Do Not Resusciate Orders
General Information - Prehospital Do Not
Resuscitate Orders
What is a do not resuscitate form?
Cancer is the second leading cause of death in the United
States, surpassed only by heart disease. Thus, health care providers regularly
encounter terminally ill patients in hospitals, emergency departments, long
term care facilities and in their homes. Often times, heroic efforts undertaken
to extend the lives of these patients are futile and undesired by both the
patient and family. Even when the patient is successfully resuscitated the
patient and family recognize that the patient may be left in a debilitating
state with a poor quality of life resulting in a financial and emotional burden
on the family. Meanwhile, health care workers and health care institutions may
feel caught in the middle of this drama. They are concerned about the patient,
but must also be concerned about medical malpractice lawsuits, vague state laws
and deal with their own personal beliefs.
Nowhere has this dilemma loomed larger than in the out-of
hospital environment. As a result, Florida, as well as many other states, has
enacted prehospital do not resuscitate legislation. The legislation serves as a
mechanism to address two competing interests that are equally valid. Namely, it
allows the patient to be involved in health care decision-making and protects
EMS personnel from liability for honoring the patient’s wishes. If a
terminally ill patient would like to have life-prolonging procedures withheld
or withdrawn in the prehospital environment, Florida law requires that they
have a properly completed do not resuscitate order form.
The following are some frequently asked questions regarding
do not resuscitate orders.
- What is a do not resuscitate form?
A do not resuscitate form is the mechanism used to inform
emergency medical services personnel that a patient does not wish to have
life-sustaining techniques performed in the event of respiratory or cardiac
arrest. A properly completed form is signed by the patient’s physician to
document that the patient is terminally ill. It must also be signed by the
patient or patient’s health care surrogate and witnessed by two
individuals. The form must be presented to the rescuers at the scene in order
for them to honor the patient’s wishes.
- Where can I obtain a do not resuscitate form?
You may obtain the canary yellow Do Not Resuscitate Form 1896,
by writing to Department of Health, Bureau of Emergency Medical
Services, 4052 Bald Cypress Way, Bin C-18, Tallahassee, Florida
32311-1738. or by calling (850) 245-4440. Health care facilities
are also encouraged to use Form 1896 since emergency medical service
personnel transport patients from one facility to another and from
the patient’s home to a facility. Health care facilities may
make as many "originals" as they wish provided they use yellow paper
and do not alter the form in any way.
- Why do I need to complete a do not resuscitate order
form if I have a living will?
A living will and a do not resuscitate order serve a
different purpose and the two are not interchangeable. A living will only
establishes a presumption of what a person’s wishes would be regarding
health care if diagnosed with a terminal condition. Note that many perfectly
healthy individuals have living wills. Thus, a living will is useful in the
hospital environment in that it assists the physician in making an educated
guess as to the patient’s wishes if the patient is critically ill and no
longer able to communicate. On the other hand, a prehospital do not resuscitate
order documents that the determination has been made that the patient has a
terminal condition and does not wish to have life-prolonging procedures
used.
- I am very old; why can’t I have a do not
resuscitate order signed and ready in the event that I have a stroke or heart
attack or some other sudden debilitating illness?
Remember, the primary criteria that must be met to have a do
not resuscitate order is the patient has been diagnosed as having a terminal
condition. Chapter 765 F.S. does not characterize old age as being a "terminal
condition", although it is true that the elderly are more likely to be left
incapacitated after a stroke or heart attack. However, legislation that allowed
such flexibility in its implementation probably would never have become law due
to concern regarding abuse or indiscriminate application. If a sudden illness
results in the deterioration of an individual’s health, whether old or
young, a do not resuscitate order may then become appropriate depending upon
the circumstances. Unfortunately, there does not exist, at this time, any way
to determine in advance who will or will not recover from a serious
illness.
- Why did the family call 911 if they did not want
emergency medical service personnel to initiate treatment?
There is no single answer to this question. Human behavior
is complex and individuals react differently when faced with a crisis
situation. Some family members call for an ambulance because they want to be
reassured that the patient is not in pain or uncomfortable. Others may be
seeking assistance in dealing with the death of a family member or want the
patient transported to the hospital so that the attending physician will be
present. Some healthcare professionals in nursing homes and private residences
mistakenly think they are obligated to call 911 to demonstrate that they were
in no way negligent in caring for the patient.
For additional information on or about Do Not Resuscitate
Orders contact The Florida Bureau of Emergency Medical Services.
Telephone: (850) 245-4440.
E-Mail: mailto:demo_ems@doh.state.fl.us
This document was copied from the State of Florida Bureau of EMS
internet site address
for our local community.
The DNRO form must be copied on plain yellow paper. Any
shade of yellow paper will be sufficient. You
can download and print this DNRO using Adobe Acrobat. Adobe Acrobat is FREE
from Adobe and you can get it by clicking on this link.
Get Adobe Acrobat After installing Adobe Acrobat, click
on the link below and choose OPEN FILE. You can then print it.
To
download the DNRO Form Click Here.
NOTICE: The DNRO MUST be printed on a single sheet
of yellow paper. No exceptions
Choice in Dying:
Provides information and
Advance Health Care Directive (Living Will) forms for each state with Internet
access and a direct download capability at no cost. Preprinted forms are also
available by mail for a small charge.
The American Association of Retired Persons:
Provides specific information on advance directives, plus extensive information
on legal and financial planning and other information of interest to mature
adults.
Scotts Home Page:
Provides one of the most
complete web sites on Advance Health Care Directives (Living Wills) and related
subjects, to date materials of interest, including living wills, advance
directives, additional references, etc.
Living Bank:
Provides information on organ
donation, a donor registry and forms.
General information on Advance Health Care Directives of
all types is available from the following Internet sites:
|
