We’re at the residence of an elderly gentleman. His family has all his medical items organized so well it’s as if we’re at a pharmacy.
But they can’t find his DNR.
Luckily we don’t need it. Rather, I’m using this as opportunity to make sure they have everything all squared away. Every old or chronically ill person I go to, I’m taking the time, no matter what the call is, to make sure either the patient or the family has the DNR ready to go, if that is what they want.
They have the DPA paperwork though.
Durable Powers of Attorney for health care decisions are useful for most situations, but in general it has the disadvantage of requiring that the attorney(s)-in-fact be physically present on the scene to make any actual decisions. For instance, the only other person on this scene on this day is not listed among the 3 attorneys-in-fact on the DPA, and therefore has no legal standing to make any health care decisions. So if this was a CPR call, no one would be available to refuse the resuscitation on behalf of the patient. A DNR has no such requirement. It is specifically for refusing CPR. It is only valid when a patient is pulseless and not breathing. It means nothing else.
If this hyper-organized family can’t get the DNR right, how can we expect anyone else to?
So, my dear patients and family members, I want you to approach it the way we, EMS people, do. Imagine for a moment that you are us, and you’re walking into someone’s home. They called 911 because their family member is pulseless and not breathing. Their family member has also made it perfectly clear that there is to be absolutely no CPR. How do you suppose they’re going to stop you from starting a resuscitation?
That’s easy – they should shove the valid DNR right in your face.
A less direct approach is to point to the DNR tacked to the wall over the patient’s bed. Or taped to the fridge. Better yet, put it all over the place. Make it the wallpaper pattern.
The goal is to show responding crews a valid DNR before we open a single bag, so, how do you do that? By keeping copies of the DNR everywhere. If the patient is the ambulatory sort, put a copy in his pocket or around his neck.
If you have to go look for it, I guarantee that you won’t find it before the monitor gets turned on, and the resuscitation starts. And the patient’s wishes are not honored.
It’s the last wish, and it’s not honored.