I have another question, that thankfully some here in this thread can help me with. My parents live with my grandmother in NC. As suggested, my mother has a copy of the DNR taped to the fridge. When they come up to NY for their visits 1-2 times a year they bring the DNR with them. Some nights my Grandmother stays in NJ with my uncle. Will the DNR be respected equally in each state, should something (God forbid) happen?
Yeah, it would suck if the person was instead a retired worker with the Department of Natural Resources who had lost a bar bet at some point.
Hello all, ER nurse here. A few points to consider. There is very little time to decide whether to initiate resuscitation and still have any chance of it being effective, therefore the burden of proof is on the patient and family members to prove a valid DNR exists. This may sound harsh, but imagine having a loved one die because of an invalid, rescinded or mis-identified DNR! Having said that, we know that most resusitations are not successful, and we DON’T WANT to do them on someone who doesn’t want it. Make it easy on us, and we’ll gladly make it easy on you. A few suggestions:
- Hospice, end of life care is their speciality.
- DNR on file with primary doc and also oncologist(or whatever).
- DNR on the fridge, paramedics know to look there, and it maybe a friend or neighbor that finds them.
- Learn the paramedic rules in your area. Where I’m at, EMS can pronounce death in the field without hospital contact, and can terminate CPR with contact. Please don’t put them in the position of having to break the law and lose their license or resusitate someone who doesn’t want it.
- This shouldn’t suggest that it’s never appropriate to call an ambulance, there are other reasons to do so. Some people even have limited DNR’s which forbid shocking, intubation and ‘‘code drugs’’ but allow IV fluids, antibiotics and passive oxygen. A personal choice.
I would like to offer a heartfelt thank you to the OP for doing this work, many family members are incapable of it and unecessary suffering and expense ensue, thank you.
Just calling the ambulance after you know the person has died might not be enough.
I’m working in a small rural hospital as a medical doctor. Part of my job entails going out in the cardiac ambulance to administer lysis to MI patients, to lead arrests or to pronounce arrests. I hate cardiac ambulance calls.
Where I work paramedics aren’t supposed to stop CPR once it has been initiated without a doctor’s order to stop. Likewise, however, they aren’t mean to resuscitate inappropriately. The last bit sometimes gets forgotten.
There is a reason one of my colleagues calls the cardiac ambulance “the mobile death certification unit”. It is not unusual to be called to a home where an extremely frail, elderly person was found pulseless and not breathing when a relative “popped round” then stayed that way for perhaps 10 minutes until the paramedics arrived (relatives rarely attempt CPR themselves). The paramedics commence CPR on arrival and continue to do so until a doctor arrives in the heart cart, perhaps 20 minutes later, to tell them to stop.
In those situations I walk through the door, assess the situation (no pulse, no breathing, aystolic, has been that way for at least 30 mins, could have been more) speak to the family and stop CPR…within about 60seconds of arriving.
Just after Christmas one of my colleagues was called to a house at 11pm where a 90 year old lady had been “sleeping” since lunchtime. Her husband realised she wasn’t breathing when he went to bed at 9pm and called his son, who came to the house, realised she was probably dead and called an ambulance and the priest. The paramedics arrived after the priest (who had already done his thing) and they took the woman out of bed and began CPR.
By the time my colleague arrived, there was a wake in full swing in the front room and meanwhile the paramedics were in the back bedroom trying to resuscitate a cold, blue, stiff corpse. My colleague, not being Irish, didn’t know it was a wake, and thought all these people were gathered at the house drinking whisky and wanting him to continue to resuscitate the woman. He was worried there would be some sort of riot if he told them it was too late.
He only realised differently when he went in to tell them he couldn’t do any more and wanted to stop the CPR and heard the family choosing funeral hymns with the priest!
St Urho I’d love it if you worked here!
In the event a DNR relative had died, I’d call the physician who has been attending them in their last illness and the undertaker, and forget all about an ambulance.
From what I can tell in this link you can print out a New York form and New Jersey form from the pdf links. The safest course would be to have your grandmothers doctor sign a form for each state and bring them with.
With all due respect ( because I have immense respect for you ! ), let me ask this: if her grandmother’s Dr. signs a form for each state, but that Dr. is not licensed to practice medicine in that state, might that be a problem? Or do all states offer a kind of reciprocity to MD’s in this case?
Wondering if it is worth it to call NY and NJ Hospice agencies to get info, and possibly have Gramma’s Dr. contact licensed MD’s in those respective states.
Overkill or a decent thought?
This bears repeating. DNRs vary wildy from state to state
In Maryland, there are two types of DNRs, an A and a B. With an A, CPR can be performed up to a certain point. A DNR-B means nothing other than pallative care can be performed. CPR cannot be performed at all with a B. Maryland DNRs are only valid in Maryland.
When we transfer patients, we must have a copy of the DNR, otherwise the patient is considered a full code, and we must work them if anything happens.
Beside the bed of the patient is a good place for a DNR - it can be forgotten if it’s on the fridge in another room. If paramedics show up and don’t see the DNR, and then start working the patient, they’ll be in trouble if the DNR shows up after the fact. As others have said, once you start CPR, it cannot be stopped except by a doctor.
The bracelets that I’ve seen are just clear hollow plastic, like a bangle bracelet, with a place to insert a small version of the DNR.