Re: DNR in the Field

[Helodoc@aol.com]

What I find interesting about this discussion is that the EMS service would 
get the paperwork in the first place.  You would think if the patient really 
wanted DNR, but the family didn't, that when the family called 911 they would 
make sure that the paperwork was out of sight of the crew.  That it isn't 
shows how ambivalent most families must be about their desires vs. the 
desires of the patient.  It may also reflect an ambivalence on the part of 
the patient.

Another part of this is the feeling that once we do something, like intubate, 
that we can't undo that act.  I have had this happen on a couple of occasions 
where I didn't have the DNR order and resuscitated the patient, only to have 
the paperwork presented to me.  The patient was sedated (if needed) and 
extubated.  This occurred in the ED, though, where I had a lot of support 
services at the ready.  In the field it is often better to go with the crowd 
somewhat and let the people in the ED sort out the mess.

Dave Thomson

David P. Thomson, MS, MD, FACEP
Associate Professor
Emergency Medicine
Upstate Medical University
Syracuse, NY 13210
315.464.6219 voice
315.464.6229 fax

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