I am looking for information on how a DNR bracelet or necklace would be treated in the field. I am considering a DNR order which as I understand it means in cases where attempts would normally be made to restart* a heart, attempts would not be made. One example my doctor gave (when talking me out of it) was a car accident where my heart stops but could be restarted and since I am in otherwise OK health, I could have many more years.
If I decide to have a DNR anyway, how would this work in the case of an accident like that, or other medical emergency? Is your first move to resuscitate the person, or would you look for a bracelet or necklace first? Would a DNR necklace or bracelet be sufficient for you to not restart me? Or would I need to carry the papers with me?
Also I have advance directives to not use extraordinary means. I am assuming these wouldn’t impact you? You would just be stabilizing the person long enough to get them to the hospital where the decision would be made to use life support or not?
Thanks for any info.
*I know this is a simplified way of referring to it – I mean it as shorthand for whatever conditions would normally indicate the heart should be shocked/I should be resuscitated.
DNRs that I looked for and experienced were big, yellow pieces of paper with “DNR” in huge block letters across the top. It was not a valid order unless there was a name, contact information, and signature of the issuing physician.
We hauled a terminally ill lady with a valid DNR to the hospital after she fell out of bed and broke her arm. No resuscitation was necessary, and the arm needed to be stabilized.
Had another case where we rolled up to the scene for a cardiac arrest. Family said he didn’t want to be resuscitated. We asked where the DNR was, and the answer was he didn’t have one, but did have a living will. Too bad was our answer, and we thumped him all the way to the hospital where he died anyway.
The short answer, colored by NC law and practice, is that unless you have that big piece of paper with a physician’s John Henry on it, we will treat you anyway. Bracelets and the like will be ignored.
ETA: If you are seemingly able bodied, the DNR itself would be questioned. DNRs are issued for the terminally ill.
An EMT I knew said the law in his state went even further, and that field personnel were directed to treat no matter who was waving what piece of paper at him.
There is a 100% chance of death if your heart stops. If it’s only quivering, you may be successfully resuscitated about 20% of the time.
I think you are confusing DNRs with living wills and advanced directives. Talk to your doctor about all three, and be sure to have a LW drawn up on your side, and have him/her put an AD in your records.
I mean whatever state I would be in where I could be saved but don’t want to be. I have a Living Will and Advance Directives filed with the doctor, the hospital, and the state of Vermont (and the card for that in my wallet). I also want the DNR so that I can die a natural death if my heart goes into whatever that state is that could be shocked back. But you’re right, the odds are on my side that it won’t work anyway.
Follow-up: Would DNR apply to the defibrillator or CPR or both?
No CPR or defib, no airways or assisted breathing, no administration of medications such as epinephrine or atropine. We could treat traumatic injury and do other things in the interest of comfort for the patient.
Depending on the state you live in, you may not be able to become a DNR unless you’re a “qualified patient” under state law. In Wisconsin, “qualified” means you have a terminal condition (one expected to most likely cause demise within a year), or a condition which makes resuscitation attempts futile or cruel.
To restate my disclaimer: my answers are based on training and real life situations in North Carolina, which only recognized a specific legal form prominently displayed at the patient’s bedside as a DNR order as of December 2010, when I last ran on an ambulance crew in that state.
To expand, according to the instructor of the last CPR class I had, TV shows have it wrong. They’re always showing people with flatlines on their heart monitors being shocked to restart their hearts. Shocks can’t do that. Shocks only work when the electrical signals in the heart have gotten out of sync, so that the heart movements are still happening, they just aren’t happening in the right order.
How likely it is that the shocks will successfully reset the synchronization depends partly on what put it out of sync to start with.
With a card at the bottom “THIS IS YOUR PORTABLE DNR CARD. REMOVE THE CARD BELOW AND KEEP IT ON YOUR PERSON AT ALL TIMES EVEN IF YOU DECIDE TO WEAR A NH-DNR BRACELET.”
Would this be ignored?
ETA: IOW, why would this card be included in the official DNR given out at discharge if it is going to be ignored in an emergency?
I would guess it’s safer legally to save someone that’s savable than to let them die and have the family sue. “Oh, Jane Doe only meant DNR if she was going to be brain damaged if resuscitated. You owe us $millions!” or “Jane Doe was clinically depressed when she signed that, and not capable of making an informed consent. You owe us $millions for letting our beloved Jane die!”
But if you’re otherwise healthy and the resuscitation attempts were successful, what would be the point of the DNR order? If you want to kill yourself there are plenty of easier ways than getting a DNR order and praying for a heart attack.
I’m not actively praying or hoping for it, but I believe a natural death (even through an accident) is morally OK even if it means eschewing existing life-saving technologies. Active suicide isn’t morally OK.
But yeah, I’m sure all of this is hypothetical and not something for me to get too het up over.
I have a living will, FTR. If I happen to get hit by shrapnel from a toilet seat from a deorbiting space station, I sure as hell WANT the first responders to do whatever they can to keep me going. I put the onus on the doctors in the hospital to decide if extraordinary measures should be attempted.
Unless it’s prominently displayed around your neck, yes it would be ignored. We’re not going in your wallet. If that’s necessary, PD would, & to look for ID. We aren’t expecting to find them in the field &aren’t explicitly looking for them as we’re busy trying to revive you. If there’s a family member with you that instructs us, & the paperwork is good, that’s a different story.
Also, there are some Med-Alert bracelets/necklaces that look more like jewelry than the standard obnoxious Med-Alert bracelet; these will be overlooked as jewelry.
I have a Living Will and Advance Directives filed with the doctor, the hospital, and the state of Vermont (and the card for that in my wallet). I also want the DNR so that I can die a natural death if my heart goes into whatever that state is that could be shocked back. But you’re right, the odds are on my side that it won’t work anyway.