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Do Not Resuscitate (DNR) Confirmation Forms

Since February 1, 2008 the province of Ontario has implemented an official “Do Not Resuscitate” (DNR) confirmation form to direct the practice of paramedics and firefighters in situations where a patient has predetermined that they do not wish to be resuscitated in the event of death. Prior to this date DNR forms were only a part of the health care profession within official facilities such as hospitals and long term care centres and were not recognized by emergency responders in the public. Unfortunately there was a misconception that a doctor could issue a letter confirming the patient’s wishes to not receive resuscitative care at home by responding emergency workers. The fact was that unless a licensed doctor was at the home to direct this request the emergency workers were bound by their own standard operating procedures that required them to attempt resuscitation. This did on occasion lead to confrontations with the family and made an already bad situation even worse. The reason for the mandatory resuscitation order to emergency workers was that if they were called to a scene, at one point in time someone called for assistance and it was not up to the emergency worker to determine if the change in attitude was the patient’s wishes or that of someone else, so err on the side of caution and attempt to resuscitate.

 

The new form that has been issued by the province now lets emergency workers respect the decision of a patient to die if they are found to be without a pulse and not breathing. The official DNR form is not something you will find in the public domain and must be issued and signed by a health care professional such as; a medical doctor or registered nurse. To be valid, the form must also have a registered serial number and all mandatory fields must be filled out accordingly. Incomplete forms cannot be considered valid, if an incomplete form is received, paramedics and firefighters are not permitted to honour the Do Not Resuscitate request.

 

So how does it work, and are there exceptions? If a patient has a valid DNR form and is found to be clinically dead; without pulse. The emergency workers will not attempt CPR, defibrillation, artificial ventilation, intubation or use resuscitation drugs. If the patient is found to be breathing and with a pulse, the patient will receive comfort or palliative care which is designed to alleviate pain or discomfort. This all sounds very simple and quite easy to understand, however real life does not always follow a script and people often change their minds especially in stressful situations. If a valid DNR form is given to an emergency worker but the patient or a family member withdraws the consent, the emergency worker will begin resuscitation when needed. Even if the request is vague or uncertain, emergency workers are told to err on the side of caution. Finally should an emergency worker question the validity of the DNR form in any way, they are then bound by their operating procedures to begin resuscitative care. If you or anyone you know feels they need a DNR form, please speak to your doctor and family about this matter.

 

For further information on this matter published on the Ontario Fire Marshals website; CLICK HERE


RFD Public Education Division
11/2/2008 4:53:49 PM