Out-of-Hospital DNR (Do Not Resuscitate)
A DNR (do not resuscitate) order is a request not to have CPR (cardiopulmonary resuscitation) if your heart stops or if you stop breathing while you are in a medical facility. An out-of-hospital DNR is for people who do not want to be resuscitated if they have problems at home or anywhere outside of a medical facility.
Like a DNR, an out-of-hospital DNR is a document signed by a physician and is usually only written for terminally ill or extremely elderly and frail individuals. If a physician approves your request for an out-of-hospital DNR then you will be informed on how to properly display the document and whether you may need to wear a bracelet or necklace indicating that you have such an order. Some states require a specific colored paper copy of your order to be posted on a refrigerator or other visible location.
How does an out-of-hospital DNR work?
If 911 is called to attend to a person who has collapsed, emergency medical services (EMS) will check for an out-of-hospital DNR order with original signatures or whether the person is wearing an out-of-hospital DNR bracelet or necklace. This gives the EMS providers permission not to perform CPR. Without an out-of-hospital DNR order or POLST (see information below), emergency crews must perform CPR. This is the law in all communities.
Can my physician refuse to issue me an out-of-hospital DNR order?
Yes. An attending physician will not issue an out-of-hospital DNR order if the person requesting the order is not eligible for it. Most physicians will only sign such a document for a person who is terminally ill or extremely elderly and frail, and mentally capable of making such a request.
If a person wears a bracelet or necklace that isn’t ordered by a physician or has DNR tattooed on their chest, will their wishes be respected?
No. EMS providers are not authorized to comply with a bracelet or necklace that has not been ordered by a physician. An EMS provider will also perform CPR on an individual who has tattooed DNR on their body unless they also have a signed out-of-hospital DNR order. Regulations vary by state, so check with your doctor about availability of a DNR bracelet.
Why wouldn’t I want to have an out-of-hospital DNR order?
Many people fear CPR or becoming debilitated if they are resuscitated. If you are a healthy individual there are many scenarios when resuscitation would return you to a normal, productive life. For example, if you were unaware that you had allergies to something as simple as a bee sting and you began to have breathing problems, an injection might save your life; however, you wouldn’t be given the injection if you had an out-of-hospital DNR. You should discuss this issue thoughtfully with your family and your physician.
Please contact your physician if you would like to obtain an out-of-hospital DNR or have additional questions.
POLST (Physician Orders for Life-Sustaining Treatment)
The POLST, or physician orders for life-sustaining treatment, is a voluntary form with medical orders indicating a patient’s wishes regarding treatments commonly used in a medical crisis. It is similar to the DNR order. It is for seriously ill or frail patients. The original POLST form always remains with the patient.
How do I complete a POLST?
The form is intended to be completed after careful advance-care planning conversations between patients, those close to them and healthcare professionals. The POLST orders should show what treatments you want now, in your current state of health. The POLST must be completed and signed by the healthcare professional accountable for the medical orders.
Is the POLST available in my state?
Individual states and regions implement POLST programs. Some state programs vary in name (e.g. MOST- Medical Orders for Life Scope of Treatment), how programs are implemented and appearance of forms. You can visit POLST.org to learn more about the program in your state, or speak to your physician.
What is the difference between a POLST, an out-of-hospital DNR and an advance directive?
The POLST and DNR are medical orders for individuals in ill health, whereas the advance directive can be created by any decisionally capable adult to express wishes regarding preferences in treatment at the end of life or in response to possible health events. The Advance Directive is a set of two documents: a living will and the naming of a Durable Power of Attorney for Healthcare. An advance directive is needed to appoint a health care representative and provide guidance for future life-sustaining treatments. The DNR guides Emergency Medical Service (EMS) providers and can give EMS permission not to perform cardiopulmonary resuscitation (CPR), whereas a POLST might include a DNR instruction regarding CPR, but provides more instructions regarding additional medical interventions. The POLST also directs other treatment choices and interventions, such as hospitalizations or artificial nutrition and hydration.
The POLST complements the advance directive but does not replace it. An advance directive is recommended for all adults, regardless of health status.
All POLST information obtained from POLST.org. Please visit that website for additional information, or speak with your physician about POLST availability in your state.