DO NOT RESUSCITATE ORDERS (DNRs)
INTRODUCTION
A DNR order is a legally binding document that requires individuals and EMTs to follow its instructions in a situation where a patient is no longer capable of making health care decisions and is in need of resuscitation. A proper DNR order will dictate what should and should not be done in these situations. Except in rare circumstances the DNR should be obeyed and resuscitation efforts limited to those outlined in the document.
In New Mexico there is broad immunity to those who follow the directions of a DNR and penalties for not obeying them except in special situations.
TYPES OF DNR DOCUMENTS
There are many ways a DNR can be written and you may encounter any of these.
1. “MOST” Form from the NM EMS Bureau. It is a DNR with a min-Power of Attorney form on the second page.
2. The EMS DNR from the EMS Bureau has been discontinued but you’ll still see them. They are still valid DNR documents.
3. Power of Attorney for Health Care (Living Will). These are longer documents usually written with legal help that designate an agent to make health care decisions for a patient and include end-of-life resuscitation instructions.
4. Advanced Directive (usually associated with institutions, clinics, and hospice). These come in many forms.
5. POLST (Physician Order for Life Sustaining Treatment). This is a document usually signed by the patient’s primary physician and often the patient outlining the terms of the DNR.
6. A written physician order is allowed as a valid DNR.
7. A “Medic Alert” bracelet or medallion may alert you to the existence of a DNR order.
8. An out of state DNR order is considered valid in New Mexico if it is a valid DNR order.
9. The most recently executed DNR order is the one to follow when more than one document exists.
WHEN IS A DNR INVOKED
The patient is incapable of making health care decisions for themselves
The DNR is properly executed (dated with signatures including the patient when appropriate)
The patient can be accurately identified
The patient is in need of medical intervention to prevent death
WHEN IS A DNR NOT INVOKED
When homicide is suspected
When suicide is suspected
A DNR may be revoked by the patient’s agent identified as having Power of Attorney for the patient’s health care.
When as a matter of “conscience” an EMT cannot invoke the directions of a DNR. New Mexico law requires that in such cases the patient be expeditiously transported to a facility where the DNR will be honored. A Squad unit should be used to avoid incurring any cost. Immunity extends to these decisions.
SPECIAL CIRCUMSTANCES
The DNR may not be revoked by a family member, another health care provider, or law enforcement.
Should the patient regain the capacity to make a health care decision they may revoke their own DNR at any time.
It is important to recognize these are often high stress situations with indecision or a change of heart occurring in family members or others. There may arise situations where a family member or other person may attempt to overturn the terms of the DNR. Though this is illegal in New Mexico and carries with it a risk of penalties the senior EMT on scene may chose to treat and transport the patient to allow for resolution of the conflict in a more secure setting. On-line medical consultation is strongly recommended by State rule when issues arise concerning a DNR.
INTRODUCTION
A DNR order is a legally binding document that requires individuals and EMTs to follow its instructions in a situation where a patient is no longer capable of making health care decisions and is in need of resuscitation. A proper DNR order will dictate what should and should not be done in these situations. Except in rare circumstances the DNR should be obeyed and resuscitation efforts limited to those outlined in the document.
In New Mexico there is broad immunity to those who follow the directions of a DNR and penalties for not obeying them except in special situations.
TYPES OF DNR DOCUMENTS
There are many ways a DNR can be written and you may encounter any of these.
1. “MOST” Form from the NM EMS Bureau. It is a DNR with a min-Power of Attorney form on the second page.
2. The EMS DNR from the EMS Bureau has been discontinued but you’ll still see them. They are still valid DNR documents.
3. Power of Attorney for Health Care (Living Will). These are longer documents usually written with legal help that designate an agent to make health care decisions for a patient and include end-of-life resuscitation instructions.
4. Advanced Directive (usually associated with institutions, clinics, and hospice). These come in many forms.
5. POLST (Physician Order for Life Sustaining Treatment). This is a document usually signed by the patient’s primary physician and often the patient outlining the terms of the DNR.
6. A written physician order is allowed as a valid DNR.
7. A “Medic Alert” bracelet or medallion may alert you to the existence of a DNR order.
8. An out of state DNR order is considered valid in New Mexico if it is a valid DNR order.
9. The most recently executed DNR order is the one to follow when more than one document exists.
WHEN IS A DNR INVOKED
The patient is incapable of making health care decisions for themselves
The DNR is properly executed (dated with signatures including the patient when appropriate)
The patient can be accurately identified
The patient is in need of medical intervention to prevent death
WHEN IS A DNR NOT INVOKED
When homicide is suspected
When suicide is suspected
A DNR may be revoked by the patient’s agent identified as having Power of Attorney for the patient’s health care.
When as a matter of “conscience” an EMT cannot invoke the directions of a DNR. New Mexico law requires that in such cases the patient be expeditiously transported to a facility where the DNR will be honored. A Squad unit should be used to avoid incurring any cost. Immunity extends to these decisions.
SPECIAL CIRCUMSTANCES
The DNR may not be revoked by a family member, another health care provider, or law enforcement.
Should the patient regain the capacity to make a health care decision they may revoke their own DNR at any time.
It is important to recognize these are often high stress situations with indecision or a change of heart occurring in family members or others. There may arise situations where a family member or other person may attempt to overturn the terms of the DNR. Though this is illegal in New Mexico and carries with it a risk of penalties the senior EMT on scene may chose to treat and transport the patient to allow for resolution of the conflict in a more secure setting. On-line medical consultation is strongly recommended by State rule when issues arise concerning a DNR.