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DNR'S for children
Over on Police link there is open discussion on kids and DNR's and other directives. Apparently bus drivers are upset over the fact that they handed DNR's on the kids that they transport to and from school. Some of the children are disabled, ill or medically stable. They are told they need to honor it and they have concerns because no medical personel ride the bus. They are not suppose to take lifesaving efforts on anyone even if they are just suffering from some type of allergic reaction (bee sting) or "artifical" incident (choking on a foreign object) etc and stop breathing and/or are pulseless.
So I am just wondering what your thought's are on this and how would you handle it. I only posted the basic,there are other concerns and questions that go along with this post.
So I am just wondering what your thought's are on this and how would you handle it. I only posted the basic,there are other concerns and questions that go along with this post.
Replies to This Discussion
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Permalink Reply by Rescuefrog on
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This is part of my discussion: In my 9 years I have not run across any children with a DNR or any other advanced directive. I am a believer of these forms but I also feel that they should belong only to those that are severely disabled, elderly, terminally ill or with illnesses so advanced that more harm than good prevails in our efforts. I respect this form and will follow it from comfort measures only to a full no code. But I think I would have a hard time following orders from parents of perfectly heathly kids who simply might have stop breathing because their airway is block and I can possibly and quickly reverse it by simply providing ventilations and using an OPA, Combi-tube etc.
I am going to post this over with EMT's and Paramedic's and get their opinions and get back to you all.
By Freezerburn: I agree with you, Rescuefrog, and your post is very well put. However, you've left out a portion of the population.......Many of these kids are not 'perfectly healthy'. Without referring to any specific real life children, theoretically there may be children with Down's Syndrome, cancer (in remission, or controlled), or some other 'condition', that have these DNR orders. In my opinion, some of the above group of children could have a long and happy life ahead. Are we starting the 'slippery slope' to euthanasia by allowing DNRs on these children? I believe that IS the case.
By me: You are right Freezerburn, I missed a whole section of the population, not intentionally though. What I meant by perfectly heathly was anyone that did not fit in severely disabled, elderly, terminally ill or with illnesses so advanced that more harm than good prevails in our efforts. I could have chosen a better word to emcompass the remaining population. My apologies.
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Permalink Reply by Joe Stoltz on
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I think I would willfully, if not cheerfully, disregard such a DNR. There are numerous cases in which parents, because of religious beliefs, withheld life-saving medical treatment for their children. Whether this is right or wrong - morally, ethically, really - is in the eye of the beholder.
Suppose a child inhales a button or other object in my presence? Heimlich maneuver, the button comes out, the child breathes again and all is well. Hopefully. Am I going to get sued for saving this child's life?
In the physical absence of a parent I would assume implied consent - the kid has a say in this, too. I also think it would be harder to be sued for doing something and saving a life, rather than be sued for doing nothing and NOT saving a life.
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Permalink Reply by Kimberly A Bownas on
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I haven't heard of a DNR for children but, I would think if a parent does has a DNR on a child it is because they are terminally ill. I would find it very difficult to not help a child that needs medical attention. I think more research should be done on this. Last time I knew and unless it has changed, a doctor has to sign the DNR and it has to be reviewed by the doctor every year and kept up to date. I would find it rather disturbing if a medical doctor signed a DNR on a healthy child. I have never seen a DNR on a child and for the years that I have been an EMT I have never been presented with a DNR on any adult patient either. Doesn't mean that I never will, just hasn't been yet. The only other thing I can say is, that if you are presented with one, then call your medical controll and see what they recommend. Always if there are questions when at a call you can call your medical control to get the answer that you need. This covers you in the end.
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Permalink Reply by Brian Dumser on
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Well said, Joe. I couldn't agree more!
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Good points, Kim.
I had one encounter with a DNR some years ago. It was on a 93 year old woman who hadn't been gone very long before she was discovered. It bothered me more to NOT do CPR, rather than start it. I was kind of surprised at my reaction, frankly - I thought it would have been easier.
I can't even think of how I would be affected by a DNR on a child, whatever the reason.
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Permalink Reply by Greenman on
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Being a layperson, and not a lawyer, I would have to wonder about the legal issues of a DNR for a child.
To my way of thinking I can understand a DNR for something related to the particular illness, such as stroke in child who has one or more due to his illness. But I cannot see how a DNR would stand up to a legal challenge for things unrelated to the particular illness. Even if the parents believe it was "God's will" that their child die from the disease, how is swallowing a button, or a bite of apple, related to the disease?
