RE: DNR in the Field

["Laurie A. Romig, MD" <laurie.romig@verizon.net>]

This case illustrates a situation in which good on-line medical control can
be very effective. Admittedly, Pinellas County has centralized medical
control with the same docs all the time, so it's easier to get these
judgement calls made. As long as I can satisfy myself what the patient's
intent was, and that all in attendance are in agreement, I'll often make the
decision to discontinue resusc. (Of course, BLS resusc starts while contact
is being made.) This  works particularly well in situations where a valid
Living Will exists, but a prehospital DNR doesn't. I'll also take into
account whether or not Hospice services are being utilized; in my mind,
that's pretty good evidence of what the patient or the POA's wishes are. Our
medics are not permitted to make these decisions independently, and I'm not
sure that all of our med control docs would make the same decisions, but
it's an approach that I'm comfortable with.

BTW, Florida currently authorizes what started out as a prehospital DNR form
to be used in all health care facilities. A smaller version of the order can
be laminated and clipped to the patient's gown or otherwise kept near the
patient, while the normal size is kept on file. Law allows for other formats
to be developed as well, including things like the aforementioned bracelets.
There are several DNR registry pilot projects ongoing as well. Education of
the public and healthcare providers is crucial, but I don't think that
anyone's invented a sure-fire way to do it yet!

Laurie Romig, MD
Bayflite & Pinellas County EMS
(In the land of the newly wed and the nearly dead...)

> -----Original Message-----
> From: flightmed-admin@flightweb.com
> [mailto:flightmed-admin@flightweb.com]On Behalf Of Rick Cosmar
> Sent: Sunday, July 22, 2001 12:51 PM
> To: flightmed@flightweb.com
> Subject: Re: DNR in the Field
>
>
> We too have a form with a specific logo that is the only form which is
> recognized. There are wallet cards with this logo as well as bracelets.
> No matter how you present it, there must be the HB 314 logo and it must
> be completely filled out and signed. The only person who can revoke this
> legal document is the POA or the person them self.
>
> It is also a huge problem that Nursing homes have been slow to respond
> to this law.  In my battalion myself and the 2 other EMS supervisors
> went to all NH facilities and held class to educate them on these forms.
> It's is still rare but we do still find old living wills that haven't
> been converted. Also we find that many times the physician is lax in
> getting this document signed. This happened the other day. We start
> working an arrest. I arrive too find a DNR form blank. The family did
> not want us to continue. I explained too them what the problem was and
> told them we will continue within our SOP's and if asystole is
> maintained then we will pronounce. This was the case and everyone
> breathed a sigh of relief.  I did advise them in the future if this were
> the case they should insist the physician complete the form as soon as
> practical.
>
> Rick
>
>
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