHICH HAPPENS ALOT WHERE IM FROM WE GO BY OUR PROTOCOLS AND THERES NO WHERE DOES IT SAY THAT ON AN ARREST WE SHOULD HOOK THEM UP TO THE MONITER, IT DOES SAY TO USE DIFIBALATOR WHICH IS INTERGRATED ON OUR ZOLL M SEREIS, BUT IF ID CALL IN WITH REPORT TO MEDICAL COMMAND AND ADVISE THEM THAT I HAD THEM HOOKED UP TO THE MONITER AND TOLD THEM WHAT KIND OF RYMTHOM WAS PRODUCED THEN ID GET A MAJOR QA FLAG FOR OPERATING OUT OF SCOPE OF PRACTICE...... BUT I KNOW SOME STATES ARE DIFFERENT AND I WAS JUST WONDERING ON THAT, NOT ONCE WAS I DOWNGRADING THIS POST.... ALSO A FEW WEEKS AGO I WAS ON A SCENE ON A 82 YEAR OLD MALE PT DOA. OUR ALS UNIT WAS ON SCENE AND THE MAN HAD JUST WENT UNRESPONSIVE LESS THAN 15MINUTES PIROR TO OUR ARRIVAL, HE WAS DEFENTILY ASTOYLE IN ALL THREE LEADS SO WE WERE GOING TO START WORKING HIM WHEN ALL OF HIS IMEADITE FAMILY WAS THERE ie WIFE AND 2 SONS, THEY HAD NO PROOF OF A DNR CARD BUT EVERYONE WAS STATING THAT HE DIDNT WANT TO BE REVIVED, WHAT DO U DO IN THAT SITUATION, THE MEDIC AT THE TIME CALLED MEDICAL COMMAND AND PUT IT IN THERE HANDS THEY ADVISED US THAT IF ALL FAMILY MEMBERS WERE IN AGREEANCE THAN CPR WAS NOT TO BE STARTED, I BELIEVE THERES A VERY GRAY LINE ON THIS ISSUSE THAT NEEDS TO BE ADJUSTED THROUGH THE HOSPITALS AND PTS
Permalink Reply by Michael Meadows on January 30, 2011 at 9:33pm
Well you do know what Walt Disney says, "wishes can come true". LMAO.
Permalink Reply by Izzy ( J. Bade) on January 30, 2011 at 9:38pm
those calls are tough. whatever family that might've been at the house when y'all arrived, should've told you.
I know here in my jurisdiction, we usually ask, and most of our civilians are instructed during open houses, fire prevention ,etc, to place the original paperwork where it can be seen. we usually ask them to place it on the side of the fridge,
we also offer the vile of life,
and also provide stickers for windows, to give us a heads up before we enter the residence. we actually also have papers for all of their current information , such as personal info, current Rx, other pertinent medical Hx. its a big help when we arrive, and have either an uninformed neighbor, or panicked family member.
unfortunately, in our state, we cannot accept anything other than original paperwork, we can't accept copies, and we cannot accept verbal instructions from family, such as they know that the family member has a DNR, but request you override it. unfortunately for the family, if the paperwork is correct, we can't override it. same as if the family is telling us " I know they dont want it" well, if we don't have the papers, we can't go by those wishes.

we are allowed to accept advanced directives, and living wills, but our state also offers the option of being able to get your DNR papers directly off the Internet, and all someone needs is 2 witnesses, not family related.
Permalink Reply by jorden caldwell on January 30, 2011 at 9:50pm
well here if ther is no dnr present when you arrive on scene then you continue on with work you cant go off of someones word . you also have to take into account that there are different types of dnr orders such as not being on a ventillator. it all depends
Permalink Reply by Russ on January 31, 2011 at 10:16am
in florida its a yellow paper and we instruct the family to tack it above the bed. while i hate to see anyone die i undertsand that its a descision that the family and the person has made and i try to ease the blow before we leave
Permalink Reply by Capt. Chris W. Button on January 31, 2011 at 10:40am
Almost 20 years ago, as a fresh out of school Paramedic, I volunteered for our local ambulance service as an Urban Responder. Urban Responders had a car and a jump bag. I got dispatched, along with an ALS unit, to a local eatery for a 65ish y/o woman with difficulty breathing. I got there and found out the reason she had trouble breathing was she was in cardiac arrest. I was about to pull her out of the booth to start working her when the family stated she had an extensive history and did not want her worked. I asked for the DNR orders but they didn’t have any. I told them I was required to start care.

As those words were coming out of my mouth, ALS pulled up out front. I told the crew Priority 0 on the radio and we made eye contact through the window. One medic gave me a what-the-heck look. They came in with their gear and I quickly told them the situation. They decided they would not work the patient. At that point, I had only touched the patient to get a pulse. All this had happened in less than a minute from my arrival.

The crew kind of explained to the family that I was trying to do what was supposed to be done but they understood the situation and would not put the family through unnecessary grief. I just left the scene with them and documented things from my side that I turned over care to them.

The most surreal part was the guy that was sitting beside her not 2 feet away in the next booth over. He was eating his pancakes like nothing was going on. Wow dude, don’t let the fact that a woman died 2 feet away from you spoil your appetite!
Permalink Reply by Brian Dumser on January 31, 2011 at 7:05pm
That's a really great idea! Of course they've always got to wear the wristband though. Nice having the DNR on file at the ER also.

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