Date: Mon, 13 Mar 2000 15:05:33 EST
From: [log in to unmask]
Subject: DNR in the pre-hospital setting
Does anyone have a protocol or policy for handling pediatric (or adult, for
that matter) DNR in the out-of-hospital setting? We've had several requests,
and haven't found any resources.
Debby Henderson, PhD, RN
Harbor-UCLA Medical Center
The state of Maryland has a DNR form that applies to all ages. There are 2 components and a lengthy manual that describes the entire program. Briefly,
the patient/ family and primary care physician select either :
DNR - B : only palliative care and transport, no treatment, traditional DNR with no resuscitation efforts
DNR - A: ALS care can be delivered to treat underlying medical conditions (diabetes, seizures etc.) that are not related to the terminal illness. The DNR is specific to not using resuscitation efforts
The form is 8 by 14 in duplicate and there are EMS DNR bracelets. The program has been in place for 4 years. Our experience indicates that frequent inservices are needed with nursing homes and long term care facilities due to the staffing turn overs. The form is easily recognized by healthcare providers and EMS. Case Managers and families have given very positive feedback.
After an emergent hospitalization we also have learned that the EMS DNR paperwork and bracelet may not be returned to the home, hospice, or nursing home. Thus leading to the primary physician redoing all the paper work. We are looking at streamlining the form and directions during the next year.
The sample forms and the manual are available from our Education and Certification Office at 410-706-3666. Mr Craig Coleman is administering the program and has conducted inservices across the state.
Cynthia J Wright-Johnson, MSN RNC
EMSC Program @ MIEMSS
653 W. Pratt St.
Baltimore, Md. 21201
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