Also, while I'm not real familiar with the rules pertaining to DNRs in all states, don't they usually only apply to Medical Personnel like EMS personnel, Doctors and Nurses, etc...? Would a DNR apply to a Good Samaritan, even a bus driver since medicine is not a prescribed part of their job. Again as a layperson, I would expect a reasonable adult working as a bus driver to try to save anyone who is suffering form a life-threatening event, adult or child, until competent medical personnel arrived and took-over care, including ceasing attempts to resuscitate if the victim has a DNR.
GM
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Permalink Reply by Kenneth on
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I'm not too knowledgable when it comes to legal situations but in my personal opinion I'd have to assess each situation I come to when dealing with this. A DNR to me basically means that if the patient will die in the next 5 minutes or so without me doing anything then I should respect the DNR. If the patient is going to suffer for an hour because they're having trouble breathing then it's my responsibility to provide them with care.
I don't know the terms in which you can get a DNR for a child. I assume it would have to be something really serious like a disease or a condition in which when the signs and symptoms occur they will be fatal. I have no problem respecting that DNR because I don't want to see any child suffer for a life time because I decided to go against a DNR and I brought them back to life. I'm not much of a religious man but the child may be better off in gods hands if he's in that bad shape.
If I were to responde to an allergic reaction and the child was diagnosed with some rare disease that could manifest itself down the road so they got a DNR, I'm going to treat the child. If the parents hand me a DNR I think i'd still treat the child. If the parents get aggrivated I think I would get child services involved and tell them that they are endangering their child. I don't know how it would all go down of course but I think eveyrthing I said it within my power.
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Permalink Reply by Marie on
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but thats not even the general scope of a DNR..... i've always been told that if the persons current state is unrelated to the reason the DNR is issued your still supposed to resuscitate..... the bee sting incident being a perfect example.... thats an issue that while life threatening is easily 100% reversible with proper immediate intervention.... whereas crashing due to the chronic illness is more of the body starting to fail and much less likely to result in the quality of life pre-crash after resuscitation (hence the fact that a DNR for crashing related to the chronic condition is the sensical thing to do)...............
An example of this is that when I went in for ACL surgery one of the forms explicitly stated that even if I had a DNR and crashed on the OR table they were going to perform full resuscitative measures due to the fact that crashing from an orthopedic related surgical procedure has nothing to do with a chronic illness that a DNR would be issued for...... I had to sign stating that I understood that DNR's are not valid when its an event unrelated to the reason they were issued that causes the apneic/pulsless state
I think its reduculous that bus drivers are being forced to deal with this issue.... either pay your bus drivers better AND send them through some type of medical training if they're txprting such sick kids OR suck it up and hire someone with the proper medical training to ride on each bus trip.
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Permalink Reply by Jason Brooks on
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Some interesting points have been brought up here already.
The bus driver is not a medical personnel, so it does not apply.
Most states do not allow field personnel to honor DNR without medical control anyhow.
If you knowingly do not honor the DNR, or call medical control and they say to honor it, you are guilty of assault and battery. This is not something to take lightly. You do not the reason for the order and you are not the person to decide whether or not to honor it, unless you are allowed to. This is the one of the things in our job that can be tough. If you cannot handle it, time to rethink what you want to do with your profession.
In Ohio, we have a confort care order. This can be either a DNR-CC or a DNR-CCA. The CC is a comfort care order, this is designed to allow basic care and to make the patient comfortable only. We do not treat cardiac issues, just make them comfortable. The CCA is comfort care arrest, you do everything up to an arrest. These are on specific state forms and must be honored by field personnel.
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Permalink Reply by Chad Furr on
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I am sorry but I would NOT honor it for a bee sting or choking situation. They could send me to jail, bar me from emergency work for life, whatever they want. BUT by damn I would never let a child die just cause a piece of paper told me to. I didnt get involved in this line of work to watch ppl die esp. kids. Sorry I just get a bit emo when it comes to kids. Tha is my 2 cents worth take it as you like
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Permalink Reply by Jay Nicholson on
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Chad, I'm going to disagree with you but respect your opinion. If you choose to disregard a DNR, you may feel better, but you have just prolonged the pain and suffering of not just that child, but the parents as well. As a parent, I hope to never have to make that choice. I don't know if I could sign a DNR on my child. But I can assure you it is not something that I would choose to do. I would do it because it was the right, caring thing to do. As you know, in this job we are constantly thinking about others over ourselves. I would hope that if, God forbid, you are placed in this situation, you can do what is right for that child and not you.
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